Vision insurance helps offset the costs of eye exams, glasses, and contact lenses. Here's what you need to know about vision coverage options in North Carolina—including what the ACA and Medicare do and don't cover.
A good health insurance plan provides essential coverage for unexpected medical expenses and prescription medications. But what about your eyes? Approximately 66% of U.S. adults use some form of vision correction—whether glasses, contact lenses, or surgery. That makes vision coverage an important consideration for most families.
Vision insurance is a supplemental benefit designed to reduce the costs of eye care. Unlike medical insurance—which covers illness, injury, and disease—vision insurance focuses on routine preventive care and corrective eyewear.
Vision insurance typically covers:
Routine eye exams: Usually one comprehensive exam per year
Prescription eyeglasses: Coverage or allowances for frames and lenses
Contact lenses: Usually as an alternative to glasses (not both)
Lens enhancements: Discounts on scratch-resistant coatings, anti-glare treatments, progressive lenses
LASIK discounts: Some plans offer 15-20% off corrective eye surgery
The distinction between medical and vision insurance can be confusing, especially since many eye visits involve both. The key is understanding the purpose of your visit:
Vision insurance: Covers routine care—annual eye exams to check your prescription, vision screenings, glasses, and contacts. Think of it as "wellness" care for your eyes.
Medical insurance: Covers medical conditions affecting your eyes—conjunctivitis (pink eye), glaucoma treatment, cataract surgery, diabetic retinopathy screening, macular degeneration treatment, and eye injuries.
Example: If you visit an optometrist to get a new glasses prescription, that's typically billed to vision insurance. If, during that exam, the doctor discovers signs of glaucoma and orders additional testing, the glaucoma workup would be billed to your medical insurance.
If you have both medical and vision insurance, it's important to understand what each plan covers. Since policies vary by provider, review your benefits carefully or ask our health insurance agents to help clarify your coverage.
Eye care costs add up quickly without coverage. Here are typical costs in 2025:
Comprehensive eye exam: $100–$200 (averages around $136–$200)
Prescription glasses: $200–$600+ for frames and lenses (standard single-vision lenses average ~$107; frames average ~$230)
Contact lenses: $200–$1,600 per year, depending on type and replacement schedule
Progressive lenses: Add $100–$300+ to lens costs
For someone needing annual exams and new glasses, costs can easily exceed $400–$500 out of pocket.
Vision insurance is one of the most affordable types of coverage. In 2025, typical costs are:
Individual plans: $5–$20 per month ($60–$240 per year)
Family plans: $20–$40 per month ($240–$480 per year)
Employer-sponsored: Often $5–$10 per month (employers frequently subsidize part of the premium)
What you typically get for that premium:
Annual eye exam with a small copay ($10–$25)
$100–$200 yearly allowance for frames
Coverage for basic lenses or a contact lens allowance
Discounts on lens upgrades (anti-glare, transitions, etc.)
Is it worth it? For regular glasses or contact lens wearers, vision insurance typically pays for itself and then some. If you only need exams every few years and don't wear corrective lenses, paying out of pocket may be more economical.
Vision insurance: Works like other insurance—you pay premiums, and the plan pays a portion of covered services. May include copays, allowances, and coinsurance.
Vision discount plans: Not insurance. You pay a membership fee for access to discounted rates at participating providers. You still pay for services—just at a reduced price.
Which is better? If you frequently need eye exams, glasses, or contacts, vision insurance usually provides better value. Discount plans may work for occasional users who want reduced rates.
Vision insurance makes the most sense if you:
Wear glasses or contact lenses regularly
Have a family history of eye conditions (glaucoma, macular degeneration)
Have diabetes or other conditions that increase the risk of eye disease
Have children who need annual vision screenings
Are over age 40 (when presbyopia and other age-related changes typically begin)
You may not need vision insurance if: You have good vision without correction, only need occasional exams (every few years), or can afford to pay out of pocket when needed.
Recommended eye exam frequency: Every 5-10 years for ages 20-39; every 2-4 years for ages 40-54; every 1-3 years for ages 55-64; and every 1-2 years for those 65 and older. More frequent exams are recommended if you have risk factors or wear corrective lenses.
Pediatric Vision (Children Under 19)
Pediatric vision care is an essential health benefit under the ACA. All individual and small-group health insurance plans—including those purchased through the Health Insurance Marketplace—must cover vision services for children under age 19.
What's covered for children:
One annual eye exam
One pair of eyeglasses (frames and lenses) per year
Contact lenses as an alternative to glasses
Important note: "Covered" doesn't always mean free. Pediatric vision services may be subject to your plan's deductible, copays, and coinsurance. Vision screening (a basic check by a pediatrician) is considered preventive care. It is covered at no cost, but a comprehensive eye exam by an optometrist may be subject to cost-sharing. Check your specific plan details.
Adult Vision (Age 19+)
The ACA does not require vision coverage for adults. Some Marketplace health plans include optional adult vision benefits, but many do not. If your health plan doesn't include adult vision coverage, you have two options:
Standalone vision plan: Purchase a separate vision insurance policy (typically $10–$20/month)
Pay out of pocket: Budget for annual exams and eyewear on your own
Note: Premium tax credits and cost-sharing reductions do not apply to standalone vision plans. They only apply to your primary health insurance plan.
What Original Medicare (Parts A & B) Covers
Original Medicare does not cover routine vision care. This means it won't pay for:
Routine eye exams for glasses or contact prescriptions
Eyeglasses or contact lenses (with one exception—see below)
Contact lens fittings
However, Medicare Part B does cover:
Diabetic eye exams: Annual screening for diabetic retinopathy if you have diabetes
Glaucoma tests: Annual screening if you're at high risk (diabetes, family history, African American age 50+, Hispanic age 65+)
Macular degeneration treatment: Testing and treatment for age-related macular degeneration
Cataract surgery: Medically necessary cataract removal, plus one pair of eyeglasses or contact lenses after surgery
For covered services, you pay 20% of the Medicare-approved amount after meeting your Part B deductible ($283 in 2026).
Medicare Advantage Vision Benefits
Most Medicare Advantage (Part C) plans include routine vision benefits that go beyond Original Medicare. In 2026, 99% of Medicare Advantage plans offer some vision coverage.
Typical Medicare Advantage vision benefits include:
Annual routine eye exam: Often with $0 copay
Eyewear allowance: $100–$500 per year for glasses or contacts (varies by plan)
Additional discounts: Reduced prices on lens upgrades and frames exceeding the allowance
Coverage varies significantly between Medicare Advantage plans. When comparing plans during Medicare Open Enrollment (October 15–December 7), review the specific vision benefits each plan offers.
Note: Medigap (Medicare Supplement) plans do not cover routine vision care. If you have Original Medicare with a Medigap plan, you'll need a separate standalone vision plan for routine eye care.
Your options depend on your situation:
Employer-sponsored: If your employer offers vision insurance, this is often the most affordable option. Premiums are typically subsidized, and you may be eligible for group rates.
ACA Marketplace: Some Marketplace health plans include adult vision benefits. You can also add a standalone vision plan during Open Enrollment (November 1–January 15 for 2026 coverage). Note: Premium subsidies don't apply to standalone vision plans.
Medicare Advantage: If you're 65+ or qualify for Medicare, consider a Medicare Advantage plan with vision benefits. Compare plans at Medicare.gov or work with a licensed agent.
Standalone vision plans: Companies like VSP, EyeMed, and Humana offer individual vision plans you can purchase directly. Premiums typically range from $10 to $20 per month.
HSA/FSA: If you have a Health Savings Account or Flexible Spending Account, you can use pre-tax dollars to pay for eye exams, glasses, contacts, and even LASIK—whether or not you have vision insurance.
Vision care is an important part of your overall health. Regular eye exams can detect not only vision problems but also early signs of diabetes, high blood pressure, and other health conditions.
Our North Carolina health insurance agents can help you:
Understand what vision benefits are included in your current health plan
Compare standalone vision plans and costs
Find ACA Marketplace plans with vision coverage for adults and children
Explore Medicare Advantage plans with comprehensive vision benefits
Choose coverage that fits your family's needs and budget
