| Scenario | Monthly Premium | Frames Retail | Frame Allowance | Cash Discount | Net Savings |
|---|---|---|---|---|---|
| Basic annual exam + frames | $12.99 | $180 | $150 | 0% | $24 |
| Higher premium, richer allowance | $19.99 | $260 | $200 | 10% | $41 |
| Infrequent use, cash discount wins | $16.50 | $220 | $130 | 20% | -$38 |
Annual Premium (taxed) = (Monthly Premium + Monthly Fees) × 12 × (1 + Tax Rate).
Plan Benefit (allowance items) ≈ min(Retail, Allowance×NetworkFactor) + OverageCoverage% × max(0, Retail − Allowance×NetworkFactor).
You Pay ≈ Copays + (Retail − Benefit) for each selected item, capped by out-of-pocket maximum.
Net Savings = Cash Cost × (1 − Cash Discount) − (Annual Premium + Total You Pay).
- Enter your monthly premium and any extra monthly fees.
- Set copays, allowances, and your typical retail prices.
- Choose planned usage and benefit frequencies in months.
- Adjust network factor if you expect out-of-network care.
- Press Calculate, then export the breakdown if needed.
Annual premium drivers and realistic ranges
Vision-only premiums commonly fall between $8 and $25 per month, depending on network breadth, age rating, and whether hardware discounts are bundled. This calculator converts your monthly premium, fees, and tax rate into a single annual figure so comparisons stay consistent across plans. For example, $14.99 monthly plus $0 fees equals $179.88 per year before tax, while a 5% premium tax lifts it to $188.87.
Allowances versus retail pricing impact
Frame and contact allowances are often the biggest value lever. When retail prices exceed an allowance, the remaining balance becomes your responsibility unless the plan pays an overage percentage. Try a $150 frame allowance against $220 retail: the uncovered amount is $70 before any overage benefit. If overage coverage is 20%, the plan adds $14 and you still pay $56, plus any copay.
Copays and expected out-of-pocket totals
Copays behave like fixed transaction costs. A $25 materials copay can outweigh small allowances if you buy budget frames. The calculator totals copays across the items you select and combines them with any uncovered retail balance to estimate annual out-of-pocket spending. If you select exam, frames, and lenses with $15, $25, and $25 copays, that is $65 in predictable spending even before overages.
Frequency assumptions and usage planning
Benefits usually renew on a schedule, such as exams every 12 months or materials every 24 months. By entering frequencies in months, the model approximates whether you will use each benefit within a year. If you replace glasses less often, plan value typically declines. A materials frequency of 24 months implies about 0.5 uses per year.
Network factor and break-even analysis
Out-of-network reimbursement is frequently lower. The network factor reduces the effective allowance or benefit, showing how reimbursement changes when providers are not contracted. A factor of 0.70 turns a $150 allowance into $105. The output highlights cash cost, plan annual cost, and net savings to help identify your break-even point and decide whether the premium is justified.
Frequently asked questions
1) What does net savings mean here?
Net savings compares your discounted cash cost to your plan’s annual cost, including premiums and expected out-of-pocket payments. Positive values suggest the plan may save money under your assumptions.
2) Why is my net savings negative?
Negative savings means premiums and copays outweigh the benefits you expect to use. This is common when you buy glasses infrequently, have low retail prices, or receive strong cash discounts.
3) How should I set the out-of-network factor?
Use 1.00 if you expect in-network care. Choose a lower value, like 0.70, if reimbursements are typically reduced or if your preferred provider is outside the network.
4) What is overage coverage?
Overage coverage models the percentage of costs above the allowance that the plan still pays. If it is 0%, you pay all costs above the allowance. If it is 20%, the plan pays 20% of that overage.
5) Can I model contacts and glasses together?
Yes. Select contacts and set a contacts frequency while also selecting frames and lenses. If your real plan restricts using both in the same cycle, run separate scenarios to compare outcomes.
6) Is this a guarantee of real costs?
No. Plans vary by carrier and location, and claims rules can be complex. Treat the result as a planning estimate and verify allowances, copays, and network rules in your policy documents.