Oklahoma Vision Insurance Guide [+ Alternate Plans]

Did you know your eye has dozens of parts that work together and make it possible for you to see? It’s an exciting part of human anatomy that allows us to blink, cry, distinguish colors, and much more. Yet, if any of those pieces aren’t operating at 100%, your vision begins to decline, resulting in one of many diseases that affect the eyes. Statistics show that over 12 million people in the United States have some form of visual impairment.

However, you can avoid many of these conditions with early detection. So having vision insurance is a wise idea. Most primary health insurance plans don’t cover optic care in Oklahoma. Therefore, you need a separate policy for vision, but not all policies are the same. This guide will walk you through how to find Oklahoma vision insurance, know what’s covered, and your alternative options to care for your eye health.

​​​​​​

Oklahoma Vision Insurance Guide

If you’re an Oklahoma resident or sports fan, you know that being a Sooner is where it’s at, and the government recognizes this, too. It’s evident in the name of the health insurance plan, called SoonerCare.

SoonerCare and Medicaid

SoonerCare is the state’s Medicaid program. The federal and state governments fund it and help cover medical bills for those who can’t afford healthcare expenses, sometimes paying the cost entirely. But unlike federally funded Medicare, SoonerCare benefits extend to dental and vision. To be eligible for SoonerCare, you must be a U.S. citizen or qualified alien and a resident of Oklahoma. You also must meet the financial income and resource requirements. But if you can’t get your Sooner vision care this way, the state has other types of vision plans.

Employer-Sponsored and Private Vision Plans

When you work in larger companies with 50 or more full-time employees, your employer must offer affordable health insurance. This coverage is federally mandated under the Affordable Care Act but does not include vision insurance as part of the required criteria. Still, your company might offer a vision care plan since it’s an inexpensive add-on. If so, you won’t have too much say in how your policy covers you, and you’ll need to go to an in-network provider (typically larger providers, like Pearle Vision or LensCrafters).

Private vision plans are available when your employer doesn’t offer coverage, or you’re a freelance UX designer, teacher, or real estate agent. You can apply for a policy through a direct vision plan provider, such as VSP Vision Care or Blue Cross and Blue Shield of Oklahoma. Some Medicare Advantage plans, like Humana, also have vision components.

If you qualify for health insurance through the Healthcare Marketplace, you can add vision and dental insurance as optional coverages for an extra monthly premium. This opportunity is only available when you choose your base health plan during the open enrollment period.

In the next section, we’ll go into what’s covered in a typical vision plan. So you can better understand your employer-sponsored or private policy.

What’s Covered in a Typical Vision Plan – Oklahoma Vision Insurance Guide

Vision insurance coverage is an excellent way to reduce out-of-pocket expenses when needing glasses or contacts. You’re also more likely to go to the optometrist for regular checkups if you have insurance for the visits.

Vision loss affects over three million people over the age of 40 annually. Yet, these conditions aren’t usually an overnight problem. Instead, they come on gradually and could have been slowed or avoided with annual checkups. But the cost of medical, dental, and vision visits has one in four Americans skipping preventive and non-urgent trips to the doctor.

With a vision plan that costs $15 per month, you can quickly catch the problems in your family or your unique DNA. The typical vision benefits include preventive wellness care, routine eye exams, part or all of glasses and contacts, and some treatments, like Lasik.

Plan Coverage

As you shop around for vision plans, each policy will be different. However, a good plan will cover the most common visits and treatments at no or low cost. Preventive care, including eye exams, vision tests, and other vision care essentials, should be free or have a small copay. Your plan should also have provisions to allow you to purchase eyeglass frames up to a specific cost, and you can pay anything that exceeds that limit if you want pricier frames.

Most plans also cover prescription lenses for your glasses with little or no expense. However, treatments for those lenses, like scratch resistance and blue-light filtering, may cost extra. If you want contact lenses, your plan likely includes a limited allowance, like eyeglass frames or a copay. When your doctor recommends therapies for your eye impairments, your insurance usually discounts those expenses.

So, for example, you can have corrective surgeries or unique lens treatments, like progressive lenses, as long as you can pay your portion of the cost. Your share of these treatments will depend on the coverage you’ve taken out with the insurer. Cheaper plans will likely involve less responsibility from the insurance and more from you. They’ll also have more exclusions. These are best for people who want their annual visits and preventive care covered.

Common Exclusions

Regardless of the type of plan, every insurance will usually have exclusions — things they don’t cover, even with a prescription. For vision policies, commonly excluded services would be:

• Subsequent eye exams in a calendar year after each annual visit
• Frames and lenses after the first sets are covered unless the glasses are under warranty
• Drinks purchased without a prescription
• Treatments for your eyes that are covered under health insurance
• Experimental treatments
• Fees or charges not related to treatment

If you aim for coverage for any of these excluded goods and services, you’ll need to shop for the top-of-the-line plans and expect to pay a higher monthly premium.

How to Shop for Vision Plans – Oklahoma Vision Insurance Guide

From the fine print to the premium, you must look at the whole picture when shopping for a vision plan.

Here, we’ll break down each part of the plan and how you can see what you’re getting into before you invest in unhelpful coverage.

What the Terms Mean

First, look at the most common — and often confusing — terminology as you look into eye care benefits.

This glossary should help you navigate the policies you’re exploring to find the one that is best for you.

• Calendar year: Begins January 1 and ends December 31. Benefit coverage usually goes by this period.
• Coinsurance: Your share of each treatment or service cost after paying the deductible. Coinsurances vary based on the charges allowed by the insurance company.
• Copay: A set amount you must pay the doctor for a particular service (annual eye exam, glasses, etc.)
• Flexible Spending Account (FSA): A particular account set up by you or your employer to pay for medical benefits not covered by your insurance. The money in an FSA contains pre-tax dollars, making it a smart financial way to protect your healthcare.
• Health Savings Account (HSA): Similar to an FSA, this savings account can create if you have a high-deductible health insurance policy. It lets you add pre-tax funds to cover your medical services.
• Health Maintenance Organization (HMO): Your plan will likely be an HMO or PPO (explained next). In an HMO, you can visit a group of doctors who provide maintenance coverage for a fixed monthly fee.
• Preferred Provider Organization (PPO): A plan that allows you to get more services if you see doctors within the insurance carrier’s network. You can go out-of-network, but you’ll pay higher costs for your treatment.
• Indemnity Plans: Coverage where you pay for services when provided and then submit a claim to the insurance for partial or full reimbursement.

Knowing the terms in this glossary gives you an edge as you search your policy for acceptable print clauses that could cost you later.

Reading the Fine Print

The last thing you want is to leave your eye doctor’s appointment expecting that you paid your copay and were done, only to get hit with a mega bill in the mail later. What happened?

Chances are, there was something in the fine print you missed.

This part of the contract is where the insurer explains exclusions, how you need to submit any claims, and if a service or procedure requires a referral for coverage.

Technically, the doctor’s office should handle this before seeing you, but that doesn’t always happen. So, instead, they add a clause to the paperwork you sign stating that you know the balance due is your responsibility, whether or not the insurance covers the claim.

Another acceptable print clause refers to in- and out-of-network status. Some insurance plans allow you to see providers out of their network if you pay a larger share of the costs. Other programs exclude out-of-network providers entirely.

Premiums, Deductibles, and Copays

Finally, check the costs for your insurance plan, adding the monthly premiums, your deductible, and any copays you expect to pay for reasonable treatment.

The least expensive premium might cost you more by the time you pay the deductible and copays for eye exams and other preventive care. Go through all the plans you’re considering, and check the overall costs before deciding which is the best deal. It might be worth it to pay a few dollars more a month for coverage with a higher allowance on various services.

4 Alternatives to Vision Insurance

Once you total your out-of-pocket costs, you might wonder if vision insurance is worth it. If you need more than an annual eye exam, or if that’s the only thing you need, is the monthly premium the correct route?

You could look into other alternatives to an insurance policy.

Here are a few other ways to cover vision care costs:

HSA and FSA Saving Plans

Instead of paying high monthly premiums for an insurance policy you might or might not use, consider investing in an HSA or FSA plan. As mentioned, health savings and flexible spending accounts are funded with pre-tax dollars.

The difference is that a flexible spending account supplements a high deductible insurance plan, while a health savings account pays for any expenses your insurance doesn’t cover. In addition, funds in an HSA roll over, but in an FSA, they do not.

Vision Savings Plans

Another alternative for self-employed individuals and families who don’t want to invest in a traditional insurance plan is the vision savings plan.

A vision savings plan, like Selfgood, gives you discounts when you go to the doctor. You pay an annual membership fee and receive a card or number that unlocks exponential savings.

With the vision plan, there are no copays or deductibles, no claim forms to submit, and no exclusions to cause you any worry. Instead, you go to one of the doctors in the plan’s network (Aetna powers Selfgood’s. So you’ll get thousands of providers to choose from) and let the savings help you.

Give them your membership ID card when you arrive, and they will discount your services. You can still submit the claim to your HSA or FSA for reimbursement if you have one.

It’s a hassle-free way of going to the eye doctor without the stress of referrals, insurance premiums, and unexpected bills in the mail.

Conclusion – Oklahoma Vision Insurance Guide

Whether you live in Tulsa, Oklahoma City, or somewhere in between, being a Sooner means you have access to various vision coverage options.

But an insurance plan isn’t your best route to healthy eyecare, especially if you can access group vision benefits through Selfgood as a gig worker.

Head to Selfhood today to see how to save money on vision, dental, health, legal, and many other products and services.