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CalOptima Vision Insurance: Plans, Coverage & Costs

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At this time, CalOptima offers basic vision insurance, providing rudimentary coverage with their plans that are generally aimed more at broader health coverage. These plans provide no LASIK or refractive surgery coverage, but they will cover routine eye exams and eyewear.

Vision Insurance Plans Offered

CalOptima Health doesn’t offer much in the way of extensive vision plans, although the four major programs they offer do have at least some health coverage. These programs are as follows:

None of these plans are vision-centric, instead being health insurance plans that also provide some vision benefits. However, it’s worth understanding these vision benefits, especially if you are on Medicare or Medicaid. 

What Does It Cover?

In terms of vision coverage, the plans mentioned above all cover routine eye exams and eyeglasses or contact lenses. CalOptima’s PACE plan also mentions coverage of corrective lenses after cataract surgery. 

In order to make use of this coverage, you will generally have to find an in-network provider. CalOptima Health has a tab on their website labeled “Find a Provider” that allows you to quickly find the providers relevant to your plan. 

LASIK & Refractive Surgery Coverage

Unfortunately, CalOptima’s plans don’t seem to offer any sort of LASIK or refractive surgery coverage. This means you can expect to pay the full cost of these types of procedures. 

According to Forbes, the average cost of LASIK in the United States was $2,632 per eye in 2022, generally ranging between $1,000 and $4,000. Particularly low quotes, such as for $250 an eye, are generally a marketing gimmick meant to get people to ask for more information, with those low costs only generally associated with very small corrections.

Costs

Every insurance plan comes with an explanation of benefits, also called a summary of benefits. This document is important to understanding what your plan will and will not cover and the costs you can expect to pay for vision-related expenses. 

The coverage provided by most of CalOptima’s plans seems to be fairly standard. As long as you use in-network providers, you can get a yearly eye exam for free as well as any eye exam considered medically necessary to diagnose and treat eye conditions.

Glasses and contact lenses are covered once every two years. For eyeglasses, this includes basic lenses and frames. It seems their plans generally pay up for glasses or contact lens costs up to $300 per two years, which should be enough to cover most people’s eyewear costs unless you decide you want high-end frames or extra features on your lenses. 

Eligibility for Coverage

CalOptima offers a variety of tools to help verify member eligibility. Some of these resources are only for Medi-Cal membership eligibility, but others, such as their CalOptima Interactive Voice Response (IVR), don’t specify you need to be checking a particular plan for eligibility. 

The plans discussed in this article are largely aimed at low-income individuals, usually needing applicants to qualify for Medicare. 

References

  1. Welcome to CalOptima. CalOptima Health.
  2. OneCare (HMO D-SNP). CalOptima Health.
  3. Medi-Cal. CalOptima Health.
  4. OneCare Connect. CalOptima Health.
  5. PACE. CalOptima Health.
  6. How Much Does LASIK Cost? (August 2022). Forbes.
  7. How to Verify Eligibility. CalOptima Health.

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