What You Need to Know About Vision Care in the FEHB Program
All FEHB plans pay for medically necessary care of your eyes, such as cataract surgery. Many pay for annual refractive examinations to determine your prescription for eye glasses or contact lens, and some pay for part of the cost for the lens and frame or arrange for a discount at plan-affiliated providers (this is often stated as an unofficial non-FEHB benefit in brochures.) Our Guide indicates which health plans pay the most toward vision services.
The nation-wide standalone FEDVIP vision plans provide tax-advantaged premiums for employees (but not retirees) and use the purchasing power of their enrollees to obtain discounts for all enrollees. They are not true insurance plans and will pay neither for lost or broken glasses nor for medical or surgical care. Instead, they are a way to prepay your anticipated and routine costs for refractive eye examination, glasses and frames, contact lenses, and related services and supplies. If you plan to purchase unusually expensive frames, or multiple pairs of glasses, you will need to rely on discounts rather than direct plan benefits.
Unfortunately, the vision plan brochures do not present benefits in a consistent format, making them very hard to compare. We have attempted to capture most of the important features of the plans to help you decide whether, and which, plans you may want to examine in depth. In general, their benefits and premiums are similar, but most offer both high and standard options with differences in both premiums and cost sharing. If you have a preferred optician or eyewear outlet you should ask which plan(s) if any it affiliates with to inform your decision.
You have several alternatives to enrolling in these plans. You can simply decide to pay for your predictable dental and vision expenses without the bother of using a plan or being restricted to its providers. If you combine this with prudent shopping, you can achieve substantial savings. For example, Washington Consumers’ Checkbook has rated dozens of DC area providers for optical services and found that prices one-fourth or more below (or above) the average for glasses or contact lenses are not uncommon. Also, most FEHB plans have unofficial plan benefits and discounts for eyewear from chains, without paying any extra premium.
You have two other major alternatives for vision care. As for other categories of expense, employees (but not retirees) can establish a Flexible Spending Account that covers vision along with other expenses. Or you can join a Consumer-Driven or High Deductible plan and use its savings account feature to pay for vision costs. You can even supplement a High Deductible plan's savings account with a LEX HCFSA. Either of these options gives employees the same tax advantage—about a one third saving—as a separate vision plan. If you use any FEHB plan, of course, the government pays most of the premium.
The primary advantages of joining a vision plan are that it enables you to lock in a provider discount as well as a tax saving while budgeting for your eye wear. You pay roughly $10, $20, or $30 a month (depending on your family size and which plan you select) knowing that each covered family member will be able to get a good deal on a refractive examination and one good set of eyewear equipment.