A Basic Explanation
Basic vision coverage for children is an essential health benefit and must be included in all qualified plans. However, that’s not the case for adults. Some marketplace plans do include vision coverage, but they don’t have to; more often, it’s sold separately from medical insurance. These stand-alone vision plans should cover at least part of your basic eye-care needs, like annual eye exams and glasses. Depending on the plan, it might cover more.
Expert Advice About Vision
1. Vision coverage typically helps pay for routine checkups and eyewear. With most plans you’ll get a free or low-cost annual exam to check eyesight and detect conditions such as glaucoma or cataracts. You also may be entitled to discounts on prescription eyewear, frames, and prescription lenses. Under many plans, contact lenses are also covered, either annually or sometimes twice a year. Benefits vary from plan to plan, so be sure to review the summary of coverage carefully.
2. Vision plans have networks just like medical insurance, and they usually work the same way. Your vision plan will likely have a network of providers, including optometrists and ophthalmologists, as well as covered services. Some plans may cover specialized services like refractive surgery, LASIK, and other vision-correction procedures. As with a medical plan, using an in-network provider will save you money. And as with medical insurance, some plans require you to meet a deductible — a fixed dollar amount you must pay your eye-care provider out-of-pocket — before your benefits take effect.
3. You can buy vision coverage anytime during the year, not just during open enrollment. That’s the good news. The not-so-good news: Because vision coverage doesn’t have to be included in qualified health plans, nor is it an essential health benefit for adults (though it is for kids), you can’t use tax credits to help offset the cost of a plan.
Stand-alone vision coverage isn’t available on healthcare.gov, but it is offered on some state-run exchanges.
What else you need to know
You won’t pay a penalty for not having vision insurance. Because vision (and dental) coverage can be sold as stand-alone policies, they don’t fall under most ACA provisions. Therefore, you won’t have to pay a penalty if you choose not to buy eye-care coverage. However, if you’re on the fence about buying a plan, and you have children, here’s an inducement: Many policies will cover your kids until they turn 26.
While your regular medical insurance should cover any major eye injury or disease, vision coverage offsets the potentially high costs of routine eye examinations and prescription eyewear. Even if your eyesight is perfect right now, getting regular eye exams will help keep it that way.
