What is the Difference: Full-Service or Exam Plus?
Understanding these vision benefits options for health plans
As a trusted advisor to our health plan partners, our team of benefits experts at VSP® is often asked questions about delivering value and improving outcomes. One question we hear often is, "What is the difference between a full-service vision plan and one that is exam plus allowance." So, let's jump right in and discuss the differences between the two.
Health plans have many different options when considering vision care for their members. A wide range of variables can affect your decision, but the options typically come down to two main programs: exam plus allowance and full-service.
Exam plus allowance plans have been the most common vision plan option in the health plan market; providing members access to exams and materials with a set allowance amount toward materials. With the overall increase of healthcare costs, vision care has been no exception. For example, the average pair of prescription eyeglasses runs about $2031. The national average cost for a vision exam is approximately $952. With a typical exam plus allowance plan, the allowance is quickly exhausted and members may experience increased out-of-pocket costs.
There are a growing number of members who expect more from their vision benefits than the exam plus option provides. For example, as more people work later in life, they do not want to lose certain familiarities of the benefits they've had once they age into Medicare. They’re used to a higher level of benefits from their employers and may be dissatisfied with a change to their benefit structure. A certain level of vision benefits is expected, and many may not be satisfied by the exam plus allowance option.
So, what are the differences and how can this help your strategy in designing your Medicare plan?
Exam Plus Allowance vs Full-Service Defined
On an exam plus allowance plan, the designated allowance is used toward all materials (lenses, frames, and any lens enhancements) with a discount applied for being a VSP member. This puts members up against usual and customary fees. This means that their allowance is, most often, entirely consumed and there will be additional out-of-pocket expenses.
A full-service model is a comprehensive vision plan where basic lenses (single vision, bifocal, trifocal) are covered in full (minus any applicable copay), and the allowance is designated for frames and/or contact lenses. Cost of services are also held at a contracted rate, which is typically lower than usual and customary fees, so members have additional savings when upgrading their lenses – typically having a lower out of pocket experience.
Maintaining a positive member experience is increasingly important amongst Medicare Advantage plans. Implementing a full-service option in your vision benefits can go a long way in member satisfaction ratings.
When deciding between offering an exam plus allowance or full-service plan, consider reaching out to a VSP Sales Executive to review market and geographic trends in your market.
1 The Vision Council Consumer inSights Q4, 2023
2 “How much do eye exams cost,” eHealthinsurance.com, January 11, 2024