Children’s vision care comes with every Covered California health plan. Adults usually need a separate vision plan for routine exams and glasses.
Quick answer: In California, vision services for children are included in every health plan sold through Covered California, because pediatric vision is an essential health benefit. Adult vision care isn’t, so most adults get routine eye exams and eyewear through an employer or a separate vision plan. Medical eye problems are generally billed to health insurance.
Vision services for children are an essential health benefit, so they’re included in every Covered California health plan.
Adult vision care isn’t an essential health benefit. Adults typically get it through work or buy a standalone vision plan directly.
Original Medicare doesn’t cover routine eye exams or glasses, so a separate vision plan is how many seniors cover routine care.
| Who | Routine eye care included? | Where coverage usually comes from |
|---|---|---|
| Children in a Covered California plan | Yes | Built into the health plan |
| Adults in a Covered California plan | No | A separate vision plan |
| Adults with job-based coverage | Often | An employer vision benefit |
| People on Original Medicare | No routine exams or glasses | A separate vision plan |
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No. For children, vision services are an essential health benefit and are included in every Covered California health plan. Adults choose whether to buy vision coverage, usually through an employer or a standalone plan, since adult vision isn’t an essential health benefit.
Not in its health plans. Adult vision care isn’t an essential health benefit, so standard Covered California plans don’t include routine adult eye exams or glasses. Adults can buy a standalone vision plan directly from a vision insurer, and many of those plans enroll year-round.
Vision services for children, which typically include eye exams and eyewear, are included in every Covered California health plan. Check your plan’s evidence of coverage for frame options, how often glasses are covered, and which eye doctors are in network.
Generally, yes, as medical care. Diagnosing and treating eye conditions such as glaucoma, cataracts, or infections is billed to your health insurance, not to a vision plan. Vision plans focus on routine exams and eyewear, so many people carry both.
Original Medicare doesn’t cover routine eye exams or glasses. It does cover some medical eye care, such as certain exams for diabetic eye disease and glasses after cataract surgery with an implanted lens. A standalone vision plan can cover the routine side.
One of our licensed agents can compare standalone vision plans by network, copays, and frame allowance.
