If you have an EyeMed plan through work, you probably know it helps pay for eye care. The details get fuzzier once you start picking out lenses or need a visit for something other than a checkup.
EyeMed plans generally help cover routine eye exams and provide benefits toward glasses or contact lenses, while medical eye problems and treatments may be billed through your health insurance instead. Your exact copays, allowances, and benefit frequency depend on your specific plan.
Once you know which kind of visit you’re booking, you can plan for the cost ahead of time.
What EyeMed Vision Benefits Include
EyeMed plans focus on routine care, including your yearly checkup and the glasses or contacts you leave with. Your employer picks the plan, but many EyeMed plans include these benefits:
- An eye exam with a flat copay you pay at check-in
- An allowance toward a new frame
- An allowance toward contact lenses
- Copays or discounts on lens options like anti-reflective coating and polycarbonate
Progressive lenses, which correct near and distance vision without a visible line, often come with a higher copay than single vision lenses. If you wear contacts, your plan may also cover the fitting and follow-up visits, where your optometrist checks how the lenses sit on your eyes.
Allowances and Copays
An allowance is the dollar amount your plan puts toward your frame or contacts. Choose a frame that costs more, and you’ll pay the difference, though many plans take a percentage off that remaining balance.
A copay works differently. It’s the fixed amount you pay for the exam, no matter what the visit would cost otherwise.
How Often You Can Use Benefits
Your plan determines how often you can use your exam and eyewear benefits. Your plan determines how often you can use your exam, frame, and contact lens benefits. Some EyeMed plans allow you to use both your frame and contact lens allowances during the same benefit year, while other plan details may vary. Check your specific benefits before you shop.
What EyeMed Usually Doesn’t Cover
If you wake up with a red, painful eye, that’s not a routine visit. Medical eye care sits outside a vision plan. These visits typically get billed to your health insurance instead:
- Eye infections
- Eye injuries
- Sudden changes in your vision
- Ongoing management of eye disease, including follow-up appointments
- Dry eye evaluation and treatment
Think of it as separate lanes. Your vision plan covers routine exams, glasses, and contacts. Your medical plan handles eye conditions and the follow-up care that comes with them.
Sometimes a single visit uses both. You come in for a routine exam, the optometrist finds something needing medical attention, and part of the visit bills one way and part bills the other.
EyeMed Discounts and Extras
A lot of members skip past the extras, and some of them can save you money on things your allowance doesn’t cover. Depending on your plan, you may get:
- Savings on a second pair of glasses, like a backup or computer pair
- Discounts on non-prescription sunglasses
- LASIK savings through a partner network
A flexible spending account (FSA) or health savings account (HSA) lets you pay for eye care with pre-tax dollars. Eye exams, glasses, contacts, and contact lens solution can all count as eligible medical expenses. Use your EyeMed allowance first, then cover what’s left with your account.
In-Network Versus Out-of-Network Care
When you visit an in-network clinic, the office bills EyeMed directly. You pay your copay plus any difference, and we handle the paperwork.
Out-of-network care takes more work on your end. You’ll pay the full bill at your visit, submit a claim yourself, and wait for a reimbursement that’s often lower than your in-network benefit. EyeMed also sets a deadline for out-of-network claims, so file yours soon after your appointment.
Is an EyeMed Plan Worth It?
Add up what you’d spend in a year on an exam plus frames and lenses, then compare that total to your yearly premium. If your costs come out higher, the plan can pay for itself.
A plan may offer more value if your prescription changes often or if more than 1 person in your household wears glasses. Kids who outgrow their frames every year or 2 can add to those savings.
How to Use EyeMed Benefits at Your Eye Exam
A little prep before your appointment can make checkout much simpler. Before you sit down in the exam chair:
- Confirm your plan is active.
- Check that the clinic is in-network.
- Bring your name and date of birth, since most offices don’t need your ID card.
- Ask for a cost breakdown before your lenses get ordered.
At check-in, ask which parts of your visit bill to EyeMed and which bill to your medical plan. It also helps to find out your frame allowance and what any lens upgrades will cost. Our team can go over both with you before you commit to anything.
Frequently Asked Questions
Can I use both my frame and contact lens allowance in the same year?
Some EyeMed plans allow you to use both allowances in the same benefit year, while others require you to choose one or the other. Check your specific plan details before shopping.
Does EyeMed cover anti-reflective coating?
Yes, many EyeMed plans offer copays or discounted rates for lens options like anti-reflective coating and polycarbonate lenses.
Make the Most of Your EyeMed Benefits This Year
We welcome walk-ins and same-day appointments, and we make glasses in our in-house lab, which can shorten your wait for new eyewear.
Eyecare Plus has 6 clinics across Greater Nashville: Antioch (Hickory Hollow), Clarksville, Green Hills, Hendersonville, Columbia, and Murfreesboro.
Call or text the location closest to you or book your appointment online, and our team can check your EyeMed benefits before you arrive.
