Vision Insurance is Making Your Glasses More Expensive

There is a prevalent belief that one needs vision insurance to get a good price on quality eyewear. At first glance it can seem like that is the case, a quality optometry practice or upscale optical can easily quote $400-$500 for a great pair of single vision eyewear, while prices with insurance for a similar pair can be less than $200. However, the truth is not so clear cut. First, in order to access those lower prices on eyewear one pays premiums to the insurance companies, which increase the net total cost of eyewear. Second, vision insurance does not allow one to fully leverage tax-advantaged Flex benefits and Health Savings Accounts. Finally, eyewear costs with insurance are generally fixed and non-negotiable, but fees for private paying individuals are not and most offices and a few retail opticals are willing to offer discounts to private payers through various programs, sales, or cash- and prompt-pay discounts. When these three factors are weighed, you are probably spending more for your eyewear with insurance than if you just buy it from a good optician.

Let’s consider a hypothetical pair of eyewear. At a good optometry practice or optical an excellent pair of single vision thin and lightweight polycarbonate lenses, with a premium quality anti-reflective and scratch resistant coating, might be $300. An average price for a good quality frame might be $200. In total this excellent pair of single vision eyewear retails for $500. What would this pair cost with insurance?

Vision insurance is not like medical insurance, or even dental insurance. It limits benefits to once a year, and offers no indemnity. One carries medical and dental insurance for the routine benefits, but also importantly for the indemnity in case of medical or dental emergency. That benefit makes the insurance and premiums useful even if you are not routinely going to the doctor or dentist. Vision insurance offers no indemnity. If you have an accident and injure your eye, vision insurance does not cover that, only medical covers that. If you break or lose your glasses, vision insurance does not cover that either, they only offer benefits on their strict once-per-year schedule. So what are vision insurance premiums for? You pay into the insurance for the privilege of buying eyewear at a reduced out-of-pocket cost at the time of purchase. But since the premiums are good for nothing else but the eyewear purchase, that money is really just additional cost of the eyewear. Your true cost of eyewear with insurance is your out-of-pocket at purchase plus your annual premiums.

The two largest national vision insurance providers are VSP and EyeMed. Both sell plans publicly and offer several tiers, and the chart below show the actual calculated costs of eyewear with their most popular plans.

	Private pay	VSP Standard	VSP Enhanced	Eyemed Healthy	Eyemed Bold	Eyemed Bright
Lenses	$300	$126	$25	$161	$161	$126
Frames	$200	$40	$40	$130	$56	$0
Copay	-	$25	$25	$55	$20	$20
Out-of-pocket	$500	$166	$65	$346	$237	$146
Premiums	-	$169	$393	$57	$199.50	$342
TOTAL	$500	$335	$458	$403	$436.50	$488

The out-of-pocket cost you pay in the optical is dramatically lower. It’s hard to argue against getting a $500 pair of glasses for $65 with VSP’s enhanced plan. One wonders how in the world can they do that, but when you factor in the premiums the picture becomes much clearer. To get that awesome $65 price you had to pay $393 in premiums, so your glasses really cost $458, $100 more than their standard plan! VSP’s standard plan ends up being the best deal, with moderate out-of-pocket costs and moderate premiums.

But there’s still a few factors to consider. The first is private pay discounts. When you use insurance the fees are contractually fixed by the insurance company, the optical is not allowed to give you additional discounts or deals. This is intended by the insurance companies to guarantee fairness to their members so they receive the same price for the same materials no matter which provider they go to, and that providers cannot give one member a better deal than another. The policies do work to that effect, however they also have the converse effect that costs are not negotiable. For private payers price can be negotiable. Retail opticals often run sales and promotions which can be a nice discount, have “package” deals on complete pairs of glasses at a lower price, and offer courtesy discounts for affiliation with medical insurances, AARP, AAA, military, unions, etc. Private opticals and optometry offices can be even more flexible. As with most small businesses, they set their own policies and can offer special pricing to whomever they like. It is common to offer a “prompt” or “cash pay” discount to private payers who pay in full for the eyewear upfront by cash or check. Apart from established policy discounts, it’s also perfectly possible to straight up negotiate the price. Not all offices will be prepared to do such a thing, but again as small businesses even if the person you are working with can’t give you a discount, certainly a decision-maker with pricing authority is present and could be asked. Through all the different pricing options available, it is not unreasonable to get at least a 20% off the regular purchase price.

The second factor is Flex Spending or Health Savings Accounts (HSA). These are special savings accounts that individuals or employers can contribute to, tax free, and those funds are available to spend on any qualified medical expenses, including eyeglasses. These are advantageous both with and without insurance, but they are more advantageous without insurance because the funds can only be used to pay for materials, and cannot be used to pay premiums. Since a significant portion of eyewear cost with insurance is in the form of premiums, a significant portion is not tax free. A private payer can get the entire purchase 100% tax free.

If we assume a very reasonable 20% discount on the private purchase, and a 25% federal tax savings on materials with a Flex or HSA, the real costs look very different. The final true out of pocket cost for the privately purchased eyewear is only $300, while the only plan that beats the private payer does so only by a meager $6.50. Every other plan actually makes the eyewear more expensive. And ironically the “better” plans end up being worse than the cheap plans.

	Private pay	VSP Standard	VSP Enhanced	Eyemed Healthy	Eyemed Bold	Eyemed Bright
20% private discount	-$100	$0	$0	$0	$0	$0
25% tax savings	-$100	-$41.50	-$16.25	-$86.5	-$59.25	-$36.5
TRUE COST	$300	$293.50	$441.75	$316.50	$377.25	$451.50

The final consideration, and the most dramatically impactful on the true cost, is frequency of eyewear purchase. So far I’ve considered just a single year. But the majority of eyeglass wearers don’t buy new eyewear every 12 months like clockwork. In fact the industry average for new eyewear purchase is only every 2½ years. The years in which you don’t buy, the premiums continue to rack up and your eyewear gets more and more expensive. Over 2 years every insurance plan here becomes more expensive than buying your eyewear privately. The worst plans cost you $800, while you could have just bought them without insurance for $300.

	Private pay	VSP Standard	VSP Enhanced	Eyemed Healthy	Eyemed Bold	Eyemed Bright
2 year cost	$300	$462.50	$834.75	$373.50	$576.75	$793.50

Once you calculate all the hidden costs of vision insurance, it clearly is not very beneficial. Almost anyone would do better to just plan ahead, save some money, get a tax advantaged health account. Private payers enjoy the freedom to choose where they shop, rather than pick from a list of insurance approved shops, and with cash in hand you have a lot of power to price shop the competition and negotiate what you pay. Drop your vision insurance and save some money.

Digital Lens Technology

The coolest thing happening now in eyeglass optics is digital lens technology, also called “free form” or “high-definition”. As with many new technologies, there is much confusion among consumers about what exactly digital lenses are. That’s because there is much confusion even among opticians about what exactly digital lenses are. The voluminous amount of information online about digital lens technology is either oversimplified and incorrect, or accurate but challengingly technical. I’m going to try to bridge the gap with a clear technically accurate explanation that is accessible to everyone, and will hopefully demystify the technology and illustrate when it is valuable and when it is not.

Curvature

The most primary benefit of digital lenses is that they are custom made exactly to each Rx, and do not suffer the compromises endemic to conventional lens manufacturing. Conventional lenses are partially premade by lens manufacturers, and when Rx lenses are produced a lab selects from among the premade materials whichever is most appropriate for the Rx and then grinds the prescription as closely as possible into the material. However, every unique Rx requires a completely unique curvature of the lens for best correction. When premaking materials, manufacturers cannot economically produce every curvature for every Rx, so they produce a dramatically reduced selection of curvatures that are satisfactory for most Rxs. But satisfactory is far from perfect. Some of the optical distortions and aberrations one experiences with conventional lenses, such as the “fish bowl” effect and blurry vision at the peripheral edges of the lenses, are because the curvatures are just not perfectly matched to the Rx.

For example, your particular Rx may require a 3.25 curvature for best correction. However, the manufacturer may only produce lens materials in 2.00 and 4.00 curvatures, so the lab must select from those. They would round up and use the 4.00, but this rounding constraint guarantees optical error in the lens fabrication even before it has begun. It’s close, but not right.

Digital lenses are produced by a digital lens fabrication process that eliminates the constraints of premade materials. The advanced machines employed in the process cut custom curvatures to exacting specifications as low as 0.01 diopters, and can produce the aforementioned 3.25 curvature, or any other that is called for, with extraordinary accuracy. This enhances visual comfort by eliminating the distortions of merely “close” curvatures, as well as preserves optical clarity in all parts of the lens providing clearer peripheral vision than conventional lenses.

The benefits of digital processing are compounded when astigmatism is involved. To correct astigmatism lenses have two prescriptions ground into them at cross directions. Since every unique Rx requires a unique curve, lenses that correct astigmatism require two unique curves. Conventional lenses that correct astigmatism are still made from the single premade curve selection, so they will err due to rounding in both directions. If the astigmatism is high, it becomes impossible to even come close to proper curvature for both prescriptions with a single premade curve, and wearers end up with lots of distortion and peripheral blur. Digital technology enables perfectly accurate curves for both prescriptions to be fabricated in the lenses, providing high astigmatism patients better vision than possible in conventional lenses.

This custom precision curvature, often called "optimized" as in the curves are optimal for any given Rx, is the simplest level of digital customization. Examples of this technology in single vision and progressive are the Essilor 360 and Varilux DRx line, Shamir Spectrum, and Zeiss Choice Series.

Position of Wear

The Rx of a lens depends on the curves cut into the lens, but also depends on the distance of the lens from the eye as well as the tilt and angle of the lens relative to the eye. The Rx from the doctor assumes a final spectacle lens that sits at the same distance from and angle of tilt relative to the eye as the lens in the exam room. The reality is that there exists a huge variety of frame shapes, angles, and sizes, of which virtually zero replicate the exam room lens position. Therefore, a lens conventionally fabricated to the Rx as written and put into a frame will not exactly reproduce the vision experienced in the exam room. Even the digitally curvature optimized lenses I just talked about only perfectly replicate the doctor's Rx if the lenses are held in exactly the same position in front of the eye as the doctor's exam room lens was.

This is where digital technology gets really cool. Since this fabrication method frees lens makers from the constraints of prefab materials, and the extremely prescise machines can cut just about any unique surface we can imagine, we can customize the lens in ways never before possible. We can measure the distance from, and angles relative to, the eye that a particular frame holds the lens on a particular patient to gather “position of wear” information. Every combination of frame, face, and Rx produces a completely unique set of parameters, and once the data is gathered a uniquely personalized lens is computer modeled to take all those factors into account, and then precision machines individually custom fabricate lenses to those exact specifications. The result is a lens perfectly designed for that patient's Rx, in a particular frame, fit to that patient's particular face, which exactly replicates the doctor's exam room Rx. Anything short of this level of customization will not perfectly recreate the exam room vision. Examples of these fully customized digital lenses are the Essilor Fit Single Vision and Varilux Physio Enhanced Fit, Shamir Autograph, and Zeiss Individual.

Who Should Wear Digital Lenses?

Anyone can wear digital lenses, but some will get more benefit than others, and some will perceive no difference. Patients with mild Rxs, in frames that are fit at a proper distance from the eye and have moderate tilt and wrap, will experience little advantage from the digital technology explained here. As Rxs increase in power, in complexity with astigmatism, and frames deviate from “classic” fitting parameters, conventional lenses will have more error and digital technology becomes more beneficial. Personally, I evaluate every patient individually on their Rx, the frame they select, and how that frame fits them to determine if they should wear digital or conventional lenses. Conventional lenses do fail to exactly replicate the exam room Rx by a calculable margin, but for some Rxs and patients the degree of error is so low it is below the threshhold of perception, i.e. the perceived difference between the conventionally corrected vision and digitally customized vision is zero. If the perceived difference is zero, the benefit of digital lenses is zero. When the frames deviate far from the classic fit parameters, most typically in highly wrapped sport sunglasses, or when Rxs are strong or have moderate or higher astigmatism, that's when digital lenses shine and can provide crispness and clarity of vision never before possible.

As always, find a good optician to design your eyewear. They will counsel you on the particular benefits of digital lens technology for your needs, and ensure you always get the best vision possible.

Want to geek out about this technology and get into gritty detail like I do? Check out these articles by two incredible Master Opticians:

Mark Mattison-Shupnick, ABOM, “The ‘...IZE’ Have It.” 20/20 Magazine, May 2011,

http://www.2020mag.com/ce/TTViewTest.aspx?LessonId=107609

Darryl Meister, ABOM, “Zeiss Individual® Single Vision.” Carl Zeiss Vision, 2010,

http://vision.zeiss.com/content/dam/Vision%20Care/Vision/en_us/PDF/ECP/ZEISS_Individual_SV_White_Paper_15630.pdf

Fun with Antiques

I had the opportunity to make some cool antique spectacles: rimless turn-of-the-century pince-nez style.

They were a lot of fun and work with the custom mounting I did. The customer is a fan of vintage and antiques, and plans to use the pince-nez pairs as "hat and tails" attire.

Teddy Roosevelt was an iconic pince-nez wearer.

Morpheus revived the coolness of the style.

Original 1.5mm thick glass lenses. The clamps on either side sit flat against the lens surface, and screw connects the clamps through a hole in the lens to keep it securely in place.

My new polycarbonate lenses were thicker (necessary for proper curvature and better vision) so I cut grooves so the clamps could be recessed into the lens. Notice here the clamps are almost flush with the lens surface, not sitting on top of it.

 

 

 

The full metal round pair was a third for the same customer: a nicely patinaed WWII-era antique. This one was cake compared to the pince-nez.

 

Chemistrie Magnetic Sunglasses on an Extremely High Power Lens

I make a lot of Chemistrie custom magnetic sunglasses. The claim of the technology is that it fits any eyewear, but I don't think they were envisioning this when they said that. Still, I made it work

A recent customer of mine had an extremely high power Rx, so strong that to mitigate the thickness on the lens some of the power had to be split onto the front surface, which made the lens bi-concave (concave on both front and back surfaces, instead of the usual concave back and convex front of most lenses). That's all fine and good, I've dealt with such powers and lenses before. But this customer also wanted the magnetic sunglasses, and the technology certainly wasn't designed with this lens in mind.

The basic Chemistrie lens is a simple polarized film laminated between their "Hivex" optical material; the front and back sides are identical, differentiated only by curvature. Since the lens is reversible, I just thought why not turn the lens around to have the convex surface match the concave lens front? The sunglasses will be the same concave front curve as the Rx lenses.

Extremely high power eyewear like this is never elegant, but I think they turned out pretty neat. It's  cool unique solution that this customer could only get from a few opticians, and I'm glad I was able to do it.

Buying Glasses Online

TopTenReviews.com has an article reviewing ten of the most well-known sites for buying glasses online. They give good details for each of the sites, but they understandably lack any professional advice to distinguish among the sites.

Something to look for when shopping glasses online, as with anything, is brands. Brands aren't just overpriced names for the same stuff. They are quality products marked with a reputable name to guarantee your confidence in the product.

The cheapest sites have no recognizable brands, which means there is zero guarantee to you of the quality of the product. Sure they're cheap, and most the sites have 100% refund policies. But when the frames won't fit or hold adjustment, or the lenses seem to strain your eyes, produce weird "fish-bowl" effects, or just seem hazy, what are you going to do? If you paid $10, even $20, are you going to contact customer service for a return authorization, package them up, ship them back at your expense, and wait for the refund, all the while without new glasses? Probably not, you'll probably just throw them in a drawer and try again (or just throw them away, as I did when I bought a couple pair online a few years ago just to see how they turned out. They were crap).

The no-brand materials the lowest-price guys use for frames and lenses are so ridiculously cheap, bought in bulk for literally pennies from Asian factories, that much of the time even if you return them for your money back they still turn a profit on the shipping! They have absolutely zero incentive to provide you quality stuff because it costs them more to take the time and use the materials to get it right than it does to churn out poor junk, half of which could be wrong, and just accept the shipping profits on the returns. If you absolutely don't care about the quality of your glasses, go ahead and throw a few bucks around and see if maybe someone accidentally makes you a useable pair. Even a stopped clock is right twice a day.

Not all glasses you buy online are crap. You can get perfectly good quality eyeglass materials online, the same level of quality you get from good opticals, even boutiques. (Note I said materials. The physical product can be the same, however the measuring, product design & selection, and frame fit can all be wrong without a optician's expertise.) The way to be sure you are getting quality is brands.

Several sites in the review sell good brand name frames, which guarantees they were made at least by a slightly decent manufacturer. Framesdirect, GlassesUSA, and Glasses.com all sell the same  kind of brand frames you'll find in mall retail opticals and eye doctors' offices. Of those Framesdirect is by far the biggest and best, with massive selection and a price match guarantee for many of the best designers. If you are going to buy a frame online, buy it from Framesdirect.

However, frames are only of secondary importance for glasses. Is is better to like your frames but not see well, or see well but not like your frames? Neither is good, but the whole point of glasses is seeing better, right? So while frames are more fun to pick out, you really need to think about and put some priority into lenses.

Not all lenses correct vision equally. Poor manufacturing creates lenses with inconsistent prescription and haziness. Vision simply will not be comfortable, clear and crisp even when the prescription is accurate. The only way to know you are not getting $0.15 per pair Asian special lenses is to buy branded lenses, the same used by reputable opticals in the U.S. Because few consumers know anything about spectacle lens brands, this is where almost every online seller skimps. Some claim to use quality brand lenses, and may do so, but they don't make it clear what you are getting. Framesdirect is great for frames, but they are not clear on their lens brands. They charge enough to suggest they are using quality materials, but there is no guarantee of what you get. Only one site in the review specifically lists it's brands, and they are all good: Eyeglasses.com.

Look at their sample price list above. Essilor, Crizal, Orma, Thin & Lite, these are brands that guarantee you are getting quality produced materials. Note the prices. No $6.95 glasses here. Because you can't make decent glasses at those prices. However, if you compare to retail stores and doctors' offices, the prices above are excellent and for the very same materials.

These best resource I've found for quality spectacle lenses online isn't in the review, probably because they don't sell frames. Eyeglass Lens Direct only sells lenses, and is and awesome source for most of the high quality spectacle lenses available in the U.S. today. You can select lenses by specific manufacturer, and then by specific lens designs and models. Through this site you can get some of the most technologically advanced and best quality materials there are, products no other online seller offers. The amount if information is daunting and can be impossible for the consumer to decipher, because most of the discrimination among brands and lens designs is the purview of the professional optician. However, because Eyeglass Lens Direct specifically states the products you a re purchasing, you can Google the names and research yourself. Every brand has an informational site to explain their particular benefits.

 

 

So then, what's the best process for buying glasses online, to get the best price, best product, and best results?

•  Research and buy the frames you want on Framesdirect.com
• Find a good optician willing to make measurements and guide you to the best lens option for your Rx and frame. Pay him for his professional expertise and time. Don't be a dick. Want my suggestion on a fair price? $30-$60 depending upon your needs and his skill.
• Buy the lenses from EyeglassLensDirect.com

You now got the best price on frames, a great price on guaranteed quality brand lenses, and if you found a good optician and compensated him adequately for his skills, you got the same accuracy and guidance you would have if you had purchased eyewear from him.