A Closer Look at Vision Coverage and the Affordable Care Act

Guest post by HealthCare.com

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Comprehensive eye exams are an important part of preventive health care. They help detect, correct and treat vision and eye health problems early on, and they can also reveal symptoms of other health problems and diseases such as hypertension, leukemia and rheumatoid arthritis.

We all know you can buy health insurance from a state exchange, the federal marketplace or from an insurance company. And, in some states, you can even buy dental insurance on the exchange. But what about vision benefits?   Are they covered under the ACA?

Read on below to learn what you need to know about paying for your eye care.

How much do eye exams cost?

The national average usual and customary cost for eye exams and eyewear without vision coverage is as follows:

Eye exam: $152

Single lens: $84

Frames: $194

This does not take into account contact lens fittings, contact lenses, lens upgrades such as UV coating, or other additional testing or services. It all adds up.

How often should I get eye exams?

The American Optometric Association recommends the following eye exam schedule for children and adults:

Recommended Schedule
Children under 18 6 months3 years of agebefore first gradeand every two years thereafter through age 18
Children at risk for developing eye and vision problems should schedule exams more frequently—annually or as recommended.
Adults age 18 to 60 Every two years, or as recommended if at risk for eye and vision problems
Adults age 61 and older Annual exam, or as recommended

Are vision benefits covered under the Affordable Care Act?

Regardless of how important regular visits to the eye doctor may be, the Affordable Care Act does not require anyone to have vision insurance. Not even children, although the health care law does include pediatric services, which includes dental and vision care, among its 10 categories of essential health benefits.

All qualified health insurance plans sold on or away from the exchanges must include pediatric dental and vision benefits unless it is available as standalone coverage—but parents are not required to buy it. The benefits vary based on the benchmark selected by each state and will at least partially cover vision care such as eye exams and glasses.

The ACA includes no such essential health benefits for adults. However, health insurance may include some benefits for medically necessary eye care.

Where can adults buy vision coverage?

Consumers may purchase vision insurance in the private marketplace from agents and brokers and also online through carrier-specific websites and websites that offer plans from a variety of companies.

Some state health insurance exchanges offer standalone vision insurance plans for adults. As with dental insurance, financial subsidies may not be used to help deflect the cost of monthly vision coverage premiums.

What is the difference between a vision insurance plan and vision discount card?

Discount card and discount insurance plan benefits will vary from card to card and plan to plan. When determining which is best for you, consider all of the associated costs and benefits as well as your typical vision care costs in a typical year. Because benefits and restrictions will be different from product to product, be sure to read the fine print when comparison shopping.

When you shop for vision benefits you will come across vision insurance plans and vision discount cards. You may want to compare them to determine which makes the most sense for you and your family members. Here are some key ways to distinguish the two:

Vision Insurance Plan Vision Discount Cards
How to enroll Fill out an application with your name, contact information and payment. Sign up or automatically gain access through another membership or insurance product.
Where to enroll Through a health insurance agent or broker, a specific carrier website, or a multi-carrier health insurance website Through a health insurance agent or broker, a discount plan provider, or a multi-carrier health insurance website; vision discounts may also be bundled in with other supplemental insurance products such as a dental plan or with association memberships such as AARP.
Cost Pay a monthly or annual premium for benefits; eHealth advertises plans starting as low as $12.50 per month. Vision insurance may be bundled with other major medical and supplemental insurance coverage. Vision discount cards may be free or require an annual membership fee—often less than $10.
Benefits Plan benefits will help reduce the cost of frames, prescription lenses, and eye care services. They often include contact lens allowances, frames allowance and a copay for lenses. You will also pay a small copay, typically as little as $10 to $15, for a vision exam. Your vision plan may also provide discounts for Lasik. At the time of service you will pay any required copays or amounts in excess of your benefits—for instance, upgrade fees for lens coatings. Discount members may receive a percentage off the usual and customary fee for services such as eye exams and a percentage off eyewear including frames, lenses and contact lenses, or the discount may be a set dollar amount in each category.
Restrictions Benefits may vary depending on whether or not you visit a network provider. Plans typically provide access to deeper discounts when you see a network provider but allow you the freedom to choose your own non-network provider as well. Network providers may include retail eye care locations as well as independent eye care providers. Only participating providers will honor discounts.