Access and Coverage

The Affordable Care Act and Your Eyes

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).

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