Complete Guide to Vision Insurance Coverage for Prosthetic Eyes: Get the Best Benefits for Optical Care

Vision insurance is an essential part of maintaining the overall health of our eyes. It covers all types of vision care products and services, including glasses, contact lenses, and even prosthetic eyes. However, prosthetic eyes often get overlooked when it comes to insurance coverage.

If you wear an artificial eye or prosthetic eye, it’s important to know that you may be entitled to some form of coverage. It is crucial to understand what falls under vision insurance coverage for prosthetic eyes or ocular prostheses. Read on to learn more about it.

The Basics of Vision Insurance Coverage for Prosthetic Eyes

Prosthetic eyes or ocular prostheses are artificially made eyes that replace a natural eye removed due to an injury or illness. The costs related to fitting, fabricating, and maintaining a prosthetic eye can be substantial. That’s why acquiring coverage through a vision insurance plan can be invaluable.

Depending on the type of vision insurance plan you have, coverage for prosthetic eyes can vary. Most vision plans will cover the fitting and follow-up care for the ocular prosthesis. The replacement of the artificial eye and any necessary modifications may or may not be covered, depending on your plan.

Types of Vision Insurance Plans

Before going into the coverage details, it’s essential to understand the different types of vision insurance plans. There are three types of vision insurance plans:

  • Indemnity Vision Insurance Plan: This type of vision insurance plan allows you to see any eye specialist of your choosing; the plan will then cover the cost of the services based on the plan’s reimbursement levels.
  • Vision Discount Plan: This plan provides you with a discount on eye care services, including eye exams and eyewear, at specific provider locations that participate in the plan.
  • Managed Vision Care Plan: This plan limits you to a network of eye care providers who have agreed to provide their services at a reduced rate. In some cases, the plan may require a copay for services.

Coverage for Prosthetic Eyes

Fitting and Fabrication Costs

The fitting and fabrication of a prosthetic eye are usually covered under most vision insurance plans. The process of fitting a prosthetic eye is a meticulous and time-consuming process that involves taking measurements of the socket and creating a mold of the eye.

The fabrication process can take up to several weeks to complete, and the prosthetic eye must be checked over several follow-up appointments to ensure proper fit and comfort. During this time, any modifications required, like adjustments to the color, are also made.

Replacement of the Prosthetic Eye

The replacement of a prosthetic eye may or may not be included in your vision insurance plan. Some plans may cover replacements that are needed due to damage or wear and tear. Others may require a specified period between replacements or may not cover them at all. It’s essential to review your insurance plan to determine what it covers and what you’ll be required to pay out of pocket.


Vision insurance coverage for prosthetic eyes is essential for those who have been fitted with an ocular prosthesis. It’s crucial to review your vision insurance plan and understand what it covers and what it doesn’t. If you’re in the process of getting a prosthetic eye, it’s recommended to speak to your insurance provider in advance to determine the coverage you’re entitled to.

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