Avoiding sticker shock at the eye doctor: 7 benefit guidelines

You might consider yourself a savvy shopper at the supermarket or electronics store, but what about when it comes to your vision benefit?

The rise in health care expenses is requiring the traditional patient to become a savvy consumer, yet many people know little about how their vision benefits work — let alone how the costs break down. And many Americans aren’t confident they can define the 4 top health insurance terms — “deductible,” “copay,” “out-of-pocket maximum” and “co-insurance.”

By not knowing, they might be passing up the kinds of treatments and eyewear that could make daily life a whole lot brighter. And we’re talking a whole lot of people: Nearly 26 million adult Americans experience vision loss,1 and 76% wear some form of vision correction, according to the Vision Council.2

7 things you should know

Forget about notions that benefits coverage is hard to understand. Interactive websites and mobile apps have simplified the language of benefits. Knowing these 7 easy guidelines may help you make better vision decisions:

  1. Copay comprehension. The copay is the fixed cost a member pays for a specific service at the time of the visit. For example, your exam copay may be around $25, depending on your benefits, but the copay on prescription glasses will vary depending on special lens add-ons, like anti-reflective treatments.
  2. Know your allowance. This figure should help you better understand what your eyeglasses will cost. An allowance is the predetermined amount of dollars the carrier applies toward eyeglass frames or other purchases. If your allowance is $100, that means you have $100 to put towards your frame purchase; you’d simply be responsible for any amount over $100.
  3. Are you properly networked? Patients save more money when choosing a doctor within their benefit network. A network is a group of physicians who have agreed to provide their services to benefit members at reduced rates. Out-of-network doctors do not partner with the provider and will likely cost more. A list of network partners should be on your vision benefit’s website.3
  4. Are you FSA approved? Many employers offer Flexible Spending Accounts (FSAs), where families can store pre-tax dollars for future medical expenses. For vision, these costs may include eye exams and corrective prescriptions, as well as LASIK surgery.4
  5. Deduce when the benefit applies. Although infrequent, some benefit structures require the patient to pay a deductible, a preset sum of money, before the plan steps in to pay its share of expenses.5 These details should be explained in the benefits outline by your employer, or on your vision plan’s website.
  6. Know your frequency. Typically, a vision benefit allows for an eye exam and prescribed care, such as eyeglasses, once a year. However, not all benefits are available every year — some may cover the cost of eyeglass frames every other year, for example. You’ll want to check your benefits for specific details.
  7. Look for specials. Some benefit companies extend promotional offers to use in conjunction with benefits. EyeMed members, for example, have access to a selection of discounts, such as 40% off a complete second pair of eyeglasses at participating in-network providers.* (Members can view full lists of discounts on their personal member portal at eyemed.com.)

Seeing better means living better. Knowing these terms can help you can enjoy the freedom of making more financially wise eye care choices. And if in doubt, ask your eye doctor. You’ll see that understanding your vision benefit might be easier than understanding your latest mobile plan.

*These discount are for in-network providers only. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Additional limitations and exclusions apply. Log into eyemed.com to check your benefits for full details.


  1. “Facts and Figures on Adults with Vision Loss,” American Foundation for the Blind, May 2018, http://www.afb.org/info/blindness-statistics/adults/facts-and-figures/235, Accessed Dec. 3, 2018
  2. “U.S. Optical Overview and Outlook”, The Vision Council, December 2015,https://www.thevisioncouncil.org/sites/default/files/Q415-Topline-Overview-Presentation-Stats-with-Notes-FINAL.PDF, Accessed Dec. 3, 2018
  3. “Glossary of Vision Insurance Terms,” AllAboutInsurance.com,http://www.allaboutvision.com/vision-insurance/glossary.htm, Accessed Dec. 4, 2018
  4. “Publication 502 (2017), Medical and Dental Expense,” Internal Revenue Service,https://www.irs.gov/publications/p502#en_US_2013_publink1000178885, Accessed Dec. 3, 2018
  5. Ibid. Accessed Dec. 3, 2018