Medical Insurance for Vision
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UPDATED: Mar 19, 2020
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- Vision coverage is not required for adults under the Affordable Care Act
- It is considered an essential health benefit for children
- Some plans on the Health Insurance Marketplace will include dental, but most do not
- You can purchase stand-alone vision plans from private health insurance companies such as Aetna or United Healthcare
- Stand-alone vision plans are not available for purchase on the Healthcare Exchange
- You will not be able to apply tax credits to these stand-alone vision plans
Vision insurance provides coverage for medical needs related to your eye care, such as routine exams, frames, and lenses. Some vision insurance plans may also provide discounts on refractive surgeries such as LASIK and PRK.
The three most common types of vision coverage include Preferred Provider Organization (PPO) plans, Health Maintenance Organization (HMO) plans, and indemnity health insurance. With an HMO plan, you will get discounted services at providers within your network. However, if you see a provider outside your network, the visit will not be covered at all.
A PPO plan works in a similar way to an HMO plan, but you have the option of seeing a provider outside of your network for a higher rate.
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Can I purchase vision insurance on the Healthcare Exchange Marketplace?
You cannot purchase a stand-alone vision plan on the Healthcare Exchange Marketplace. However, some plans have vision coverage included in the plan for both children and adults. If you find a marketplace plan with vision coverage, you are able to apply any tax credits you are eligible for to the monthly premium.
You can also use other cost sharing savings that are available to you to help pay for the plan. You are not able to apply tax credits to any stand-alone vision plan that you buy.
Many of the benefits and protections outlined in the Affordable Care Act do not apply to vision and dental coverage. There are typically maximum dollar limits affiliated with vision coverage. This means that once you have spent a certain amount, your vision insurance will not cover any more services at all. In some cases, only routine care might be covered by your vision insurance.
In some cases, only routine care might be covered by your vision insurance.
When you are purchasing a plan that includes vision through the Healthcare Exchange Marketplace, you will only be responsible for paying one premium. However, you may have to meet a deductible before any vision care services will be covered.
It is important to be aware of all aspects of your vision coverage including deductible, premium, and copay amount before purchasing a new plan.
You should also be aware of the services and benefits that are covered by your plan. Do not purchase a plan solely because it includes vision coverage without knowing all of the facts.
If you wish to cancel your stand-alone vision plan, you can typically do so by not paying your monthly premium. However, if you have a Marketplace plan that includes vision coverage, you typically will have to wait until open enrollment to enroll in a new plan because you cannot drop your vision coverage without canceling the entire plan.
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Is vision coverage required for my children? What are the essential health benefits under the Affordable Care Act?
Under the Affordable Care Act regulations, vision coverage is required for children who are younger than 19. Pediatric vision care is considered one of the 10 essential health benefits.
Vision coverage for children must include an annual eye exam, contacts, and lenses and frames for glasses. You may have to meet a deductible on your plan before it will begin to cover vision services even for children.
Marketplace plans must offer pediatric vision coverage for everyone, even if you do not have children. If you do have children and a stand-alone vision plan, your Marketplace health insurance must still offer pediatric vision care for your children.
Can I purchase a medical vision plan from a private insurance company?
You cannot purchase a standalone vision plan from the Health Insurance Marketplace, but you can buy vision plans from private insurance companies such as Aetna and United Healthcare. Some insurance companies, such as Aetna, will not allow you to purchase a stand alone vision plan, but they will let you enroll in a vision discount program.
You can also purchase an Aetna medical plan that includes vision coverage or enroll in one through your employer. United Healthcare and other insurance companies do offer stand-alone vision insurance.
Medical Insurance for Vision
You can purchase a medical plan that includes vision coverage through the Healthcare Exchange Marketplace or through a private insurance company.
Some private insurance companies also offer stand alone vision coverage, but the Healthcare Marketplace does not. Pediatric vision care is required by all Marketplace plans under the Affordable Care Act regulations because it is considered an essential health benefit.
Pediatric vision care is required by all Marketplace plans under the Affordable Care Act regulations because it is considered an essential health benefit.
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