Understanding the Basics: What Does Vision Insurance Cover?

Posted on May 31, 2019

74% of Canadians rely on prescription vision correction.

But if you're a Canadian citizen, you already know that Medicare doesn't cover them. So how do most people afford them?

The answer is simple: vision insurance.

While Medicare does cover some aspects of vision care, you definitely need a supplement if you are going to require long-term or more complex vision care.

So what does vision insurance cover? In this blog post, we'll go over what you can expect to receive for your vision care coverage, and the average price most Canadians pay for care.

Read on for more information.

What Does Medicare Cover in Terms of Vision Health?

All Canadian citizens and residents are entitled to Medicare, which may be known as different acronyms in different provinces. In Ontario, for example, it is known as OHIP.

Generally, Medicare does not cover glasses or contact lenses in any way, shape or form. You'll need optional or supplemental health coverage to pay for prescription vision aids.

In some provinces, low-income families can get assistance with the cost of glasses and eye examinations. But this is not a nationwide policy, and you'll need to check with your province before determining your eligibility.

Some provinces will also provide routine examinations for people under the age of 18 and over the age of 65. Medicare will not, however, cover glasses or contact lenses that may be prescribed as a result of the examination.

Medicare will pay for diseases of the eye that have to do with diabetes, glaucoma and cataracts. Medicare will also often pay for sudden eye injuries.

Surgery of these conditions are generally paid for, but it is worth checking on in your province just to be sure. There is nothing worse than thinking Medicare will pay for an expensive procedure, only to find out that it will set you back thousands of dollars.

How Much Do Glasses Cost?

If you'd rather take a risk, or pay for your glasses out of pocket, you may wonder how much glasses can set you back without insurance. The answer is dependent on a variety of factors, such as what type of glasses you need to correct your vision.

Many people just need glasses to see up close or far away. These glasses, known as single-vision glasses, will set you back around $100 to $200. That's for a medium-range price. If you want something a bit more designer, you'll have to pay more for the frames themselves.

But, it isn't only those with designer tastes who are expected to shell out a pretty penny for glasses. Instead, glasses that benefit from newer bifocal technology can break the bank, especially if you weren't expecting them.

Some of the more advanced, and more comfortable bifocals, can cost around $700 to $1000. While there are cheaper lenses on the market, they require you to adjust your head as you wear them to allow you to see clearly. Most people prefer the higher-end design, but their pockets may not.

Extras will also set you back as well. These may include UV protection and scratch resistant surfaces. Without these, your glasses might become useless relatively quickly.

Why You Should Have Vision Insurance If Your Eyesight Isn't the Best

So, if your vision isn't the best, it might be a better idea to consider buying vision insurance before your vision progresses to a point where you're shelling out $1,000 for lenses alone. The frames will likely cost extra, and a lot more if you want certain types of frames.

Many people want more than one pair of glasses to ensure they don't lose them. So if you decide to get two bifocals, you could set yourself back a couple of thousands of dollars. If you and a spouse both have bad vision and are paying out of pocket together, this can really be a financial blow, especially if you weren't expecting it.

Some people get by just fine on the $10 glasses you can buy at a drug store for reading. But if you have anything more complex than being unable to read up close, you may find your wallet is in for a shock at your next eye appointment.

What Else Might You Have to Buy Out-of-Pocket Without Vision Insurance?

As we mentioned previously, some provinces will pay for routine eye exams for people under the age of 18 and over the age of 65. Typically, though, the provinces' health coverage will not pay for any follow-up appointments. So, if the doctor wants to see something extra in your or your child's eyes, you'll likely have to foot the bill.

You'll also have to pay to see an eye doctor if you're between the ages of 18 and 65. You won't get a free examination and will have to pay for the services out of pocket. If you haven't been to the eye doctor in a while, this could include extras like tests that can quickly add up.

Skimping on the tests can make for worse eye health overall, so it is recommended that you have a way to have these done instead of skipping them in order to save a little bit of cash.

Medicare Doesn't Pay for Contact Lenses

After reading about how Medicare doesn't pay for most prescription lenses, except in some cases where provinces pay for low-income minors, you shouldn't be surprised to find it doesn't pay for contact lenses.

Many people opt for contact lenses because they are more convenient and comfortable. Nowadays, there are even contact lenses that dissolve in your eye so that you don't have to worry about taking them out at night.

Your contact lenses may help you have the peripheral vision you're unable to have with glasses. Additionally, many people who play sports find them more comfortable and less dangerous. When you're playing a high contact (or even a low contact) sport, you don't run the risk of having someone run into you and smash your glasses in your face.

Many people also say they find contacts more comfortable than glasses, as they don't have to worry about them sliding off of their face when they're physically active.

Contacts are not always as expensive as glasses, but their price point can run the gamete. Like glasses, there are many different types and extras you can have. Your eye doctor will be able to best advise you on what works best for your particular eye and any conditions you have.

But be aware, Medicare isn't going to pay for your contacts for any reason, so don't get your hopes up.

What Does Vision Insurance Cover?

Vision insurance covers a wide variety of services. With some vision care benefits, you can have issues related to diabetes or eye diseases and injury, and receive private care. This means that while Medicare will pay for it, you'll be able to surpass the queue of other people waiting for the same procedure. You may even receive the procedure in a facility that has better amenities.

Aside from that, vision insurance can cover eyeglasses, examinations, bifocals, surgery beyond those covered by Medicare and anything else that could come up.

What your policy covers will depend on what you've chosen and your premium. Your policy, like any other private policy, may also exclude pre-existing conditions.

Speaking to an insurance provider about the best policy for you is generally your best bet. They can go over your needs, as well as the needs of your family, and figure out what works best for you.

Vision Correction

If you've decided you're done with glasses and contact lenses, you may opt for optional vision correction. Many people have done this to satisfactory results. But, Medicare will not pay for this surgery, as it is deemed elective.

In some cases, Medicare will pay for cataracts surgery, which may lead to secondary vision correction. But this is not the same as primary vision correction surgery.

Some private vision coverage plans will pay for this if it is part of your plan. Otherwise, this may be something you'll have to consider paying out of pocket.

Choosing the Right Vision Coverage Plan

The answer to the question of, "What does vision insurance cover?" will depend on the plan you've settled on with your insurance broker and carrier.

Before you settle on a plan, remember to take into account that although you may have perfect vision now, things may not always stay that way. If you have children, their vision may also change rapidly as they mature, which is something to consider.

For more information, click here to initiate a free quote consultation.

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