When it’s time to use your vision plan, terms like "frame allowance," "lens copay," and "exam copay" can seem confusing. But once you break it down, your vision benefits make a lot more sense — and knowing how they work can help you make the best decision for your needs.
Here’s a simple guide to understanding your benefits and making the most of your plan.
Almost all vision plans cover an annual eye exam. An exam copay is the small fee you pay out of pocket for your check-up. It’s usually between $10 and $25 (VSP Vision Care, 2024: https://www.vsp.com/eyewear-wellness/vision-insurance-basics).
During the exam, your eye doctor checks your vision, screens for health problems like glaucoma, and updates your glasses and/or contact lens prescription if needed. Regular exams are important for keeping your eyes healthy and catching issues early.
One of the biggest surprises for many people is learning that "getting glasses" actually involves two parts of your vision plan:
Your frame allowance helps pay for the cost of the frames — the part that holds the lenses. For example, your plan might offer a $150 frame allowance. If you pick a frame that costs $150 or less, you might pay nothing. If you pick a frame that costs more, you usually pay the difference (Versant Health, 2024: https://www.versanthealth.com/blog/how-to-use-vision-benefits/).
Your lens copay is what you will pay for the lenses that go into your frames. Many plans fully cover basic single-vision lenses, which correct for either distance or reading — but not both. If you need more complex lenses, like progressive lenses (which correct distance, intermediate, and reading all in one pair without a visible line), you may pay a higher copay. Special features like anti-glare coatings, photochromic lenses (lenses that darken in sunlight), or high-index lenses (lighter, thinner lenses for strong prescriptions) can also cost extra (VSP Vision Care, 2024: https://www.vsp.com/eyewear-wellness/vision-insurance-basics).
Plans help lower the cost of basic lenses, but it’s good to know ahead of time if you want extras that might cost more.
If you prefer contacts instead of glasses, your plan usually gives you a contact lens allowance. This allowance typically goes toward:
For example, if your plan gives you $150 toward contacts, and your lenses cost $200, the plan would pay $150, and you would pay the extra $50 (Versant Health, 2024: https://www.versanthealth.com/blog/how-to-use-vision-benefits/).
It’s important to know that getting contact lenses also involves a contact lens fitting.
This is a separate service from your regular eye exam. During the fitting, your eye doctor measures your eyes and evaluates your vision to make sure your lenses fit safely and comfortably.
Typically, the fitting fee is not deducted from your contact lens allowance — meaning you can use your entire allowance toward the cost of your lenses (VSP Vision Care, 2024: https://www.vsp.com/eyewear-wellness/vision-insurance-basics).
The fitting is usually a separate out-of-pocket cost for members. On average, a contact lens fitting can cost anywhere from $25 to $150, depending on whether you need basic, toric, or multifocal lenses (American Optometric Association, 2024).
Some PCBG vision plans even help cover the fitting fee, offering a low copay instead of paying the full fitting cost. Always check your specific plan details to know exactly how your benefits work.
In most vision plans, you can choose to use your benefits for either glasses or contacts each plan year — but not both.
However, PrimeCare Benefits Group (PCBG) offers plans that allow you to use your benefits toward both glasses and contacts within the same benefit year, giving you even more flexibility.
Because many plans stretch farther on glasses — especially when you combine the frame and lens allowances — a lot of people choose to use their benefits toward glasses. Then, if they also want contacts, they often buy them separately online, using an FSA, HSA, or out-of-pocket method.
Buying contacts online can be cost-effective. Many online stores offer sales, rebates, and free shipping. Plus, using an FSA or HSA means you're using pre-tax dollars, helping you save even more (Healthcare.gov, 2024: https://www.healthcare.gov/glossary/flexible-spending-account-fsa/).
It’s also helpful to know just how much glasses can cost without insurance. On average, an eye exam costs between $100 and $200, frames can range from $100 to $400, and lenses can add another $100 to $400, depending on your prescription and options (VSP Vision Care, 2024: https://www.vsp.com/eyewear-wellness/vision-insurance-basics). That means a complete pair of glasses could easily run $300 to $700 — or even more — without a vision plan.
Using your benefits wisely can stretch your dollars and help you get the eyewear you need without the sticker shock.
Here’s a simple way to think about it:
Here’s a simple cheat sheet to remember:
Your vision benefits are there to help you stay healthy, see clearly, and save money. Knowing how they work gives you the power to make the best choice for your eyes — and your wallet.
|
Service |
With Vision Plan |
Without Vision Plan |
|
Eye Exam |
Copay: $10–$25 |
$100–$200 |
|
Frames |
Covered up to set allowance ($150, for example) |
$100–$400 |
|
Basic Single-Vision Lenses |
Often fully covered |
$100–$400 |
|
Extras (anti-glare, progressive, thinner lenses) |
Discounted add-ons |
$100–$300+ extra |
|
Total Out-of-Pocket |
Minimal (copay + extras) |
$300–$700+ |
Chart is for illustrative purposes. Costs vary based on provider, location, and specific vision plan benefits. Sources: VSP Vision Care, 2024: https://www.vsp.com/eyewear-wellness/vision-insurance-basics; Versant Health, 2024: https://www.versanthealth.com/blog/how-to-use-vision-benefits/