Are vision plans ACA-compliant?

No, vision plans are not qualified health plans under the terms of the ACA.

However, the Affordable Care Act (ACA) lists vision coverage as an essential health benefit for children under age 19.[1] Vision screening is considered preventive care, which means that it is covered under ACA plans at no charge for your child.[2]

The specific vision coverage benefits provided for your child depends on where you live and the plan you purchase. Some states’ “benchmark” ACA plans include pediatric vision benefits, while in other states, vision coverage for children is provided by the Federal Employee Dental and Vision Insurance Plan (FEDVIP) or the state’s Children’s Health Insurance Program.[3]

This means that your child may be covered for eye exams or corrective lenses, either at no charge or with these benefits subject to copays, coinsurance, or deductibles.[4] Be sure to check your plan for specific details.

The ACA does not consider vision coverage to be an essential health benefit for adults age 18 and over, so plans are not required to include vision coverage for adults.[5] If your plan does not include vision coverage, a stand-alone vision insurance plan may meet your needs.

Learn more about ACA vision coverage.

Footnotes