For kids and ODs, pediatric vision benefit is a success

For kids and ODs, pediatric vision benefit is a success

The AOA's efforts to guarantee comprehensive pediatric eye health and vision care under the Affordable Care Act (ACA) are paying off for millions of American kids.

"This is one of the most significant achievements in the history of our profession."

The AOA fought to ensure such care was embedded in plans sold on new health insurance exchanges, as well as in most new plans sold outside of them.

"This is one of the most significant achievements in the history of our profession because it is shaping how eye health and vision care will be delivered for decades to come," says AOA President David A. Cockrell, O.D.

New enrollment data from the Department of Health and Human Services' (HHS's) Office of the Assistant Secretary for Planning and Evaluation (ASPE) reflects that achievement.

According to ASPE data, more than 8 million individuals enrolled in a plan sold through the exchanges during the ACA's first enrollment period. Of those enrollees, 100 percent received coverage under the ACA's pediatric vision benefit—a mandated coverage provision under the law. This compares with just 14 percent (1.1 million people) who enrolled in a stand-alone dental plan.

Under the ACA, qualified health plans are required to include pediatric vision coverage, thanks to AOA efforts, but are not required to do so for pediatric dental coverage.

Why it's not a stand-alone benefit
The pediatric vision benefit's success hinges on how it is designed, says Stephen Montaquila, O.D., chair of the AOA Third Party Center (TPC) Executive Committee. The vision benefit was embedded within medical plans.

"This inclusion and integration was no accident," Dr. Montaquila says. A number of AOA advocacy committees fought for it, including TPC, the Federal Relations Committee, and the State Government Relations Committee.

Congress and HHS have since endorsed the AOA's approach for integrating eye health and vision care coverage with other core benefits provided by health plans.

"For America's families, this essential coverage helps to ensure that kids no longer face developmental delays or barriers to educational success due to undiagnosed or untreated eye or vision problems," Dr. Montaquila says. "For AOA member optometrists, it brings with it a wealth of new health plan participation, patient care and practice building opportunities."

The AOA's proposal had its opponents, among them stand-alone plans, Dr. Cockrell says. Some vision plans, for example, fought to make consumers purchase pediatric vision coverage separately from the health plan, rather than what the AOA and Congress envisioned as embedded coverage.

"It is important for us to remember if they had prevailed, the mandatory and comprehensive eye health and vision coverage for millions of children would be like the optional dental coverage, which as we have just confirmed has been restricted to just a small fraction of those who could have gained coverage," he says.

August 15, 2014

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