Can You Buy Sunglasses With Vision Insurance?

Vision insurance helps individuals manage eye care costs. Whether it covers sunglasses depends on the specific type and your individual plan.

Understanding Vision Insurance Coverage

Vision insurance provides financial assistance for routine eye care, differing significantly from general health insurance. While medical insurance addresses eye injuries, diseases, or conditions like glaucoma or cataracts, vision insurance primarily focuses on maintaining healthy vision and covering corrective aids. It typically includes benefits for annual eye examinations, which are crucial for detecting vision changes and eye health issues early.

Most plans also offer coverage for corrective eyewear, such as prescription eyeglasses and contact lenses. This often encompasses a portion of the cost for frames and lenses, with some plans extending to basic lens enhancements like scratch-resistant or anti-glare coatings. Specific benefits, including allowances, co-pays, and deductibles, can vary widely among providers and policies.

Prescription Sunglasses Coverage

Prescription sunglasses are often covered by vision insurance plans because they serve a dual purpose: providing vision correction and protecting eyes from harmful ultraviolet (UV) rays. Similar to regular eyeglasses, these sunglasses are considered corrective eyewear, making them eligible for benefits under many policies. Coverage typically works through a frame allowance, a fixed dollar amount often ranging from $100 to $200, that the plan contributes towards the cost of the frames. If chosen frames exceed this allowance, the policyholder pays the difference.

Lens coverage for prescription sunglasses often aligns with that for regular prescription lenses, though some plans might cover only a percentage of the cost. Policyholders may also encounter co-pays, set fees paid at the time of service, typically ranging from $10 to $25 for materials or an exam. Some plans might also have a deductible, an amount that must be paid out-of-pocket before insurance benefits begin. Non-prescription, or “fashion,” sunglasses are generally not covered by vision insurance, as they do not provide vision correction. However, some plans may offer discounts on non-prescription sunglasses from in-network providers.

Using Your Vision Insurance Benefits

To utilize your vision insurance benefits for prescription sunglasses, verify your plan’s specifics. This can typically be done through your insurance provider’s online portal or by contacting them directly. Before purchasing, understand your allowances for frames and lenses, as well as any applicable co-pays or deductibles.

Once familiar with your benefits, locating an in-network provider is often beneficial, as these providers have agreements with your insurance company that can lead to lower out-of-pocket costs. When visiting an optical shop, present your insurance information, such as your member ID, so the provider can apply your benefits directly at the point of sale. For out-of-network purchases, you may need to pay the full amount upfront and then submit a claim form along with an itemized receipt to your insurance company for reimbursement. The reimbursement amount will depend on your plan’s specific out-of-network allowances.