Top 3 health insurance exchange trends to watch in 2015

Top 3 health insurance exchange trends to watch in 2015

The Affordable Care Act (ACA) is ushering in its second year of major insurance coverage expansions. To make the most of new patient volume and coverage trends, members of the AOA Third Party Center (TPC) Executive Committee advise optometrists to stay on top of the following developments:

In some states, new insurance entities or even co-ops may develop. Such arrangements may offer new opportunities for ODs.

1. Pediatric visits will continue to increase
The AOA's hard-fought pediatric provision in the ACA guarantees comprehensive pediatric eye health and vision care for plans sold on new health insurance exchanges, as well as in most new plans sold outside of them.

Some ODs have already reported increasing patient numbers. As parental awareness of this benefit increases, ODs should expect to see more pediatric patient visits in 2015, as well. According to Stephen Montaquila, O.D., who chairs the TPC Executive Committee, this presents new opportunities to educate parents on the availability of this benefit and the importance of scheduling regular comprehensive eye health and vision examinations for their children.

2. More competition on exchanges could present more opportunities for optometrists to join new networks, provided that ODs are credentialed with those networks. 

"As the insurers build their offerings, they must have providers. This highlights the importance of state associations having a good understanding of what is developing in their local market so that doctors can be informed ahead of any changes and ensure that they join networks that make sense for their businesses," Dr. Montaquila says.

In some states, new insurance entities or even co-ops may develop as well. Such arrangements may offer new opportunities for ODs, says Jason Ortman, O.D., a member of the TPC executive committee.

3. Narrow network trends may continue
With increased competition, sometimes more restricted networks follow.

One of the ways insurers try to lower premiums is to reduce access points to care. "This is why narrow networks have become more prominent," Dr. Ortman says. Unfortunately, excluding ODs from narrow networks has been a common practice in exchange plans.

Narrow networks continue to be a top priority issue for the TPC, Dr. Montaquila says. "While we understand marketplace pressures that lead to narrowing of networks, we also understand that there are unintended consequences of severely restricted access."

All ODs are encouraged to visit, which provides an evidence-based argument against severely restricted access and how it could lead to higher costs for both patients and health plans. AOA members can use these tools when confronting such a situation.

September 29, 2014

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