A recent state-by-state analysis of health plans to be offered under the 2010
health care law indicates that nearly all states will feature a pediatric vision
care benefit that is based on an annual comprehensive eye exam provided by an
eye doctor and is embedded with other benefits as part of the overall health
insurance plan.
The AOA has made the recognition of early and periodic comprehensive eye
exams for America’s children a top priority. Throughout the multi-year
legislative and regulatory battle over health care reform, the AOA successfully
fought for inclusion of the new benefit within the law and to ensure that it is
integrated within the health plan and based on an annual comprehensive eye exam
with coverage for materials.
Now, in all 50 states and Washington, D.C., pediatric eye health coverage has
been specifically recognized as essential and is to be based on an embedded
comprehensive eye exam benefit, through age 18, offered by all health plans in
the state-based health insurance marketplaces as well as certain new health
plans to be sold outside of the state marketplaces.
In 48 states and Washington, D.C., pediatric eye health coverage includes an
annual exam, at least through age 18, with Hawaii indicating that it will follow
recommendations from the American Academy of Pediatrics and Massachusetts
signifying that it will cover eye exams every two years. In Kentucky, the
pediatric essential benefit extends to age 21.
The analysis also indicates that no restrictions exist that would prevent any
of the roughly eight million currently-uninsured kids who will gain eye health
coverage from directly accessing an optometrist for their eye health care.
Though adult eye exams may be covered in health plans offered through state
marketplaces at no additional cost to consumers – and roughly 27 states have
included an adult eye health benefit in their benchmark plan - it is unclear at
this point how widespread this coverage may be as the state-based marketplaces
come online.
In 48 states and the District of Columbia, pediatric eye health coverage
includes materials. In Massachusetts and Colorado, the plans reportedly do not
cover materials. In Kansas, though, the benefit includes up to three sets of
lenses and frames per year.
The analysis also indicates that vision therapy services can be covered. In
Washington State, the habilitative portion of the essential health benefits
package includes coverage for vision therapy. In Kentucky, coverage for vision
therapy is included within the pediatric vision care essential benefit.
The pediatric vision care essential benefit analysis was prepared by the AOA
Washington Office team in consultation with state associations. For more
information on the coordinated efforts of the AOA and state associations to
shape the patient access and eye health provisions of the new health law, please
contact Jon Hymes, AOA Washington Office Director, at 1-800-365-2219 or jfhymes@aoa.org.
This story originally appeared in AOA First Look.
