The short answer
If you work for yourself, your kids' vision care is already part of every Marketplace health plan, but your own may not be. HealthCare.gov says all Marketplace plans include vision coverage for children, while only some include it for adults. If yours doesn't, you can buy a separate stand-alone vision plan, just not through the Marketplace itself. Their vision coverage definition lays it out, and I'll walk through what it means for you and your family.
Why vision catches people off guard
When you had a job with benefits, vision often showed up as its own card in your benefits packet. You picked it during sign-up and forgot about it. Once you're on your own, there's no packet. A lot of folks don't notice the gap until they need new glasses or contacts.
Kids get vision coverage in every Marketplace plan
HealthCare.gov lists pediatric services, including oral and vision care, as one of the 10 essential health benefits that every Marketplace plan has to cover. You can see the full list on their page about what Marketplace plans cover. That's true for every metal level and every plan type, including HMOs and PPOs.
So if you're shopping for a family plan, your children's vision care comes with it. You still want to look at the details, since the specific services covered can vary by state.
Adult vision is a different story
That same HealthCare.gov page says adult dental and vision coverage aren't essential health benefits. Some plans add adult vision as an extra benefit. Others don't include it at all.
If good eye care matters to you, check each plan's details before you pick. When you compare plans side by side, you'll see what each one offers.
Your option if your plan skips adult vision
HealthCare.gov says you can buy a stand-alone vision plan to help with your vision care costs. The Marketplace doesn't sell those plans, though. To shop for one, they suggest contacting an insurance agent or broker, searching for plans online, or reaching out to your state's Department of Insurance.
This is different from dental. With dental, you can add a separate plan right inside the Marketplace while you shop for your health plan. I covered that in my post on dental insurance when you're self-employed. Vision has to be shopped on its own.
How I'd think it through for your household
Start with what your family actually uses. Does anyone wear glasses or contacts? How often does each person get an eye exam? Those answers tell you whether adult vision coverage is worth paying attention to.
Then look at the health plans that fit your doctors and budget. If one of them includes adult vision, that may settle it. If none do, a stand-alone vision plan is the next thing to look at.
Timing matters too. Marketplace Open Enrollment runs November 1 through January 15, and I put the Open Enrollment dates for self-employed people in one place so you can plan ahead.
FAQ
Do all Marketplace health plans include vision coverage?
For children, yes. HealthCare.gov says all Marketplace plans include vision coverage for children. Only some plans include vision coverage for adults.
Is adult vision coverage an essential health benefit?
No. HealthCare.gov says adult dental and vision coverage aren't essential health benefits, so plans don't have to include them.
Can I buy a stand-alone vision plan on the Marketplace?
No. HealthCare.gov says the Marketplace doesn't offer stand-alone vision plans. You can shop for one through an insurance agent or broker, online, or by contacting your state's Department of Insurance.
How is vision different from dental on the Marketplace?
You can add a separate dental plan through the Marketplace when you buy a health plan. Stand-alone vision plans aren't sold there, so you shop for them separately.
How do I know if a plan includes adult vision?
Check the plan details when you compare plans. HealthCare.gov says you'll see exactly what each plan offers when you compare them.