Do you have vision insurance? Not covered on ACA plan

[disneysteve]

Our health insurance has always included vision care. I just signed up for an ACA plan and was surprised to find that vision isn't included. What do you all do for vision coverage or do you just pay out of pocket?

 

[Midpack]

We both wear prescription glasses, and we pay out of pocket for vision. If you wear prescription glasses, it doesn't seem likely a vision plan alone would pay off for the buyer. People who don't wear glasses don't buy insurance, so you're in the pool with others who also wear glasses, have exams, etc. just like everyone else. And the premiums would have to be for basic frames and lenses to be at all competitive, so you're going to pay out of pocket for anything more.

Generally insurance is useful when expenses are high, and risk is more random. True for medical, auto and homeowner expenses, much less so for vision or dental for that matter?

 

[MichaelB]

Eye disease is covered, including most ophthalmologist services. Eyeglasses and optometrist services are not covered. I’ve always paid out of pocket.

My mum has a MA plan that does cover eyeglasses and optometrists. It’s like a dental plan, with payout limits and moderately small networks, but it’s better than nothing.

 

[audreyh1]

No. That is easily paid out of pocket.

 

[GenXguy]

I was surprised my ACA coverage does say it includes an eye exam because I wasn't expecting any. But, it doesn't cover glasses, lens, or contacts.

Dental on the other hand, is not included in my plan.

 

[braumeister]

AFAIK, dental plans only have value if they are subsidized by an employer. We are fortunate that DW's last employer did that, including for retirees. Even with the subsidy, the premiums eat up much of the annual benefit, so if we need a lot of dental work in one year there is no real value.

I would imagine that vision plans would be in the same category, and I've heard of very few that are subsidized.

 

[youbet]

Generally insurance is useful when expenses are high, and risk is more random. True for medical, auto and homeowner expenses, much less so for vision or dental for that matter?

Exactly. Vision insurance covering refractions and eye glasses turns out to be more of a pre-pay program than insurance.

 

[youbet]

Our health insurance has always included vision care. I just signed up for an ACA plan and was surprised to find that vision isn't included. What do you all do for vision coverage or do you just pay out of pocket?

Be careful to define "vision care." For example, Medicare pays for an annual eye examination looking for various diseases and deterioration of the eyes. (Glaucoma, cataracts, etc.) But Medicare does not pay for a simple refraction and prescription for eye glasses nor for the glasses themselves. I pay for that out of pocket. DW has a Medicare Advantage plan that does pay for refractions.

 

[Cobra9777]

DW and I both have subsidized pre-Medicare HI thru our prior employers. Hers also offers vision coverage for both of us for $10/mo total. We both have eye exams every year. With the vision coverage, we only pay a $5 copay vs $78 without the coverage. That alone, makes it worthwhile. But each of us also gets a free pair of glasses with progressive lenses every other year. Would be $300 without the coverage. The UHC vision plan has a cozy relationship with Warby Parker and we both really like their frames... and updating frequently. So this works extremely well for us.

We also have dental coverage through my prior employer. The premiums are almost exactly equal to the un-insured cost of 4 normal dental exams. So worst-case, it's a break-even deal. But if either of us has a procedure (which is getting more frequent as we age), then it pays off pretty good.

 

[jimbee]

I pay out of pocket for my eye exams and my eye glasses. It's a lot cheaper than when I had eye insurance, and my exams and glasses were covered. Go figure. I recommend an internet search for keyword, "Luxottica".

 

[Aerides]

Yup on the ACA you have to cover your teeth and eyeballs separately. I just OOP for both. You can, however, use HSA dollars for payment/reimbursements.

 

[audreyh1]

Yes, HSA dollars cover the cost of prescription eyeglasses and contacts too.

 

[Fermion]

What happens if someone gets a really bad infection (emergency room type) from a bad tooth. Is that covered?

 

[MichaelB]

What happens if someone gets a really bad infection (emergency room type) from a bad tooth. Is that covered?

I think the tooth itself is not covered but treating the infection is.

 

[Fermion]

I think the tooth itself is not covered but treating the infection is.

So the emergency room visit and ambulance ride, totaling $5,000 would be covered but the $40 tooth extraction you would need to pay oop?

Makes sense. I can see why dental is not in the ACA

 

[disneysteve]

So the emergency room visit and ambulance ride, totaling $5,000 would be covered but the $40 tooth extraction you would need to pay oop?

Why would you need an ambulance ride and an ER visit for an infected tooth? Call your PCP or go to Urgent Care and get a prescription for an antibiotic. I treat that frequently in Urgent Care.

 

[pb4uski]

No. That is easily paid out of pocket.

+1 We each have annual exams for about $75 each and our prescriptions don't change much. We did get new glasses this year ($836 for both of us combined) but it had been many years... so many years that the Transitions coating on my glasses was sometimes getting splotchy.

 

[EastWest Gal]

So the emergency room visit and ambulance ride, totaling $5,000 would be covered but the $40 tooth extraction you would need to pay oop?

Makes sense. I can see why dental is not in the ACA

$40 tooth extraction? You're dreaming.

I have vision and dental covered under the American Academy of Pediatrics, for not much. It helped a lot with glasses and with a crown I needed this year, plus it covered cleanings and Xrays. I also have treated dental abscesses children. The urgent need is for antibiotics, but dental follow-up is important. No ambulance ride needed.

When I was an intern we had an inpatient-a poor adolescent with no dental care who had multiple tooth infections, but the reason she was hospitalized was that the bacteria from her teeth infected her heart valves. Getting an oral surgeon to see her in the hospital was quite difficult, but necessary.

Our state exchange in PA offers dental insurance. DH and I get a better deal through my professional organization.

 

[GenXguy]

My vision insurance was completely free where I used to work. There was a small deductible like $20, and it didn't cover the contact lens fitting fee. But it paid for the other services and most of my contact lens costs each year.

Dental through my employer (at the time) was low cost, and I definitely came out way ahead vs. paying out of pocket.

So the emergency room visit and ambulance ride, totaling $5,000 would be covered but the $40 tooth extraction you would need to pay oop?

Makes sense. I can see why dental is not in the ACA

The $5,000 "covered" may still cost you $5,000 out of pocket on an ACA plan depending on deductible, coinsurance, and out of pocket. My plan says after deductible, there's 30% coinsurance for both emergency care and transportation. So, I would still have to pay 30% of it if I had already met my deductible.

Dental was in the ACA marketplace (healthcare.gov) when I just recently signed up, but they were separate from the healthcare plans and not subsidized. I did not purchase one.

 

[easysurfer]

Yes, HSA dollars cover the cost of prescription eyeglasses and contacts too.

That's my strategy too.

 

[GenXguy]

Be careful to define "vision care." For example, Medicare pays for an annual eye examination looking for various diseases and deterioration of the eyes. (Glaucoma, cataracts, etc.) But Medicare does not pay for a simple refraction and prescription for eye glasses nor for the glasses themselves. I pay for that out of pocket. DW has a Medicare Advantage plan that does pay for refractions.

Hmmm. Maybe that's the same with my ACA plan. It only words it as "routine eye exam" and "routine eye care" in the plan info. But it also uses that same terminology for children and says it does cover glasses for children. Either way, it's not going to cover adult glasses.

 

[Fermion]

Why would you need an ambulance ride and an ER visit for an infected tooth? Call your PCP or go to Urgent Care and get a prescription for an antibiotic. I treat that frequently in Urgent Care.

I wasn't thinking for me personally, but rather for some lower income person on ACA who didn't have dental. A lot of those people will ignore their health until the point where they get in really bad shape.

As later was posted, seems like someone had to go to hospital over a bad infection that got in a heart valve.

To me it seems dental health is as important as mental health, which is covered by ACA.

 

[Dash man]

I have a VSP insurance plan through USAA. I probably could drop it, but it’s less than $20/mo and it levels out my spending for glasses and exams.

 

[disneysteve]

I wasn't thinking for me personally, but rather for some lower income person on ACA who didn't have dental. A lot of those people will ignore their health until the point where they get in really bad shape.

I would estimate that 95+% of the people I see in Urgent Care for dental infections are Medicaid patients who have no access to a dentist. People with private insurance rarely have that problem.

 

[W2R]

Our health insurance has always included vision care. I just signed up for an ACA plan and was surprised to find that vision isn't included. What do you all do for vision coverage or do you just pay out of pocket?

I never went through ACA. I have Medicare supplemented by federal retiree BCBS.

They pay if there's anything medically wrong with my eyes, such as needing cataract surgery, but I pay out of pocket for basic vision coverage such as glasses.