Does Insurance Cover Colored Contacts?

Colored contacts offer a way to change one’s eye color. Generally, coverage for these lenses depends on whether they are purely for aesthetic purposes or if they also provide vision correction.

Distinguishing Colored Contact Types

Colored contact lenses are categorized into two main types: purely cosmetic and corrective. Purely cosmetic colored contacts are designed solely to alter eye color without providing any vision correction. All contact lenses, including those without vision correction, are classified as medical devices by the U.S. Food and Drug Administration (FDA) and require a valid prescription from an eye care professional for health and safety reasons.

Corrective colored contacts not only change eye color but also correct refractive errors such as nearsightedness or farsightedness. These lenses serve a dual purpose, addressing both visual acuity and aesthetic preferences. Selling any type of contact lens without a prescription is illegal, underscoring the importance of a professional eye exam and fitting for all wearers to prevent potential eye injuries or infections.

Vision Insurance and Coverage

Vision insurance plans typically focus on covering medically necessary eye care and corrective eyewear. If colored contacts are prescribed by an eye care professional to correct vision, they generally qualify for coverage similar to clear corrective contact lenses. This means that if the colored contacts provide the necessary vision correction, they are often treated as a standard contact lens benefit.

Coverage for corrective colored contacts commonly involves an annual allowance or a co-payment structure. Many plans offer an annual allowance, which is a specific dollar amount, often ranging from $150 to $200, that can be applied toward the cost of contact lenses or eyeglasses. Additionally, members typically pay a co-pay for eye exams, which can range from $10 to $20, and sometimes a separate co-pay for a contact lens fitting. Purely cosmetic colored contacts are almost universally excluded from vision insurance coverage because they are not considered medically necessary.

Navigating Your Insurance Benefits

Understanding your specific vision insurance benefits is important for determining coverage for corrective colored contacts. Review your vision insurance policy documents, which detail allowances, co-pays, and specific terms related to contact lens benefits. These documents often outline whether corrective colored contacts are included under the general contact lens allowance.

For precise information, contact your insurance provider directly using the member services number on your insurance card. Inquire about coverage for corrective colored contacts, clarifying if they are treated the same as clear corrective lenses under your plan’s annual allowance. Confirming this information upfront can help manage expectations regarding out-of-pocket expenses. Always obtain a valid prescription from an eye care professional, as this is a fundamental requirement for purchasing any type of contact lens.

Locate in-network providers or retailers to maximize your benefits, as using out-of-network providers may result in reduced coverage or higher costs. Many vision insurance plans have online tools or directories to help you find participating eye care professionals and optical retailers. If you purchase corrective colored contacts from an out-of-network provider, and your plan permits it, you may need to submit a claim for reimbursement. This process typically involves completing a claim form and providing itemized receipts within a specified timeframe, often 12 months from the date of service.