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Affordable health dental and vision insurance

Affordable Care Act Vision Coverage

Vision insurance generally isn’t covered under the Affordable Care Act (ObamaCare). However, pediatric eye care is a required benefit included on all plans that qualify as minimum essential coverage under the ACA.

Even though adult vision coverage isn’t a required benefit of ObamaCare, “vision health” is still an important aspect of wellness. On this page we will discuss what vision insurance is, how you can get an eye care plan, and how the new healthcare law affects vision coverage.

Vision coverage is a health benefit that at least partially covers vision care, like eye exams and glasses. All kids under 19 in individual, family, and small group markets must be offered vision benefits.

If vision benefits are part of the plan, you can use cost assistance. If vision benefits are part of a stand-alone plan, you cannot use cost assistance. This is true for kids and adults.

Vision Coverage: How it Works with the ACA

Here is a quick summary of what you need to know vision insurance under the Affordable Care Act:

  • Vision coverage is a required for children as an Essential Health Benefit (EHB). All Qualified Health Plans must cover basic eye care services for children 18 or younger.
  • The pediatric vision services covered as an EHB include annual examinations, glasses (both lenses and frames), and contact lenses instead of glasses.
  • Marketplace health plans do not have to offer vision care to adults.
  • Adults can purchase vision coverage either as a part of their marketplace insurance or as a stand-alone vision plan.
  • Stand-alone vision plans are not available directly from the federal or state marketplaces and must be bought from a private health insurance provider.
  • You can only apply tax credits to vision coverage if that coverage is part of a Marketplace plan.
  • You cannot apply tax credits to stand-alone vision plans.
  • Most of the ACA’s benefits, rights, and protections (like new cost sharing requirements) don’t apply to dental and vision coverage.
  • Your marketplace health insurance must cover pediatric essential vision benefits even if you do not have children.
  • Your health insurance policy must cover the pediatric vision EHB, even if you have separate stand-alone vision coverage.
  • No one has to take vision (or dental) for kids if it’s offered as a standalone plan. It has to be offered, but you don’t have to take it. If it’s part of a plan, and that plan is offered to children, then there is no way to remove it from the plan.

Vision insurance is a type of coverage that entitles you to certain eye care benefits. Typical benefits include

  • routine eye exams
  • discounts for the purchase of eyeglasses and contact lenses
  • discounts on refractive surgery (such as LASIK and PRK)

Indemnity Health Insurance is a traditional insurance plan which allows policyholders to choose which medical providers they access.

Health Maintenance Organization (HMO) is a network of healthcare providers which provide policyholders with discounted rates. However, policyholders’ access to care is restricted to the providers within the HMO.

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