Do you have vision insurance? Not covered on ACA plan

[jollystomper]

Our Medicare Advantage PPO covers the annual routine annual eye exam and $200 towards prescription eyeglasses or contacts. Medical eye issues are covered fully, as with other specialists, only a copay needed. While our optometrist does not accept it durectly (before Medicare our retiree plan covered it through EyeMed which they did), we have to submit the claim ourselves and the plan will reimburse us.

 

[audreyh1]

That's my strategy too.

We haven’t tapped ours yet for that, but we save the receipts.

 

[Buckeye]

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?

We use Cosco for glasses that are high quality at a reasonable price. We also use their independent optometrist's office because they're good and also reasonably priced. No optical insurance.

 

[Cayman]

We purchase a dental plan that has more than paid for itself, we've had it for about 5 years. If we just have cleanings and exams, then we break even on what we pay in premiums and our cost of care.

The biggest benefit for us is in the negotiated rates. Had a root canal last week and the negotiated rates for each service were reduced 40-45% from retail prices at the Endodontist and our DDS. The policy we have has a wide range of providers, excellent ones here and is a national network.

 

[DrRoy]

I always had it while working, but when it was dropped, I found that I can get glasses at Costco for about what I used to pay with the insurance.

 

[scrabbler1]

I have wearing prescription distance glasses for just over a year. The visits to the eye doctor were covered by the ACA ($50 copay per visit) but the $160 eyeglasses were not.

As for dental, I investigated adding dental to my ACA policy a few years ago. However, I faced several consequences I found unworkable. To add an ACA plan with its reduced premium, I would have had to (1) add a plan I didn't really want, or (2) change dentists (because my current dentist was not part of that plan's network). If I wanted my desired plan and stay with my current dentist, I would have go outside the ACA's few listed plans and buy my own and pay twice the premium, making it not worthwhile.

So I have stayed put, with no dental insurance.

 

[jim584672]

The NY Essential Plan (up to 200% FPL, about $29K) and NY Medicaid cover vision (exam and glasses contacts) and dental.

Next April the Essential Plan goes up to 250% FPL, about $36.5K. The 200-250 band max OOP will be $2K. The 150-200 band max OOP will be $360, below that range max OOP is $200. Essential Plan also includes a gym membership reimbursement.

 

[scrabbler1]

The NY Essential Plan (up to 200% FPL, about $29K) and NY Medicaid cover vision (exam and glasses contacts) and dental.

Next April the Essential Plan goes up to 250% FPL, about $36.5K. The 200-250 band max OOP will be $2K. The 150-200 band max OOP will be $360, below that range max OOP is $200. Essential Plan also includes a gym membership reimbursement.

Jim, I am in NY and my MAGI is in the low 30s, so it will move into this expanded range for Essential Plan eligibility. I remember when I changed my MAGI a few years ago when signing up for a plan within the NY exchange and up came several plans, none of which like my existing plan (because the MAGI was just low enough to qualify). I didn't like those choices so I raised my MAGI just enough to get my current plan back on the list.

Will this happen to me again when that MAGI amount gets raised again? For now, I did a simple renewal of my current plan and am fine with that. Could I simply stay with my current plan anyway? I can't see my insurance company caring if I stay with them as long as I pay my (subsidized) premium.

 

[jim584672]

Jim, I am in NY and my MAGI is in the low 30s, so it will move into this expanded range for Essential Plan eligibility. I remember when I changed my MAGI a few years ago when signing up for a plan within the NY exchange and up came several plans, none of which like my existing plan (because the MAGI was just low enough to qualify). I didn't like those choices so I raised my MAGI just enough to get my current plan back on the list.

Will this happen to me again when that MAGI amount gets raised again? For now, I did a simple renewal of my current plan and am fine with that. Could I simply stay with my current plan anyway? I can't see my insurance company caring if I stay with them as long as I pay my (subsidized) premium.

If you are in a regular plan with subsidies and under 250% they will inform you in April that you can move to the Essential Plan. EP has much lower out of pockets and $0 premiums. You can also re-estimate and you could drop in. EP has no subsidies.

https://info.nystateofhealth.ny.gov...332 Waiver_Updated Application_12.18.2023.pdf

https://info.nystateofhealth.ny.gov...nefits and Cost-Sharing_Revised 6 20 2023.pdf

https://pndslookup.health.ny.gov/ - To see what plans your doctor takes.

The FPL amount will increase shortly after January. Unlike ACA policies the FPL is not a year back, it updates right away.

 

[Midpack]

We purchase a dental plan that has more than paid for itself, we've had it for about 5 years. If we just have cleanings and exams, then we break even on what we pay in premiums and our cost of care.

We have a similar dental plan. We don't save anything, it's really more of a pre-pay program than "insurance" IME. It fully covers our dental exams every 6 months. For any serious dental work, the plan doesn't pay anything, it might help negotiate price down (worth something) but that's it.

 

[tmitchell]

This was my first year on ACA and I purchased vision insurance for $7/mo. I just got reimbursed $115 for a claim on a pair of eye glasses.

So the insurance saved me $31. Not sure it was worth filling out the claim and cost of stamp lol.

 

[rk911]

My wife has vision and dental coverage through her pension plan. I do not have either. With our NW this is not an issue for me.

 

[Cayman]

Our PPO dental insurance (Guardian Select Florida market) is $180/year pp. with an annual $60 deductible. It's comprehensive - covering preventive (cleanings X-rays) basic services (fillings), and the expensive stuff - covers crowns, bridges, etc. Many dental plans only cover preventive or basic, this one is comprehensive.

For $180 premium and $60 deductible I get 2 exams and thorough cleanings w/xrays. That's what I'd pay anyway without insurance, so it's a no-brainer. If I have any other dental issues I'm ahead. The plan payout is $800 max - I hit that last week with a Root canal. Great thing is if I had even more dental issues I'd get the low negotiated rates. Much rather pay half of the retail on dental services.

- large number of participating DDS and Endodontists here.
- National plan

This is a no brainer for us.

 

[big-papa]

Out of pocket - I specifically asked my optometrist about this back in the spring when I knew I was going to retire this year. His opinion was that vision insurance wasn't worth the cost given the benefit. So when I retired this past summer, we did go on COBRA, but only medical + dental.

We're moving to an ACA plan in January, but keeping dental COBRA for 1 more year as my wife is in the middle of some dental work.

Cheers.

 

[Buckeye]

This is a reminder to all veterans about the VA Dental Insurance (VADIP) program. I live in Central FL and the high option Delta Dental plan is $43.58 per month. $3,000/100% preventative/70% basic restorative/70% major restorative/50% endodontics/50% prosthodontics/50% implants. I have the option of adding a spouse. I believe MetLife is the other provider option. I have been extremely pleased with the plan.

 

[GalaxyBoy]

I have a vision plan with my group insurance, but when the optometrist runs the numbers of out of pocket vs insurance, it always comes out that I’m better off paying for it myself. Go figure.

 

[5Miler]

This is a reminder to all veterans about the VA Dental Insurance (VADIP) program. I live in Central FL and the high option Delta Dental plan is $43.58 per month. $3,000/100% preventative/70% basic restorative/70% major restorative/50% endodontics/50% prosthodontics/50% implants. I have the option of adding a spouse. I believe MetLife is the other provider option. I have been extremely pleased with the plan.

I have the same VA high coverage except with the MetLife plan and have been using it since the plan first started. It has served me well although I have not had much major work done until an implant in the last year. The Oral Surgeon quoted almost $6K ($8K if sinus surgery needed but it wasn't) but my final cost due to the high coverage was under $2K. I think I paid them almost $2.4K but just received a $459 refund from the Oral Surgeon last month unexpectedly. It fully covers my two to three cleanings a year so I fully intend to continue the coverage. I only wish I could get DGF covered as well.

 

[pacergal]

On medicare now, but, yes, we pay a bit extra each month towards vision coverage.

 

[swakyaby]

DH is on Medicare and I am on ACA. I purchased a combined dental and vision insurance through Blue Shield of CA. Comes out to $101/month for both of us. It covers dental up to $1000 max and covered eye exams and $200 towards contacts/glasses.

Recently, DH experienced some disturbing visual changes including flashing lights when he closed his eyes. Attempted to see an ophthalmologist urgently without success. Went to his optometrist who did a retinal exam. They billed his vision insurance which declined the charges. He called medicare who said the visit would be fully covered, so it was rebilled.

 

[ldychill]

We each have a Medicare Advantage plan. It does pay for an annual routine vision exam, and it applies an amount towards glasses and frames. There is a separate coverage that pays if there is a diagnosis ( such as glaucoma), our plan requires a small co-pay for seeing a specialist.

 

[Raygun99]

We go to an Ophthalmologist for annual checkups and prescriptions if needed. Medicare and Tricare cover it all. Sometimes there is a non-covered component but usually $25 or less.

 

[2retireearly]

I used my AARP membership as my vision insurance. The benefits of this $16/year coverage were pretty good!

 

[meleana]

Never had vision insurance my whole life. Usually the opthamologist /optomotrist was covered under medical. Refraction just cost me $50. I get my glasses online at Glasses USA.

 

[teej1985]

I used my AARP membership as my vision insurance. The benefits of this $16/year coverage were pretty good!

AARP includes vision benefits in your membership?

 

[JDARNELL]

Tomorrow our Aetna vision insurance kicks in. This is the first year we have tried the insurance so I can let you know. My Wife and I both wear bifocals and have a second pair of sunglasses. I have the info from two years ago to compare. We will see how it turns out next week then we get our exam and update our glasses.