Adults without employer-sponsored vision coverage are twice as likely to forgo an eye exam entirely because of cost, according to Keeping Vision Care Within Reach survey released by the Alliance for Affordable Vision Care (AAVC). Among those without coverage who had an unmet vision need but did not seek care, 84% cited cost as the main reason or a contributing factor. That pattern mirrors what is happening across employer health benefits more broadly.
The survey, conducted online between July and August 2026 among 4,027 employed adults aged 21 to 64 enrolled in employer-sponsored insurance, also drew responses from 201 benefits decision-makers at small and mid-size employers, a relatively small sample that was not statistically weighted. The AAVC is a national coalition whose funders include VSP Vision, a commercial interest worth keeping in mind when reading its conclusions. Even with that caveat, the access-cost relationship the survey documents is consistent with patterns visible across the employer benefits market.
A separate Commonwealth Fund survey, published this month, found that nearly one in three employer-insured workers cannot afford the care their plan is supposed to cover, and that cost-driven care avoidance has increased even among workers who remained insured all year. Vision benefits operate in the same dynamic at a smaller scale: when affordability breaks down, utilization follows.
Among workers with vision coverage, satisfaction is high. Eighty-two percent of covered adults said their plan meets their needs, and 77% said it protects them from full out-of-pocket costs. On the employer side, 90% of benefits decision-makers reported being satisfied with the value vision benefits deliver to employees, and 74% rated them a good or excellent value relative to cost.
The numbers are more revealing about what breaks when coverage disappears than they are as a case for coverage itself. The 2x utilization gap between covered and uncovered workers is the more consequential number. Employees without vision coverage are not simply going without corrective lenses. They are also skipping the annual eye exam itself, which has established value as a chronic disease detection tool.
The American Optometric Association (AOA) notes that a comprehensive eye exam can surface early indicators of conditions including diabetes, hypertension, and high cholesterol. Eighty percent of respondents to the AAVC survey said regular eye exams are important to maintaining overall health, and 67% knew that exams can flag signs of chronic conditions.
Chronic conditions caught late are more expensive to treat. If an employee does not have vision coverage and skips the exam, an early warning goes with it. Employer health benefit costs are projected to rise 8.2% in 2027, the largest increase since 2003, according to Mercer’s 2026 National Survey of Employer-Sponsored Health Plans. That backdrop makes the cost case for vision as a preventive touchpoint harder to dismiss.
The survey also captures a policy concern gaining traction in statehouses. Sixty percent of covered adults expressed worry that policy changes could raise their out-of-pocket costs or narrow their provider choices. Among employers, 56% shared concerns about legislative changes that could increase what they pay for vision benefits.
Illinois enacted new regulations on vision benefit managers in August 2026, becoming the second state that year to add accountability requirements on how vision benefit plans are structured and administered, according to AOA. Louisiana became the first state in 2026 to enact VBM reform legislation, passing SB 404 in May. Illinois followed in August, becoming the second. South Carolina has also introduced legislation targeting vision plan transparency and provider protections.
The legislative activity reflects a broader push by optometry groups to limit what they describe as practices by vision benefit managers that undermine provider choice and patient access. Those are the same affordability and access concerns the AAVC survey’s respondents flagged.
Seventy-four percent of consumers and 83% of employers in the survey said elected officials should prioritize keeping vision care affordable for working families. That sentiment has not yet translated into consistent legislative outcomes, but it points to a benefits environment where vision plan design could face more external constraints than it has historically.
