Maria gets new glasses: how the vision math works

Available under 65 and 65+

Maria, 66 · deductible already met this year

Maria gets her yearly eye exam ($150) and picks out new glasses ($400). Vision pays 80%, but each item has a cap. She uses the eye doctor she’s seen for years, since there’s no network.

Total bills$550

Policy pays$400

Maria pays$150

What happened

VisitEye exam: $150

Same dayPicks out glasses: $400

AfterPolicy pays 80% of each, up to the cap.

Follow the money

Paid by the policyPaid by the person (or not covered by this policy)Step in the math

Eye exam: $150

80% of the examFigure 80%

$150 × 80% = $120

$120

Capped at $100Policy pays

The exam benefit tops out at $100

$100

Maria pays the restYour share

$150 − $100

$50

Policy pays on the exam$100

Glasses: $400

80% of the glassesFigure 80%

$400 × 80% = $320

$320

Capped at $300Policy pays

Lenses and frames top out at $300 every 24 months

$300

Maria pays the restYour share

$400 − $300

$100

Policy pays on glasses$300

Who paid Maria’s $550

$400

$150

$400 Paid by the policy ($100 exam + $300 glasses)

$150 Paid by Maria ($50 + $100)

The takeaway

The percentage tells you the starting point; the cap tells you the most the policy will pay for that item. Picking frames near the cap is the easiest way to keep your share low.

These are illustrative examples with made-up names. Dollar amounts come from one sample plan design and are shown only to explain how the benefits work. Your actual benefits depend on the plan and options you choose, your state, and the terms, limitations, exclusions and waiting periods in your policy.

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More real-life examples

James, 69: two cleanings and a crownDental & vision: see the math Linda, 62: 4 days in the hospitalHospital indemnity: see the math Carol, 59: overnight observationHospital indemnity: see the math Dorothy, 77: 6 weeks recovering at homeHome health care: see the math

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This page is educational and is not an offer of coverage or a recommendation of any specific policy. The policies described are individually underwritten supplemental (indemnity) insurance. They are not major medical coverage, not Medicare Supplement insurance, not long-term care insurance, and not “minimum essential coverage” under the Affordable Care Act. Benefits, benefit amounts, riders, availability and eligibility vary by state and are subject to the terms, limitations, exclusions, waiting periods and pre-existing condition provisions of the actual policy and its outline of coverage. Senior Benefits Hub is an independent insurance agency; licensed since 2013. Not affiliated with or endorsed by any government agency.