In the individual and small-group health insurance market, coverage for adult dental and vision services is generally:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The essential health benefits (EHB) package mandates limited pediatric dental and vision coverage for children, but adult dental and vision services are not required EHBs. Insurers in the individual and small-group markets may exclude adult dental and vision entirely or offer them as optional, separate, or limited coverage with their own premiums and limits. A plan that omits adult dental or vision is therefore generally compliant with the EHB rules, whereas omitting the limited pediatric benefit would violate the mandate. This contrast between mandatory pediatric and optional adult benefits is a specific exam point.
Why the other options are wrong
- B) Only limited pediatric dental and vision are mandatory EHB categories. Adult dental and vision were deliberately left out of the mandatory package, so adults may go without them in an ACA-compliant plan.
- C) The ACA does not prohibit adult dental and vision coverage; it simply does not require it as part of the EHB package. Plans remain free to offer such coverage voluntarily.
- D) Adult dental and vision is not age-triggered at 65. Medicare generally excludes routine dental and vision care, so the optional rule is not a senior-specific mandate.
Memory hook
Kids' teeth and eyes are required; adults' are optional. The mandate stops at adulthood.