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Optometrists see gaps in essential health benefits

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The American Optometric Association (AOA) would like to get coverage for regular vision exams into the standard package of benefits that all major medical plans must offer.

Yi-Jhen Li and other researchers recently reported in the Archives of Ophthalmology that people with vision insurance are about 25 percent to 75 percent more likely to do well on selected vision health indicators than comparable people without vision insurance.

The AOA put out a statement welcoming the study, and the authors’ conclusion that vision insurance for preventive eye care should be “mandatory in all health plans.”

The Patient Protection and Affordable Care Act of 2010 (PPACA) calls for regulators to require all health insurers to offer a standard package of “essential health benefits” (EHB),  to help consumers compare coverage more readily and reduce the likelihood that some insurers’ will try to hold down prices by skimping on benefits.

PPACA requires the EHB to include some preventive vision care benefits for children. The law does not require plans for adults to include preventive vision care benefits.

Dr. Stephen Montaquila, an AOA official, said the association agrees with Jhen and the other authors of the new Archives of Ophthalmology paper that vision care should be part of all medical plans.

The “optional, supplemental vision coverage that has predominated over the last 40 years is simply no longer good enough,” Montaquila said in a statement. “Eye health and vision are much too important to remain just an option.”

Montaquila noted that the Li group found that only about 60 percent of the people in their study had vision benefits, and that about 90 percent had major medical coverage.

That gap between vision benefits and medical benefits affects the likelihood that individuals will get eye exams, and that the individuals will get appropriate, timely care for conditions that could affect their vision, Montaquila said.

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