The Affordable Care Act makes vision and dental care available to more children. The law requires that insurance companies offer these benefits for children in all new health plans offered in the Marketplace, in the individual market, and through employers with 50 or fewer employees.
But plans that have grandfathered status -- those that were in place before the Affordable Care Act became law on March 23, 2010, and have not substantially changed -- don't have to offer this type of coverage. Also, the law doesn't require that large companies -- those with more than 50 employees -- offer dental and vision services for children, though the majority already do.
Your children may also get care for their eyes and teeth through two programs for people with low incomes: Medicaid and the Children's Health Insurance Program (CHIP). You have to qualify for those programs, based on your income, for your children to be covered.
Vision Benefits for Kids
Children up to age 19 can get a free eye exam every year under the Affordable Care Act.
If your child has a vision problem, your insurance might help with treatment, though the benefits vary depending on your health plan. Where you live matters, too. In some states, you may have to pay some or all of the cost of your child's glasses or contacts. Check your health plan's summary of benefits carefully to be sure.
If you qualify, programs like Medicaid and CHIP -- for families with low incomes -- usually cover the cost of glasses or contacts to correct vision problems.
Dental Benefits for Kids
Under the Affordable Care Act, dental health coverage for kids up through age 19 is an essential health benefit. If you buy a policy from your state's health insurance Marketplace, dental coverage for your kids must be included or at least available.
You can get dental coverage for your kids in two different ways.
- You might get it through your general health plan.
- Or, in some cases, you might have to buy a separate stand-alone dental plan.
What will your child's dental plan cover? That varies from state to state. But many plans will cover things like:
- A dental exam every 6 months
- Cleanings, fluoride treatments, and X-rays
The benefits in your state and specific plan may be different. Also, your plan may require you to visit an in-network dentist to get these benefits. Make sure you understand what dental care is covered -- and what isn't -- before you buy a plan.
If you qualify, your child may also get dental coverage through programs like Medicaid and CHIP. The kinds of care also vary by state, but in general, they must include services to:
- Keep your child's teeth healthy
- Relieve pain or infection
- Restore teeth