If Your Health Plan Doesn’t Include Vision, You Can Purchase A Stand-Alone Vision Plan

Vision care coverage is not mandated for adults by the ACA.

If a health plan includes dental, the premium covers both health and dental coverage. Having said that, in most states, stand-alone vision plans are not offered through the exchanges, and even if they are, you can’t use your premium subsidy to offset their cost.

Several of the fully state-run exchanges have established partnership arrangements with a stand-alone vision coverage company (VSP, in most cases, although California’s exchange also works with EyeMed). In these states, visitors to the exchange are directed to a link where they can purchase stand-alone vision coverage directly from the vision coverage provider.

Keep in mind though, that when you choose a separate vision plan, you’ll pay a separate, additional premium. To shop for stand-alone vision plans, contact Insurance Pro at (888) 575-7475.

What’s the difference between Optometry and Ophthalmology?

• Optometry focuses on routine vision care, such as eye exams, refractions, and prescribing corrective lenses. These services are often excluded from regular health insurance policies unless you have a vision insurance rider or standalone vision plan.
• Ophthalmology, on the other hand, involves medical care for eye injuries and diseases, such as:
  • Cataracts
  • Glaucoma
  • Eye infections or trauma
  • Diabetic retinopathy

Health insurance plans—whether through the Marketplace (ACA plans), Medicare, or employer-sponsored coverage—generally cover ophthalmology services, subject to your plan’s deductible, copays, and coinsurance, just like any other medical condition.

👉 Note: LASIK and other vision correction surgeries performed by ophthalmologists are almost never covered by insurance, as they are considered elective and cosmetic procedures, not medically necessary.

Do Health Insurance Plans Cover Vision Care in 2025?

In 2025, only some health insurance plans offer adult vision coverage. If included, it may be part of:

• A standalone vision plan
• An add-on (rider) to your health insurance
• A Medicare Advantage plan that includes dental and vision benefits
• Employer-sponsored plans with optional vision benefits

This coverage may include:

• Discounts on LASIK (in rare cases)
• Annual eye exams
• Eyeglass frames and lenses
• Contact lenses

Pediatric Vision Care is Covered Under the ACA

The Affordable Care Act (ACA) still mandates that all Marketplace health plans and most small group plans include pediatric vision care as one of the ten Essential Health Benefits.

This means that children under age 19 with ACA-compliant plans are covered for:

• Routine eye exams
• Vision screenings
• Eyeglasses or contact lenses when medically necessary

In 2025, these benefits remain standard on all new ACA-compliant plans, both on and off the federal and state marketplaces.

Need Help Navigating Vision Coverage Options?

If you’re shopping for health insurance in 2025 and want to make sure vision care is part of your plan, we can help!

📍 Stop by our Lake County office or schedule a phone appointment today at (888) 575-7475.

Let’s make sure you (and your family) can see clearly in 2025—literally!