How Many Glasses Will Vision Insurance Cover in 12 Months?
Understand your vision insurance: learn how often your plan covers new eyeglasses and what other benefits it offers.
Vision insurance helps manage the costs associated with eye care and prescription eyewear. A frequent question for many individuals concerns how often their vision insurance will cover new glasses within a 12-month period. Coverage for eyeglasses varies significantly depending on the specific policy. Understanding your plan’s terms is important for maximizing benefits and planning eyewear purchases.
Common Eyeglass Coverage Frequencies
Vision insurance plans commonly provide benefits for eyeglasses on a set frequency, most often once every 12 or 24 months. Some policies might also offer a specific monetary allowance towards the cost of frames and lenses, rather than strictly limiting the number of pairs. A “pair of glasses” typically includes both the frames and standard prescription lenses. If you select frames that exceed your plan’s allowance, you are usually responsible for the difference.
Coverage for new frames and new lenses can sometimes differ within the same plan. For example, a plan might cover new lenses annually but new frames only every two years.
Defining Your Plan’s Benefit Period
The concept of a “12-month period” in vision insurance can refer to different benefit cycles. Many vision insurance plans operate on a calendar year basis, where benefits reset on January 1st each year. This means any unused benefits from the previous year typically do not roll over. For these plans, you could potentially get new glasses in December and again in January if your plan allows for annual coverage.
Other plans might use a rolling 12-month period, meaning benefits become available 12 months after your last date of service for a particular benefit. For instance, if you received new glasses in March, you would not be eligible for another covered pair until the following March. It is important to identify whether your plan follows a calendar year or a rolling period, as this distinction impacts when you can utilize your benefits for new eyewear.
Locating Your Specific Coverage Information
To understand your exact eyeglass coverage, you need to access your specific plan details. A primary method is through your insurance provider’s online member portal, where you can log in to view benefit summaries or policy documents. These portals often provide a breakdown of your allowances, frequency limits, and any associated co-pays.
Another direct approach is to call the member services phone number, typically found on your insurance card. When speaking with a representative, you can ask specific questions about your eyeglass allowance, how often frames and lenses are covered, and whether your plan operates on a calendar year or a rolling benefit period. Reviewing documents like your Summary of Benefits and Coverage (SBC) or Explanation of Benefits (EOB) can also provide comprehensive details. For employer-sponsored plans, your human resources or benefits department can also provide guidance and access to these documents.
Other Covered Vision Benefits
Beyond eyeglasses, vision insurance plans typically cover a range of other services and products. Routine comprehensive eye exams are a standard benefit, often covered annually, which are important for detecting changes in vision and overall eye health. These exams can also reveal signs of broader health conditions such as diabetes or high blood pressure.
Coverage for contact lenses is also common, though it often differs from eyeglass coverage. Contact lens benefits are frequently provided as a monetary allowance that can be used towards the cost of lenses and fitting fees. Individuals often must choose between using their benefit for glasses or contacts within a given period.
Many plans also provide coverage for lens enhancements, such as anti-glare coatings, scratch resistance, UV protection, and progressive lenses, which can improve the functionality and durability of eyewear. Frame allowances, which are the monetary limits your plan will pay towards new frames, are also a common feature, with typical allowances ranging from $130 to $200.