Vision Plans


Covered California’s Pathway to Vision Coverage

Covered California and VSP® Vision Care have partnered to offer consumers a pathway to vision coverage,

  • $15 exam copay/$25 glasses copay
  • Single vision, lined bifocal, or lined trifocal lenses when glasses are selected versus contact lenses
  • $120 frame allowance or contact lens allowance
  • Contact lens – the fitting and evaluation is fully covered with no copay, allowing members to use their full allowance toward the purchase of contacts

While adult vision care is important for Covered California members, adult vision care is not an essential health benefit under the Affordable Care Act and coverage is handled directly through VSP.

Vision services for children are an essential health benefit and are included in all health plans purchased through Covered California. Enrollment with VSP into vision plans is available year-round and is available during and outside of the Open Enrollment Period.

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3 comments on “Vision

  1. I find it interesting that they did not consider vision care insurance essential [10 essential benefits] for adults.

    I’ve been under doctors care for high blood pressure and Type 2 diabetes since the late 1990’s and it’s mandatory to have annual eye exams as part of your Wellness Heath Care.

    • It’s rather technical, but it’s my belief that an eye exam to monitor diabetes and high blood pressure would be covered. Check the vision exclusion in the specimen policy page 118 It refers to benefits if covered under the Medical Portion of the policy. Check the clinical bulletins and see what and how are things covered for each type of disease or illness.

      Clinical Bulletin from Oscar Insurance on when they will pay contact lenses & eyeglasses under the medical benefit.

      Eye exams

      Medicare doesn’t cover eye exams (sometimes called “eye refractions”) for eyeglasses or
      contact lenses. Medicare covers some preventive and diagnostic eye exams:

      • See “Yearly eye exam” under “Diabetes services & supplies” on pages 23–25.
      • See “Glaucoma tests” on page 31.
      • See “Macular degeneration” on pages 38–39.

      Eyeglasses/contact lenses

      Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following
      cataract surgery that implants an intraocular lens, Part B helps pay for corrective
      lenses (one pair of eyeglasses with standard frames or one set of contact lenses).
      Medicare covers the surgery if it’s done using traditional surgical techniques or
      using lasers.

      In 2018, you pay 100% for non-covered services, including most eyeglasses or contact
      lenses. You pay 20% of the Medicare-approved amount for one pair of eyeglasses or
      one set of contact lenses after each cataract surgery with an intraocular lens, and the
      Part B deductible applies. You pay any additional costs for upgraded frames. Medicare
      will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no
      matter who submits the claim (you or your supplier).

      Glaucoma tests

      Part B covers a glaucoma test once every 12 months if you’re at high risk for glaucoma.
      You’re at high risk if you have diabetes, a family history of glaucoma, are African
      American and 50 or older, or are Hispanic and 65 or older. An eye doctor who’s legally
      allowed to do this test in your state must do or supervise the screening.
      In 2018, you pay 20% of the Medicare-approved amount, and the Part B deductible
      applies. In a hospital outpatient setting, you also pay a copayment.

      See also:

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