Routine adult vision care and prescription eyeglasses are not one of the essential benefits required under the Affordable Care act (ACA). The law does require eye care coverage for children (those younger than 19) in all individual and small group policies as preventive care.
Adult vision care
Some health plans offered in the health insurance exchanges may include coverage for eye exams, glasses and contact lenses, but this coverage is not required for a plan to be classified as a Qualifying Health Plan (QHP). Stand-alone vision policies, ones that are not part of a comprehensive health plan, are not offered in the health insurance marketplace.
If you have health insurance through your employer, you may have vision care coverage. Often employers offer vision care in a stand-alone policy. Check your policy documents or ask the director in your company’s Human Resources department about the availability of coverage for eyeglasses and contacts.
If you are insured through the Medicaid program, the odds are you do have coverage for glasses. The coverage varies by state, but most states include eyeglasses in their Medicaid benefits package. Each state has its own limitations. For example, the Connecticut Medicaid program will only cover new glasses every two years. Some states require a small co-payment for glasses.
Pediatric vision care
To be compliant with the ACA, vision care for children must be included in a health plan’s coverages. As a preventive care service, insurers cannot require a co-pay, co-insurance or deductible for pediatric vision care. Grandfathered plans, those in effect prior to implementation of the new law, are not required to offer pediatric vision care, although many do.
Children who are insured by Medicaid or the Children’s Health Insurance Program (CHIP) will have coverage for exams and glasses, although limits vary by state. CHIP is administered by the states in partnership with the federal government, and each state determines its levels of coverage for eyeglasses. Visit the InsureKidsNow.gov website to locate insurance programs for children in your state.
This article was written by Gillian Burdett. Gillian is a freelance writer covering all things home and living. Her work can be found on Examiner.com.