Do Obamacare Plans Cover Eye Exams?

Jenifer Dorsey
July 19th, 2019 April 25th, 2017 |
Read time: 9 minutes

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4 Healthcare Costs You May Pay Out of Pocket, Even With Major Medical Insurance

Under the Affordable Care Act (ACA), there are many things all major medical health insurance plans must cover: preventive services, maternity care, emergency services and prescription drugs, to name a few.1 But what about other healthcare expenses such as adult dental checkups or doctor office visit when your allergies flare up on vacation?

Listed below are four expenses your health plan may not cover and what related health benefits may help you save money.

1. Adult dental and vision services

The ACA may list pediatric services, including oral and vision care, among its 10 essential health benefits; however, adult dental and vision benefits are not included.

While Obamacare plans may provide benefits for medically necessary dental work (e.g., non-cosmetic dental work related to an accident), most do not cover common dental services such as cleanings and fillings. If you are unsure what, if any dental benefits your health plan includes, check your policy for details and call your insurer with questions.

A plan that may help: Dental insurance plans offer a range of benefits to help with the cost of oral care. Depending on the plan you select, these benefits may include preventive services such as cleanings and exams as well as basic and major care such as fillings and root canals.

Some dental plans may include vision benefits. Otherwise, you may purchase a separate vision plan.

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2. Health insurance deductibles

Your health insurance deductible is the annual dollar amount an insured person or persons must pay out of pocket for healthcare services before the health plan’s benefits fully take effect.2 Depending on the major medical plan you selected (e.g., bronze, silver, gold), and whether or not it is an individual or a family plan, this amount could be thousands of dollars.

A plan that may help: Supplemental plans, which are sometimes known as gap plans, pay a lump-sum benefit when a covered injury or illness occurs. These payments can be used in whatever way you choose: to pay your Obamacare deductible, transportation to and from your appointments, groceries, bills, childcare and more.

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3. Non-emergency out-of-network healthcare

If you’re traveling and come down with a sinus infection or a case of pink eye, you may need out-of-network healthcare that isn’t necessarily an emergency. Depending on your health plan, that care may or may not be covered—and if it is, it may be at a lower percentage than in-network care.

A plan that may help: Telemedicine, which is also referred to as telehealth, allows you to receive healthcare almost anywhere. The Telemedicine plan sold through connects you with licensed physicians by phone, and those physicians can treat common, non-emergency conditions and may even prescribe medications when medically necessary. These consultations typically cost a fraction of an office visit and are available 365 days a year, 24 hours a day.

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4. Household living expenses

When you experience a serious medical condition such as a heart attack or stroke, it can take a while to heal—and sometimes that means time away from work. Your health insurance may help with the medical bills, but how will you pay for life’s other expenses?

A plan that may help: Critical illness coverage pays a lump-sum benefit upon diagnosis of certain critical illnesses, which are listed in the policy. Depending on your plan benefits, covered critical health events may include heart attack, stroke, cancer, coma, paralysis or severe burn. Much like supplemental plans, a critical illness plan benefit may be used in whatever way you prefer: your child’s tuition, experimental treatment, medical bills, groceries, rent or mortgage payments and more.

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Originally Published On April 25th, 2017
Independence American Insurance Company, Madison National Life Insurance Company, Inc. and/or Standard Security Life Insurance Company of New York may underwrite the products referenced on this website. Legal Disclaimers.