ACA, Or Obamacare, Vision Insurance For Kids Under 19
Under the ACA, or Obamacare, pediatric vision care is included as an essential health benefit. This includes eye exams and contact lenses.
However, adult vision coverage is not mandated by the ACA. Health insurance providers are free to offer vision coverage, and some do.
Many marketplace plans include vision coverage, and these policies can be purchased with market tax credits.
Pediatric Vision Care
Pediatric vision care is now included as an essential health benefit in all new individual and small group plans offered through the ACA’s Health Insurance Marketplace (also known as exchanges). Kids under 19 will get coverage for annual eye exams, screenings, and glasses or contact lenses. In addition to traditional insurance options, there are also plans such as Preferred Provider Organizations that offer access to healthcare providers at fixed rates below retail prices.
Although vision coverage isn’t required under the ACA, lack of insurance could lead to hefty fees. If you are unsure whether your Obamacare plan offers vision coverage, check its details carefully or invest in a stand-alone vision plan. However, these can be quite expensive and may not save you much money in the long run. If you are interested in buying a standalone vision plan, you can compare the best vision insurance plans online. You can also ask your current healthcare provider to recommend a provider that fits your needs.
Adult Vision Care
While routine vision care is not mandated for adults through the ACA, many health plans offer it as an optional benefit. This includes marketplace plans and the Children’s Health Insurance Plan (CHIP) that offers free or low-cost coverage for kids based on income.
Adult vision care is often offered as a value-added feature of indemnity health insurance or preferred provider organization (PPO) plans that contract with managed vision care networks to offer discounted rates for services. PPOs generally do not require patients to have a primary care physician and allow them to access services outside of the network, though these costs would be subject to the health plan’s deductible.
To control for potential state-level factors that influence both coverage policies and outcomes, we use a within-state control group to compare changes in access to eye care among low income adults. This strategy limits the possibility of falsely attributing changes in access to Medicaid vision benefits to concurrent changes in other state resources.
Indemnity Health Insurance
Regular eye exams can help detect health problems, including diabetes, at an early stage. That’s why many people consider getting a stand-alone vision insurance policy or adding a vision benefits package to their major medical insurance plan.
Most major medical insurance plans include vision care, especially when it comes to prescription glasses and contacts. However, if you’re looking for comprehensive eye care, consider an indemnity plan that covers both routine and serious procedures.
These plans pay a fixed amount on a per-period or per-incident basis, regardless of the actual charges. They are considered to be “excepted benefit coverage” under the ACA and do not count toward your annual out-of-pocket limit.
The ACA requires most kids to be offered vision care through their marketplace or exchange plans. The law also requires all Qualified Health Plans to offer basic vision care for kids and teens, and vision benefits are generally covered under most CHIP plans for kids.
Preferred Provider Organization
Most obamacare plans offer a Preferred Provider Organization, or PPO, that provides access to a large network of providers. These networks include doctors, hospitals and other healthcare facilities. The network may also cover the cost of certain types of eyeglasses and contacts. However, if you want to access a provider outside of the network, you will have to pay more for your care. You will also likely have to meet a separate out-of-pocket maximum for out-of-network services.
You can also buy a stand-alone vision insurance plan that is not part of your obamacare health care plan. These plans typically require a yearly or monthly premium, but they provide specific benefits and discounts for vision care. They can help reduce your costs for routine eye exams, prescription eyewear and elective eye surgeries like LASIK. They are often based on the model of a health maintenance organization or an HMO, but they do not restrict your choice of medical practitioners to those within the network.