DO THE MATHS FIRST
Before you buy vision insurance for a child, check what already pays.
The Affordable Care Act requires children's vision coverage in many health plans. For a lot of families, a separate vision plan means paying twice for something they already have.
Buddy's quick answer
Often not, as a separate purchase. Individual and small-group health plans must cover vision for children under 19, typically an annual eye exam and one pair of glasses a year, and Medicaid and CHIP cover children's vision too. A stand-alone vision plan, commonly $10 to $20 a month, only wins if the exam and glasses it pays for are worth more than the $120 to $240 a year in premiums. Check what your health plan already covers first.
START HERE
What may already be paying for your child's glasses
Work down this list before you enrol in anything. The first two are the ones most parents don't know about.
Medicaid or CHIP
If your child is enrolled, vision care is a covered children's benefit. We walk through what Medicaid's children's benefit includes in our post on failed school screenings.
A Marketplace or small-group health plan
HealthCare.gov states that all Marketplace plans include vision coverage for children. The Affordable Care Act requires it in individual and small-group plans for children under 19, typically an annual exam and one pair of glasses a year, though copays and cost-sharing may apply.
An employer plan
Whether a large employer's medical plan must include children's vision is not something the sources we checked settle, so read your plan's summary of benefits rather than assuming. Some employers offer vision as a separate, optional add-on.
A stand-alone vision plan
The last thing to reach for, and only after the maths below says it beats paying yourself.
THE MATHS
How to tell whether a vision plan pays for itself
Vision plans are not insurance in the usual sense. They are a prepaid discount on predictable costs: an exam and, if your child needs them, glasses. So the test is simple arithmetic.
Premiums in the range of $10 to $20 a month are common, and some plans start around $5, according to figures Investopedia has reported. Exam copays of $10 to $40 are typical. That puts a mid-range premium at $120 to $240 a year before you use anything.
Two things change the answer more than any price. The first is whether your child needs glasses at all. A child with healthy eyes and no prescription uses only the exam, and a plan that costs $180 a year has to save more than that on one exam. The second is what your health plan already covers, which is why the list above comes first.
| Health plan's built-in kids' vision | Stand-alone vision plan | Pay cash, with FSA or HSA | |
|---|---|---|---|
| What you pay up front | Already part of your health premium | A separate monthly premium, commonly $10 to $20 | Nothing until you use it |
| What you pay when you use it | Possible copays or cost-sharing | Exam copay, plus anything above the frame allowance | The full price, paid with pre-tax dollars |
| Best suited to | Any child covered by a qualifying plan | Kids who reliably need an exam and glasses every year | Families who want any shop and any frame |
If pre-tax spending is on your list, here is how FSA and HSA money works for kids' glasses.
WHEN A PLAN CAN EARN ITS KEEP
The cases where insurance does help
Being honest about this cuts both ways. A stand-alone plan can make sense when your child's health plan doesn't include vision, when your child needs an exam and a new pair every single year, or when you are choosing between two plans and one includes an in-network eye doctor you already trust. It can also make sense when income puts your family outside Medicaid and CHIP and the plan through work has no children's vision benefit. All About Vision lists household income above the CHIP eligibility threshold as one reason to consider a separate plan.
What none of these cases needs is buying a plan for a baby. Exam schedules differ, but InfantSEE offers a free comprehensive eye exam between 6 and 12 months, regardless of income or insurance.
PARENT QUESTIONS
Frequently asked
Does health insurance cover kids' glasses?
Often, yes. HealthCare.gov states that all Marketplace plans include vision coverage for children, and the Affordable Care Act requires it in individual and small-group plans for children under 19. That typically means an annual eye exam and one pair of glasses a year, though copays and cost-sharing may apply. Medicaid and CHIP also cover children's vision.
Do I need separate vision insurance for my child?
Not if your child's health plan already includes the required pediatric vision benefit. A separate plan is worth considering when your medical plan has no children's vision coverage, or when the maths shows your child will use more in exams and glasses each year than the plan costs in premiums.
How much does a kids' vision plan cost?
Premiums of $10 to $20 a month are common, and some plans start around $5, according to figures Investopedia has reported. Exam copays of $10 to $40 are typical. Your quote will differ, so compare the yearly premium against what you expect to use.
Should I enrol my newborn in vision benefits?
A baby rarely needs glasses, and a free comprehensive exam through InfantSEE is available between 6 and 12 months regardless of income or insurance. Check whether your health plan already covers pediatric vision before paying for a separate vision plan.
Will my plan pay if I buy glasses online?
It depends on the plan. Some reimburse purchases from out-of-network sellers and some do not, and the rules and forms differ. Ask your plan before you buy, and ask the seller for an itemized receipt. EyeBuddy includes one on every order.
Can I use an FSA or HSA instead of insurance?
Yes. Prescription glasses and eye exams for children are qualified medical expenses for both FSA and HSA accounts. You pay the full price, using pre-tax dollars, and you can choose any eye doctor and any frames.
KEEP EXPLORING
Helpful next reads
Pre-tax dollars are the other big lever, so read how to use your FSA or HSA for your child's glasses. Not sure what to expect at the appointment? See what happens at your child's first eye exam. Comparing options end to end? Try the complete guide to buying kids' glasses, and if a school referral started this, here is what to do next, including what Medicaid already covers.
SOURCES
Where this comes from
HealthCare.gov: What Marketplace health insurance plans cover ยท Prevent Blindness: Pediatric vision benefits available under the Affordable Care Act ยท All About Vision: Vision insurance for kids ยท healthinsurance.org: What does vision insurance cover? (premium and copay ranges, citing Investopedia) ยท American Academy of Ophthalmology: The Affordable Care Act's children's eye health benefit
Paying cash, or using an FSA?
EyeBuddy frames are listed from $14.95 to $39.95 before lenses, and every order includes an itemized receipt for FSA, HSA or insurance reimbursement.
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