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Is eye care covered by health insurance?

To sum it up...
  • Some health insurance plans available through the healthcare exchange marketplace include vision coverage as part of your health plan
  • However, most insurance plans do not. You need to purchase separate vision insurance for eye exams and similar services
  • Under the Affordable Care Act regulations, all health insurance marketplace plans must include vision coverage for children under the age of 19
  • Medicare does not typically cover routine eye exams but may cover other eye care services

What is vision coverage?

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Vision coverage helps you pay for routine eye exams, glasses, contacts, and various other eye services. There are some plans on the healthcare exchange marketplace that offer vision care. However, it is not necessary for adults under the Affordable Care Act requirements.

If you know that you are going to need vision coverage, look for it listed in the benefits summary of a marketplace plan before purchasing and enrolling in it.

If you have a marketplace plan that does not offer vision coverage, you can still purchase “stand-alone” vision insurance. However, you can not purchase these plans on the marketplace. You will have to purchase one from a private insurance company.

How does vision coverage work?

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If you choose a marketplace plan that does not include vision coverage, you can purchase it separately from a private broker or company. You will not be able to apply any tax credits or savings to private vision insurance plans. However, you can apply them to your marketplace plan if it includes vision coverage. Most of the Affordable Care Act regulations and requirements do not apply to vision or dental insurance.

Marketplace plans that include vision coverage only require you to pay one monthly premium for both your basic health coverage and vision coverage. However, these plans often have a high deductible that must be met before your insurance company will begin to pay for vision care.

Vision insurance typically covers eye exams, helps pay for the cost of glasses and contacts, and may contribute towards LASIK surgery and similar procedures.

You are not required to have vision insurance and you will not be responsible for paying the individual mandate penalty fine if you do not have it. Some employers may offer vision insurance, in addition to the required health insurance offer for full-time employees.

Does my health insurance plan include vision coverage for children?

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It is a requirement under the Affordable Care Act that all marketplace plans include vision coverage for children under the age of 19. Your medical plan must include this benefit even if you do not have children.

Pediatric vision insurance must cover routine eye exams, the lenses and frames of glasses, and contacts. These are the minimum benefits that the plan must offer, but some plans might cover additional services.

Some of these benefits are not considered preventative services, even for children, so you may need to meet your deductible before your insurance will kick in and assist with the cost of vision services.

Under the Affordable Care Act, preventative services, such as annual wellness visits, are covered before you have met your deductible. Vision screening is the only service that is considered a preventative service and will be covered free of cost without a co-payment for children even before your deductible is met.

Does Medicare include vision coverage?

Medicare Part A does not offer vision coverage because it only functions as hospital insurance. Medicare Part B may cover an annual eye exam for those who are at greater risk for glaucoma or for those who have already been diagnosed with diabetes.

Additionally, Medicare Part B will cover treatment for a limited amount of eye diseases, such as aflibercept and Lucentis. Medicare Part B might also cover ocular photodynamic therapy. You also have the option of purchasing a Medicare Advantage plan that includes vision coverage, as well.

Is eye care covered by health insurance?

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The Affordable Care Act only mandates vision coverage for children under the age of 19. However, some health insurance plans still include vision coverage in their benefits summary. If your health plan does not include vision insurance, you can purchase stand-alone vision coverage.

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