Public and Private Exchanges to Bring More Patients




With the media all abuzz about the challenges being faced by the public health insurance exchanges being established to sell health insurance in each state, the private exchanges being created throughout the country for the same purpose are getting far less attention. But both are on the upswing, and both will include the sale of managed vision care plans.

Public Exchanges

Depending on the state, public health insurance exchanges are being managed in one of three ways—by the state itself, by the federal government, or by the state and federal government in partnership.

Of the 51 health insurance marketplaces being developed across the U.S., 19 will be state-based exchanges, 25 will be federally facilitated, and seven will be “partnership” exchanges, developed jointly by state and federal government, according to the American Optometric Association’s Third Party Center Executive Committee. In addition, multi-state plans will be available in 31 states in 2014 and in all states by 2017.

The U.S. Department of Health and Human Services (HHS) gave states the flexibility to select an insurance plan that reflects the scope of services offered by a “typical employer plan” by using one of the following health insurance plans as a benchmark—one of the three largest small group plans in the state by enrollment, one of the three largest state employee health plans by enrollment, one of the three largest federal employee health plan options by enrollment, or the largest HMO plan offered in the state’s commercial market by enrollment

“Not every benchmark plan includes coverage of all 10 categories of benefits identified [as essential health benefits],” according to HHS, which added that among the most commonly non-covered categories of benefits among typical employer plans are pediatric vision services. To determine what pediatric vision services should be offered, HHS reviewed the Federal Employees Dental/Vision Insurance Program (FEDVIP). “The FEDVIP program is a stand-alone vision and dental program where eligible federal employees pay the full cost of their coverage,” according to HHS. “The FEDVIP vision plan with the highest enrollment covers routine eye examinations with refraction, corrective lenses and contact lenses.”


According to a spreadsheet of each state’s benchmark plans released by the National Association of Vision Care Plans, most states (40) and the District of Columbia resorted to using FEDVIP as its model because pediatric vision care was not included in their benchmark plans.

To participate in these public exchanges, some managed vision care plans have partnered with some of the qualified health plans being sold on them. For example, Davis Vision is participating in 15 health plans being sold on state exchanges, primarily in the East Coast, and VSP established committed partnerships with 60 health plans in which the company is providing pediatric essential benefits coverage for delivery in 25 different states.”

Private Exchanges

With all the controversy and glitches surrounding the launch of the state exchanges on Oct. 1, 2013, private exchanges that are also selling health insurance have come online more quietly. These private exchanges will become a major factor, market observers tell Vision Monday.

Insurance consulting firms such as Aon Hewitt, Mercer and others are forming private exchanges to sell health insurance that will include vision benefits. “You will see these private exchanges continue to grow at the same time that the public exchanges are growing,” said Julian Roberts, executive director of the NAVCP. While private exchanges are currently selling insurance for small and medium sized groups, Roberts is confident that private exchanges will soon appear to sell individual insurance throughout the country, and there will be “a lot more managed vision care programs getting into the individual market.”

On both the Aon Hewitt and Mercer Marketplace exchanges, “VSP Vision Care is working and in discussions with several private exchanges, both on a national and regional level,” a VSP spokesperson told Vision Monday.

John W. Lahr, OD, FAAO, EyeMed’s VP, provider relations and medical director, said that his organization is involved in or is in discussions with “pretty much all” of the firms establishing private insurance exchanges.

“EyeMed’s response to health care reform has been two-pronged,” said Gerg Hare, EyeMed vice president of provider relations. “First, we have solid relationships with major medical carriers planning to operate in the public exchanges, so we have a presence on those platforms. Second, we’re participating in several private national and regional exchanges, and will continue to evaluate private exchange opportunities over the next few years.”

Other managed vision care executives also see the value in the exchanges, both public and private. Davis Vision just created a position for vice president of exchanges, national accounts and network development.

Bob Stein, chief professional development officer, National Vision, said “Preparedness for the Federal public exchanges, state public exchanges, and private exchanges is key for the future.” ■