Affordable Care Act

How Does Vision Insurance Fit Within the Affordable Care Act?


When juggling bills for living expenses, incidentals and medical insurance, many Americans may wonder whether they can justify purchasing vision insurance. Given the increase in the number of people with vision loss not correctable by glasses, concerns about eye diseases and the importance of good vision for performing well in school, people should ask whether they can afford not to have vision insurance.

Under the Affordable Care Act, Americans will be required to have health insurance or pay a penalty. Insurers are required to offer Essential Health Benefit Packages (EHBPs), which include vision coverage for children under age 19. Some medical insurance plans in the public exchange marketplace may list vision coverage, but it’s probably only for pediatric members, and may include only a set amount for vision exam costs. Adults will need to purchase their own vision plan, and may want to consider purchasing additional vision coverage for their dependent family members for expenses not covered, such as prescription eyeglasses.

Consider the following truths about vision coverage within the ACA:

  • Adult vision plans in the public exchanges may not be less expensive than those offered by stand-alone vision insurance companies, such as plans offered by Ameritas
  • Vision insurance combined within a medical plan may have prerequisites for coverage, including meeting the plan deductible before vision expenses will be paid
  • Employers purchasing vision coverage within a public exchange cannot customize the plans to fit employee group needs
  • Tax credits available in the ACA may not be large enough to cover separate vision plans
  • Individuals purchasing insurance through the public exchange may need to change eye doctors if their current provider is not listed in the plan network
  • Parents and children likely will have different vision plans and insurance cards, eye doctors and covered benefits, making it difficult to monitor and control costs
  • Parents are not required to purchase any health or vision coverage in the public marketplace; plans may be purchased as stand-alone through an employer or individual coverage

To learn more about vision insurance within the ACA, visit our Affordable Care Act section.

For more information on scheduling regular eye exams or understanding your vision coverage, read these ameritasinsight blogs:

Understanding Pediatric Essential Benefits

Save Your Vision, Schedule an Eye Exam

Evaluating Vision Plans