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Children's Vision Services Under the ACA

​Good vision is key to a child’s physical development, school success and well-being. The visual system is not fully developed in babies and young children. Equal input from both eyes is necessary for normal development of the brain’s vision centers. If a young child’s eyes do not send clear images to the brain, vision may become limited in ways that cannot be corrected later in life.

Routine vision screenings are important for early detection of vision problems. If a problem is detected during a screening, a comprehensive eye exam should be obtained. However, most children do not need such an exam.

Your Child’s Vision Services Under the Affordable Care Act

The Affordable Care Act (ACA) requires insurance plans to offer pediatric services including vision services, through state health insurance exchanges, as one of the 10 required categories of essential health care benefits beginning January 1, 2014.

Qualified health plans will provide coverage for timely vision screening for the early detection and treatment of eye and vision problems in the medical home. This includes maintaining a schedule of vision screening during childhood and adolescence. Ideally, these screenings are done in the pediatrician’s office.

The American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus recommend the following childhood vision screenings:

  • Newborns to age 3: Red reflex test, corneal light reflection, ocular motility, pupil examination, external examination, and vision assessment at all well-child visits
  • Ages 3 to 5 years: Vision screening, with an emphasis on age-appropriate visual acuity testing, each year
  • After 5 years of age: Vision screening every 1-2 years

Pediatric Vision Services Provided Under the ACA

Each state is required to provide:

  • Vision screenings in the medical home
  • An annual fully-dilated comprehensive eye exam with refraction if required
  • Correction of refractive error with eye glasses and contact lenses

What is a Medical Home?

A family-centered medical home is not a building, house, hospital, or home healthcare service, but an approach to providing comprehensive care. In this home, the pediatric care team works in partnership with a child’s family to ensure that all of the medical and non-medical needs of the child are met.

Under new insurance plans purchased in the marketplace, the medical home can help facilitate family/patient access, coordinate, and understand specialty care, educational services, out-of-home care, family support and other public and private community services that are important for the overall health of the child and family.

Good vision is essential for proper physical development in growing children and educational progress. Under the ACA, new private health plans must cover the cost of preventive care, including vision screenings performed in the medical home. For more information about the medical home approach, click here.

The Benefits of Vision Screenings

  • Quick and accurate at minimal expense
  • High rate of problem detection
  • Minimizes unnecessary referrals
  • Convenience and frequency
  1. Beginning October 1, 2013 – You can sign up through your state-based exchange for a qualified health plan. Visit to learn how.
  2. Talk to your doctor or school nurse if you have concerns about your child’s vision
  3. Inquire about vision screening, including chart-based and instrument-based methods, at your next visit to your medical home or take advantage of vision screenings offered at schools, community health centers or community events.
  4. Contact an ophthalmologist or optometrist for an exam if:
    • Referred by your pediatrician or school nurse
    • Your child fails a vision screening
    • Vision screening is inconclusive or cannot be performed
    • Your child has a vision complaint

Click Here to Download Children's

Vision Services Under the ACA (PDF)

Last Updated
American Academy of Ophthalmology (Copyright © 2013)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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