Essential Health Benefits
The Affordable Care Act (ACA) requires that insurers offering health plans through state-based exchanges must cover services related to 10 established categories of care, or “essential health benefits” (EHBs). These are minimum requirements for marketplace plans; however, states can offer additional benefits or vary the level of covered services under each benefit. EHBs include pediatric vision care services and chronic disease management for adults. However, adult vision care services are not considered to be an EHB. In some cases, states may offer vision coverage as an additional or supplemental benefit.
Preventive and wellness care are considered to be EHBs on marketplace plans, and may include covered services for diseases that may impact vision (such as diabetes, falls prevention, and smoking cessation).
Advocacy Updates:
- Prevent Blindness urges CMS to include assistive devices and adult vision screenings as EHBs under ACA marketplace plans
- Prevent Blindness recommends HHS to retain federal definition of EHBs in annual payment rule
- Congressional Statement for the Record on American Healthcare Act of 2017
- Statement Opposing American Healthcare Act of 2017
Resources:
- Vision Coverage on Marketplace Insurance Plans – healthcare.gov
- Preventive Health Services – healthcare.gov