Can I Buy Sunglasses With Insurance?

Vision insurance often helps with the cost of sunglasses, especially prescription ones. Vision plans frequently reduce out-of-pocket expenses. Coverage depends on your plan and sunglass type.

Types of Sunglasses Covered by Insurance

Insurance coverage primarily distinguishes between prescription and non-prescription sunglasses. Prescription sunglasses are typically covered as they provide vision correction and sun protection. They are treated like regular prescription eyeglasses, subject to frame and lens allowances. Common lens add-ons like UV protection, polarization, and anti-glare coatings may also be covered.

General vision insurance plans usually do not cover non-prescription sunglasses. These are considered cosmetic or elective, not medically necessary. Limited exceptions exist for Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA) if a doctor deems them medically necessary for conditions like severe light sensitivity or post-surgical recovery. For general wear, non-prescription sunglasses are typically not eligible for reimbursement. Some plans may offer discounts from in-network providers, but full coverage is uncommon.

Understanding Vision Insurance Benefits

Reviewing your vision insurance policy is important before purchasing sunglasses. Policies outline key terms like annual allowances, specifying the maximum plan contribution for frames or lenses. Frame allowances typically range from $100 to $150. If eyewear cost exceeds this, you pay the difference.

You may also encounter co-pays, fixed amounts for eye exams or lenses. Deductibles, the out-of-pocket amount before insurance covers costs, can also apply. Understand if benefits apply to in-network or out-of-network providers, as in-network coverage is typically more comprehensive. Check policy details via the insurer’s website, member portal, or customer service. Policies impose frequency limits on new frames or lenses, often allowing purchases every 12 or 24 months.

Purchasing Sunglasses with Insurance

Purchasing sunglasses with vision insurance involves a clear process. Begin by locating an in-network eye care provider or optical shop, usually via your insurance company’s online directory. Scheduling an eye exam is often necessary, especially if you require prescription sunglasses or need to update an existing prescription. An up-to-date prescription is typically a prerequisite for corrective eyewear coverage.

At the provider’s office, select frames and lenses, discussing coverage with the optical staff. In-network providers typically process the claim at the point of sale, applying allowances and collecting any remaining balance. This streamlined approach means you only pay your out-of-pocket expense.

If purchasing from an out-of-network provider, the process differs; you generally pay the full cost upfront. Submit a claim form with itemized receipts and your prescription to your insurance company for reimbursement. Reimbursement claims typically require submission within 12 to 15 months from the date of service, and usually take a few weeks to process.