Young girls wearing glasses

4 things parents should know about the pediatric optometric care benefit

As part of the massive health care overhaul, millions of children will benefit from better eye care.

Parents can directly access eye care for their children through their local doctor of optometry.

Optometric eye health and vision care for children has been deemed essential and will be included in new health insurance coverage. This new requirement recognizes that regular comprehensive eye exams during childhood are critical to ensuring visual health and readiness for school.

The AOA is the only national eye health organization Congress and the U.S. Department of Health & Human Services heeded when developing the new requirement. The AOA has been working for years to inform officials and the public about the urgent need for children to have greater access to annual comprehensive eye exams. Now, the AOA and its members are taking the lead by educating people about how the benefit will work.

Here's what every parent needs to know about the new pediatric optometric care benefit, which will take effect nationwide Jan. 1, 2014:

  1. Your child's coverage is based on a comprehensive eye exam
    The federal government requires states to define the new benefit as coverage for regular comprehensive eye exams, including all follow-up care and—in almost every case when needed—eyeglasses and contact lenses. This coverage will be included in all health insurance plans sold in health insurance marketplaces, as well as most new plans sold outside of the marketplaces. Concerned parents covered by health plans delaying a move toward this new standard can contact the AOA Advocacy Group and urge their employer and plan to make children's eye health care a priority now.

  2. Your child's coverage extends through at least age 18
    Consistent with the AOA's recommendations, families may use the new coverage for children beginning in infancy and continuing through age 18. A comprehensive eye examination provided by a doctor of optometry, unlike a vision screening, is designed to consistently identify every eye health and vision issue that can affect a child's overall development and achievement.

  3. Your child's coverage is included in your health plan
    Unlike limited stand-alone plans that can be offered as add-ons to coverage but are not required, the new pediatric eye care essential health benefit will be included as a core benefit and embedded within the overall health plan. This approach provides the seamless primary eye health and vision care children need.

  4. Your child's coverage assures direct access to optometrists
    Parents can directly access eye care for their children through their local doctor of optometry, both for comprehensive eye exams and needed treatment. When a health plan does not include the family's favorite optometrist in their network, concerned parents can contact the AOA Advocacy Group and urge insurers to modernize their provider panel by including more optometrists.

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October 10, 2013

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