Will My Health Insurance Cover an Eye Exam?

All health insurance plans that comply with the Affordable Care Act (ACA) must cover eye exams and prescription glasses or contacts for children but insurance companies are not required to cover vision care for adults. As a result, you may need to purchase a separate vision insurance plan to make sure your optometrist visits are covered.

Read on to learn more about when health insurance covers eye exams, what types of vision care are not covered by insurance and what other options exist for making vision care more affordable.

On This Page

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  Why Won’t Health Insurance Cover an Eye Exam?

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  What Type of Insurance Do You Need for Eye Exams?

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  What Is Covered by Vision Insurance?

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  Are Insurance Alternatives Available for an Eye Exam?

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  FAQs

Why Won’t Health Insurance Cover an Eye Exam?

Even though eye exams are a type of preventive health care, ACA Marketplace health plans are not required to cover vision care for adults.^[1] While a standard health plan will likely cover treatments for a medical condition involving the eyes such as glaucoma or cataracts, it may not cover routine care such as getting an eye exam or purchasing glasses or contacts.

You should note that, although Marketplace plans don’t have to cover adult vision care, they do have to cover vision care for children.^[1] If your child receives a vision screening from an in-network provider, a Marketplace plan will cover it with no copay or coinsurance regardless of whether you’ve hit your yearly deductible.^[2]

What Type of Insurance Do You Need for Eye Exams?

Vision coverage may be included in your health plan or you may need to purchase a separate vision insurance plan to obtain eye exam coverage. Standalone vision plans are not available on the Health Insurance Marketplace but you should be able to buy one directly from a private health insurance company.^[1] You can also sign up for vision insurance through some state-run health insurance exchanges such as Covered California.^[3]

How Is Vision Insurance Different From Health Insurance?

Unlike health insurance, vision insurance generally doesn’t cover surgeries or medications for eye-related illnesses or injuries and instead exclusively covers routine care. As a result, standalone vision insurance tends to be far cheaper than medical insurance. Vision insurance usually costs around $5 to $30 per month, while the average nationwide cost of health insurance is $477 per month if you opt for a Marketplace benchmark plan.^[4][5]

What Is Covered by Vision Insurance?

Vision insurance plans predominantly cover basic eye care such as undergoing an annual eye exam and getting prescription contact lenses or eyeglass frames and lenses. However, some plans may include broader coverage that extends to transition lenses, prescription sunglasses and eyewear accessories.^[6]

Conversely, LASIK eye surgery generally isn’t covered by health insurance or vision insurance since insurance companies typically don’t consider it to be a medically necessary procedure. That said, some vision insurance companies offer discount coupons that can help make LASIK surgery more affordable.^[7]

Are Insurance Alternatives Available for an Eye Exam?

If you are struggling to find a cost-effective vision insurance plan, you may want to look into the numerous organizations that offer free or low-cost vision care such as EyeCare America for senior citizens, InfantSEE for babies or Lions Club International for people of all ages. Additionally, many optometry schools offer cheap vision care if you are willing to have your eyes examined by a supervised student.^[8]