Female patient eye exam

ODs view “use it or lose it” change as incentive for eye care

Because of a recent change to the "use it or lose it" requirement for health flexible spending accounts (FSAs), consumers now can roll over $500 of these funds to the following year.

AOA members believe the change should incentivize patients to pay for timely eye care.

"Getting timely care is the whole point of the FSA."

For example, Gregory D. Foley, O.D., who practices optometry in the Washington, D.C., metropolitan area, said his patients often have busy work schedules and wait until the last minute to get important eye care. They may avoid crucial eye exams, which can detect disease such as diabetes or hypertension, or stretch their contact lens use beyond the prescribed limit.

"People are natural born procrastinators," he said.

While allowing consumers to roll over $500 in FSA funds to the next year might encourage some procrastination, Dr. Foley sees "use it or lose it" on the whole as an incentive for patients to seek care earlier.

"It should entice people to come in and use their benefits," he said. "I see this as a good compromise."

AOA pushed for new approach

FSAs allow employees in insurance plans to set aside pre-tax dollars for health care expenses. Many use FSAs to pay for eye exams and purchase contact lenses and glasses.

However, the "use it or lose it" provision in force for the last three decades has required employees to forfeit unused funds at year's end, save for a short grace period.

On Oct. 31, the Treasury Department and Internal Revenue Service (IRS) announced the roll-over change to this requirement. The AOA views this as a positive development for both optometrists and consumers—and a vast improvement over an earlier IRS proposal that would have eliminated "use it or lose it" altogether.

Without the requirement, patients would have no incentive to get timely care using FSA funds, said AOA Vice President Steven A. Loomis, O.D. "And getting timely care is the whole point of the FSA," he said.

The AOA lobbied hard for a different approach. "We're the only entity I'm aware of that stood up and said that this wasn't good for patients," Dr. Loomis said. He added that the roll-over solution strikes a good balance between consumer flexibility and the goal of encouraging them to seek care using their funds.

"Consumers shouldn't feel coerced into spending something they don't want or need, so a small carryover seems reasonable while maintaining the integrity of the objectives of the FSA," he said.

Easing the year-end rush

The IRS modification should help alleviate the year-end rush to seek eye care at optometry offices, said Allan Barker, O.D., an optometrist in Rocky Mount, N.C.

FSAs are in high demand where Dr. Barker practices. In his experience, patients with these types of accounts tend to flood offices between Christmas and New Year's to use their benefits before they expire on Dec. 31. "I know some doctors and their staff who worked until midnight just to handle demand," Dr. Barker said.

Rolling over a small portion of FSA funds to the following year gives patients the flexibility of avoiding last-minute appointments, Dr. Barker said.

"They can make wiser purchases, and we believe that this will lead them to spending money on eye care," he said.

December 4, 2013

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