Update 2: Assure parents pediatric optometric care benefit included and available in all states

January 9, 2014
The AOA’s fight for inclusion is a win for patients and practitioners

National news outlets continue to call attention to the gap in children's dental coverage. Thanks to AOA, there is no gap in children's vision coverage.

Today, Jan. 9, National Public Radio (NPR) had a story on the legal loopholes leaving some kids without dental insurance. Past news coverage in USA Today and The New York Times pointed out the flaws of the benefit, as well.

When parents sign up for new insurance plans under the Affordable Care Act (ACA), their children will be guaranteed access to doctors of optometry for much-needed eye care.

This is true no matter what state they live in—a key point that separates the pediatric optometric care benefit from other benefits.

Health advocates expressed concern that because the dental benefit can be offered in optional stand-alone plans, it won't serve as many children as it could and should. Dental coverage for children will be "essential," but it will not be "mandatory."

The pediatric optometric care benefit comes with no such uncertainty.

"The road our country has taken toward integrating eye health and vision coverage in health plans was unfortunately not the road taken for dental coverage. Although the story behind how the new dental benefit became lost may be news to some, AOA members were alerted years ago to the harm that would result from allowing insurers to dictate how essential pediatric care should be delivered," Mitchell T. Munson, O.D., AOA president, said in a statement. "That's when we fought back and that's how we won the full coverage our patients need, instead of what insurers would be willing to offer."

Dr. Munson said the pediatric eye benefit will extend coverage to millions of children across the country and include doctor of optometry-provided annual eye exams, treatment and follow-up visits.

He encouraged AOA members and others to share details of the coverage with "friends, family, and patients." He pointed to a recent AOA article, "Four Things Every Parent Should Know about the Pediatric Optometric Care Benefit," as a way to help spread the news.

Stephen Montaquila, O.D., chair of the AOA Third Party Center Executive Committee, called the coverage a huge win for patients and the profession. "It is a true medical benefit because it's embedded within insurance plans," said Dr. Montaquila.

The value of inclusion

Under plans sold in health insurance marketplaces and individual and small-group plans, the pediatric eye care benefit is included. It covers regular comprehensive eye exams, follow-up care, and glasses and contact lenses in almost every case when needed.

This inclusiveness is no accident, said Roger Jordan, O.D., chair of the AOA Federal Relations Committee.

"The AOA's staff and volunteers have been educating Congress and CMS (Centers for Medicare & Medicaid Services) administrators for years about the need to integrate pediatric eye care in medical plans," Dr. Jordan said.

Integration and inclusion make life simpler for pediatric patients and their parents, according to Dr. Montaquila. For example, parents with limited resources might choose not to pay for optional add-ons such as dental plans.

"Because of the way the pediatric optometric care benefit is structured, they won't have to make that choice," Dr. Montaquila said. "It will be in every single plan when a child is being insured."

Benefits for doctors of optometry

For parents, the pediatric benefit brings clarity and consistency. For doctors of optometry, it brings new opportunities such as participating in new plans and serving on provider panels.

"Health plans will truly need to bring optometrists on board," Dr. Montaquila said. "Not only will optometrists not be excluded, they are going to be a crucial part of the plan."

In addition, doctors of optometry—already the primary providers of eye care—will be needed to meet the demand brought by millions of new pediatric patients. That demand will be even greater because the benefit is part of mandatory coverage rather than being optional.

"Optometry is going to have to step up to take over this volume of patients," Dr. Jordan said. "We're going to become a very essential need not only for the patient population, but also for the medical community."

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