Over a third of Medicare beneficiaries have vision problems, yet more than half (57%) fail to receive a yearly eye exam.¹ With this in mind, the United States House of Representatives recently reintroduced a bill that would expand vision coverage to those enrolled in Medicare Part B. 

The Medicare Vision Act of 2021 would expand Medicare Part B coverage to include routine vision care services and materials for the program’s 60 million seniors and younger people with disabilities.¹ This expansion would not only realize the preventive health benefits afforded by routine eye care, including the early detection of systemic disease, but also help seniors retain their sight and independence through affordable vision coverage, according to the American Optometric Association (AOA).¹

Medicare currently does not provide coverage for annual, comprehensive eye exams—only covering a complete exam if a medical condition is found—and typically requires beneficiaries to pay 100% of costs for eyeglasses or contact lenses, creating conditions wherein many seniors either delay or completely forgo the annual eye exams they need.¹

The bill would expand Medicare Part B coverage to include annual refraction and contact lens–fitting services; ensure direct administration of the benefit by Medicare, which would circumvent vision plans from subcontracting to provide the benefit; and provide coverage up to $100 for one pair of eyeglasses or a one-year supply of contact lenses bill would also provide a pathway for low-vision aids.¹

“More than ever, Medicare beneficiaries need expanded access to eye health and vision care, including coverage for annual, comprehensive eye exams. The AOA proudly supports the Medicare Vision Act. It will advance this priority and uphold doctors of optometry and the full breadth of care they deliver to patients,” said AOA president, Robert C. Layman, OD, “We will continue to advocate for this legislation and efforts to maintain doctor-patient decision making at the center of health care, including in the Medicare program.” 

State affiliates are also touting the benefits of the pending bill.

“The California Optometric Association supports H.R. 4187, the Medicare Vision Act of 2021,” said Dr. Ida Chung, president of the California Optometric Association. “With over 6.4 million California residents covered by Medicare, the expansion of vision coverage will have a tremendous impact on the people of California. Not only will seniors and those with disabilities be able to see more clearly and better maintain their independence, eye exams can diagnose life and sight threatening conditions that have no symptoms.”

Research has shown that adding an eyeglasses benefit will encourage more diabetic patients to get an annual eye exam, Dr. Chung adds. According to a recent CDC study, just over half of the Medicare patients with diabetes have had a recommended annual eye exam.²

ODs on the front lines also routinely see the need for expanded vision coverage for their elderly patients who are on limited budgets.

Optometrist Mark T. Marciano, of West Palm Beach, FL, says older individuals now retired who were previously covered by a vision insurance plan through their employer and now rely on Medicare often shy away from annual eye exams due to their fixed incomes, unless they have ocular diseases that can be charged as medical visits.

Recently, Dr. Marciano, who estimated between 30% and 40% of his patients are age 60 and older, saw a patient who was 68 years old and wearing a pair of five-year-old glasses that under-corrected him by 0.75D. Still, the patient decided not to get a new pair of glasses because of the cost.

“Even though you try to adjust pricing for Medicare patients, or you try to provide different products that fit into their budget, it’s still not an incentive for them to get the glasses they need to do their day-to-day activities.”

As a result, this impacts their quality of life, he adds.

“Patients don’t want to drive at night, feel uncomfortable in large groups because they can’t see people in dim lighting and choose not to participate in certain social activities that ultimately impacts their mental health and well-being. So, it’s a cascading effect.”

A Senate companion bill is possibly on deck for later this month.

1. AOA advocacy helps shape new U.S. House bill to expand essential eye health and vision coverage for Medicare beneficiaries. www.aoa.org/news/advocacy/federal-advocacy/medicare-vision-expansion?sso=y. July 1, 2021. Accessed July 6, 2021. 2. Lundeen EA, Wittenborn J, Benoit SR, et al. Disparities in receipt of eye exams among Medicare Part B fee-for-service beneficiaries with diabetes—United States, 2017.  Morb Mortal Wkly Rep. 2019;68(45):1020-23.