Expanded Affordable Healthcare Coverage

The Expanded Affordable Care Act


What can eye care and ENT practices expect under this new administration?

One of Joe Biden’s first acts as President after being sworn in January 20 was to sign an executive order reopening the enrollment window for health insurance coverage under the Affordable Care Act (ACA). That means millions of Americans have through May 15, 2021 to buy health insurance. “Biden’s action is intended to address rising numbers of people who have lost their health insurance related to COVID-19,” reported United Press International (UPI).

What changes can medical practices, specifically eye care and ENT, expect to see in the Biden administration? Read on to find out.

More coverage options for patients young and old

The Biden administration will spend $50 million on outreach and education to strengthen the healthcare program also known as “Obamacare,” established in 2010 under then-Vice President Biden and President Barack Obama. Millions of Americans lost their health coverage under former President Trump before and after the pandemic, according to the Journal of the American Medical Association (JAMA).

The expanded ACA will offer more coverage options for patients of all ages. It requires coverage for pediatric vision care as one of the essential health benefits, meaning that children under the age of 19 have coverage for eye exams, vision screening, and glasses or contact lenses to correct vision problems.

The expanded ACA will offer more coverage options for patients of all ages, including requiring pediatric vision screening with no copay.

As noted by HealthInsurance.org, while vision screening for children falls under the category of preventive care, so it does not require a copay and can be performed by a pediatrician or family physician, patients may not realize that a vision screening is not the same thing as a comprehensive eye exam. You may want to explain when and why a comprehensive exam is necessary, and also make patients aware that depending on their plan, it may require a copay or count towards their deductible.

For more information on addressing the needs of young eye care patients, read our post, Myopia: A Growing Concern for Young Patients.

President Biden has also proposed lowering the age of eligibility for Medicare from 65 to 60. This proposal is intended to ensure that older adults who become unemployed don’t have to go without insurance; however, it may also encourage others to retire early without fear of losing their employer-provided insurance coverage. Here are the pros and cons to the changes to Medicare, according to Newswire. 

Lowering prescription drug costs

President Biden’s administration also plans to address the skyrocketing costs of prescription drugs. According to NBC News, “Biden’s plan would repeal existing law that currently bans Medicare from negotiating lower prices with drug manufacturers. He would also limit price increases ‘for all brand, biotech and abusively priced generic drugs’ and launch prices for drugs that do not have competition, according to a Biden campaign official.” Consumers would also be able to buy lower-cost prescription drugs from other countries, which could help spur competition.

Callout: While larger solutions to rising drug costs are pending, share resources with your patients to help them comparison shop and potentially save on their prescriptions. 

Some of your patients may not be aware that prescription drug costs can vary considerably from pharmacy to pharmacy, or that it may be possible to lower costs by ordering a 90-day supply of a medication instead of a 30-day supply. Encourage them to use a website or app like GoodRx to comparison shop. You can also share our video to make this point. 

View Video

Help your patients advocate for themselves

For the first time, many people are finding themselves in the position of having to advocate for their own health care needs. Whether they’re trying to find out how to get the COVID-19 vaccine or fighting for PPE required to do their jobs safely, many Americans have had to be more proactive than ever before about their health. 

For many, this includes purchasing and understanding their own health insurance coverage. In 2020, as many as 12 million Americans lost their employer-sponsored health insurance. That may have included any vision plan they previously had. As of March 2020, just over 50 percent of the U.S. adult population – approximately 130 million people – had some type of vision insurance or managed vision care coverage, according to the Review of Optometric Business

Callout: 12 million Americans lost their employer-sponsored health insurance in 2020; only 50 percent had vision coverage. Help educate your patients about the best insurance for them. 

As an eye doctor, you can educate your patients about vision insurance and what it covers. Explain that, typically, the options are either a vision benefits package, which provides free eye care services and eyewear within fixed dollar amounts in exchange for an annual premium and a small copay, or a discount vision plan, which provides eye care and eyewear at discounted rates after you pay an annual premium. According to AllAboutVision.com, vision plans typically cover

  • Annual eye examinations
  • Eyeglass frames and lenses (including lens coatings and enhancements)
  • Contact lenses
  • Discounted rates for LASIK and PRK

As an example, patients with Vision Service Plan (VSP), the largest vision plan provider in the U.S., may pay $13/month for coverage, which allows them to get a comprehensive eye exam for a $10 copay instead of the $163 it would cost without insurance. Just as with prescriptions, let patients know it’s a good idea to comparison shop for vision insurance that offers the best value for the eye care benefits they want.

Healthcare is a right, not a privilege,” President Biden said in a statement. “And I will do everything in my power to ensure that all Americans have access to the quality, affordable healthcare they deserve.” Doctors can, too. 



Sign up for the Rendia Insider

Monthly update from experts in the field aimed to improve efficiency in your practice.