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Health Care Reform:

Health Insurance & Affordable Care Act


Reviewed by Lisa Zamosky

WebMD Feature

How to Choose Vision Insurance

If you wear glasses or contacts, you'll know there's a hefty price tag for keeping your vision clear. The average cost of frames and lenses alone is over $250. But a vision care plan can help make eye care more affordable.

You may get vision care coverage through your employer, or you may purchase it separately on your own.

Vision Care and the Affordable Care Act

Under the Affordable Care Act, insurance Marketplaces, also called Exchanges, were set up in each state. A Marketplace is a web site that lets you enroll in health plans.

The Affordable Care Act considers vision care for children to be an "essential benefit." This means that every plan sold in the Marketplaces must include vision care for children. But health insurance plans for adults that are sold in the Marketplaces do not have to include vision coverage.

What Types of Plans Are Available?

There are two general kinds of vision care coverage: vision benefits plans and discount vision plans.

Vision benefits plans. These are true insurance policies. You pay a monthly fee called a premium. You then get coverage for annual eye exams, frames and lenses, and other eye care needs. You usually have to pay a small fee, called a co-pay, each time you use one of these services.

"It's very important that consumers, of any age, get an annual comprehensive eye exam, and you should always choose a plan that has that as a basic benefit," says Julian Roberts, executive director of the National Association of Vision Plans. "That's not only to detect changes in your actual vision, but because a comprehensive eye exam can detect early signs of other systemic diseases, like diabetes."

Most plans are set up as a PPO. In this type of insurance, there is a network of eye doctors that you are allowed to use. If you go "out of network" for your vision care, you pay a higher percentage of the cost yourself.

"Most plans will give you something of an allowance when it comes to materials," says Roberts. "They may pay up to $175 for frames, for example, and if the frames you want cost more than that, you'll have to pay the additional cost yourself."

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