Nevada: Huh. NV Health Link now offering standalone vision plans as well.
This is kind of interesting. It looks like the Nevada Health Link (NV's state-based ACA exchange) is offering something new this year:
Nevada Health Link connects consumers to VSP Individual Vision Plans, in time for Open Enrollment 2021
Carson City, Nev. – The Silver State Health Insurance Exchange (Exchange), the state agency that connects Nevadans to Qualified Health Plans (QHPs) through the online State Based Exchange (SBE), known as Nevada Health Link, announces a partnership with VSP® Individual Vision Plans, an offering of VSP Vision Care, the only national not-for-profit vision benefits company.
The Open Enrollment Period for 2021 insurance plans runs from Nov. 1, 2020 through Jan. 15, 2021. Health plans offered through Nevada Health Link are ideal for Nevadans who don’t qualify for Medicare or Medicaid but still need financial assistance; those who don’t have employee-sponsored health insurance, including independent contractors and gig workers; and anyone seeking comprehensive, quality and affordable plans.
“We are excited to partner with VSP to offer vision coverage to Nevadans, diversifying our portfolio of health plans and enabling consumers to widen their insurance safety net,” said Heather Korbulic, executive director, Silver State Health Insurance Exchange. “Having healthy vision and getting regular comprehensive eye exams is critical since eye doctors are often the first to detect signs of chronic conditions like diabetes. With two VSP Individual Vision Plan options available on Nevada Health Link, I encourage everyone to see if a plan is right for them.”
Through VSP Individual Vision Plans, consumers can buy their own coverage for glasses and eye exams and can start using their vision coverage the same day they enroll. Savings are typically more than $200 a year on eye care and eyewear.
Consumers should know that purchasing a regular health plan is not required to purchase a vision plan. Visit Nevada Health Link’s online marketplace in early November to review the vision plans available.
Nevada Health Link always recommends consumers to reach out to a certified agent, broker or certified enrollment counselor to navigate the application and eligibility process. Available in various languages, help is available virtually or in person in select locations, for those who prefer it. Advance Premium Tax Credit (APTC), or subsidies, and Cost-Sharing Reductions (CSR) cannot be applied to vision coverage.
About VSP Global
VSP Global® is a doctor-governed company that exists to create value for members and opportunities for VSP network doctors. Their industry-leading businesses include VSP® Vision Care, the only national not-for-profit vision benefits company, which provides access to eye care for nearly 90 million members through a network of over 40,000 doctors worldwide; Marchon® Eyewear Inc., one of the world’s largest designers, manufacturers and distributors of high-quality eyewear and sunwear; VSP Optics, industry leaders in ophthalmic technology and lab services, providing custom lens solutions for the vision and lifestyle needs of patients; Eyefinity®, the industry leader in practice management and electronic health record software; VSP Retail, which focuses on increasing access to eye care and eyewear through multiple channels, and VSP® Ventures, which offers care-focused, customized choices for doctors looking to transition their practice.
Every healthcare policy offered through the ACA includes 10 Essential Health Benefits for every enrollee regardless of age. Unfortunately, two additional health benefits--dental care and vision/optical--aren't considered "essential"...at least for adults. Here's the skinny on both of these types of coverage, courtesy of my colleague, Louise Norris:
Q: Can you explain the requirements for pediatric dental coverage? I’ve read that it’s an essential health benefit that has to be covered on all plans, but I’m also hearing that it’s optional?
A: It depends. There is no penalty for not having pediatric dental on your policy. And in most exchanges, you can purchase a plan without pediatric dental. But off-exchange, carriers are required to include pediatric dental unless they have determined that you have pediatric dental from another source.
Pediatric dental coverage is one of the ten essential health benefits (EHBs) that the ACA has required on all individual and small group plans since 2014. But section 1302 of the ACA (see page 61) explains that a policy sold in an exchange without embedded pediatric dental coverage can still be a qualified health plan (QHP) as long as there is also a stand-alone pediatric dental plan available in the exchange.
Exchanges must offer pediatric dental, either via coverage that is embedded in the medical plans, or in separate stand-alone plans. But in most states, enrollees are not required to have pediatric dental coverage if they buy a health plan through the exchange, even if there are children on the policy, as long as there are stand-alone pediatric dental plans available for purchase. They can simply purchase a QHP that does not have pediatric dental and will have satisfied the ACA’s individual mandate.
I've written about standalone dental plan enrollment on the ACA exchanges a few times before, most notably way back in November 2014, when it was discovered that then-CMS Administrator Marilyn Tavenner had mistakenly included around 400,000 standalone dental enrollees in her testimony before Congress regarding how many Americans were enrolled in ACA exchange policies at the time, thus overstating the success of the first Open Enrollment Period.
As for vision policies, I haven't really written about that...ever. At all. I don't think I've ever seen any other articles written about it in connection with the ACA exchanges either, beyond this FAQ by Norris on the subject:
Q: How is vision care covered under the Affordable Care Act?
A: The Affordable Care Act requires coverage for pediatric vision care as one of the essential health benefits. So for children under the age of 19, vision coverage is included in all new individual market plans (with effective dates of January 2014 or later), on and off-exchange. This means kids have coverage for eye exams, vision screening, and glasses or contact lenses to correct vision problems.
Vision screening for children falls under the category of preventive care, which means it’s covered at no charge until kids turn 19 (as long as you have an ACA-compliant plan). But vision screening is not the same thing as an eye exam. Vision screening can be performed by a pediatrician or family physician to identify or detect vision difficulties. The screening may not diagnose the child’s condition, but it can indicate whether the screening should be followed up with a comprehensive exam.
Although pediatric vision care beyond vision screening is covered under the ACA, everything other than vision screening can have copays, or be counted towards the deductible and/or covered with coinsurance. Some carriers do offer free eye exams and glasses for kids though – it depends on the carrier, so read the fine print on the plans you’re considering.
What about adults?
Vision care coverage is not mandated for adults by the ACA. Health plans can opt to include adult vision coverage in their benefit design, but they are not required to do so.
If the health plan you’re considering – on or off-exchange – doesn’t include adult vision coverage, you may want to purchase a stand-alone adult vision plan. Stand-alone vision plans are not offered through the exchanges, and you can’t use your premium subsidy to offset their cost.
If your employer offers health insurance, there’s a good chance that vision coverage is included in your employee benefit package. If it’s not, you can purchase a stand-alone vision plan. Depending on how much vision care you use, it may or may not make financial sense to do so.
The bit about "stand-alone vision plans not being offered through the exchanges" appears to no longer be accurate...unless the NV Health Link simply provides info about them and includes a link to a separate VSP site. Note, however, that both Norris' FAQ and the NV Health Link press release make sure to clarify that ACA subsidies can NOT be applied to stand-alone vision plans.