Access and Coverage

Understanding Insurance Benefits for Eye Care

If you’re looking for help navigating your eye care coverage, visit Understanding Insurance Benefits for Eye Care. It explains the difference between vision and medical insurance and offers practical guidance on how to access and use your benefits.

This page focuses on Prevent Blindness policy and advocacy efforts to make vision care more affordable and accessible.

Affordable Care Act (ACA)

Why It Matters for Vision and Eye Health

The Affordable Care Act (ACA) established 10 categories of Essential Health Benefits (EHBs), including pediatric vision care—but adult vision coverage is not required. This leaves millions of adults without access to affordable vision services, even though healthy vision is vital to overall well-being.

A woman wearing glasses
A woman wearing glasses
Understanding Insurance Benefits for Eye Care
Learn how insurance may relate to your specific eye health needs....
Learn how insurance may relate to your specific eye health needs....
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Our Advocacy Priorities

  • Protect and strengthen pediatric vision care as an essential health benefit under the ACA
  • Expand ACA essential health benefits to include adult vision screenings as preventive care
  • Ensure preventive and chronic disease management services fully integrate vision and eye health
  • Protect the affordability of ACA coverage to prevent coverage loss and preserve access to vision and eye care

Advocacy in Action

Cost of Vision Care

Why It Matters for Vision and Eye Health

The high cost of health care is one of the biggest barriers to vision and eye care. National spending on vision problems was $172 billion in 2020 and is projected to rise to nearly $400 billion by 2032. Despite these costs, for every $28,923 that our nation spends addressing vision problems, only a single federal dollar is invested annually toward early detection and prevention programs at the Centers for Disease Control and Prevention and toward innovation and research at the National Eye Institute.

Our Advocacy Priorities

  • Promote policies that make eye care more affordable and accessible
  • Integrate vision and eye health into broader efforts to reduce national health care costs
  • Support public health investments in prevention, early detection, and research
  • Encourage policymakers to treat vision health as a key part of overall well-being

Advocacy in Action

Prevent Blindness advocates for policies that promote access to health care for patients as well as coverage options that allow patients to prioritize their vision health and eye care as a part of their overall health and well-being. We encourage policymakers to consider vision and eye health as part of overall health and well-being. Prevent Blindness reiterates that vision health is an essential contributor to overall health and well-being, and therefore should be an aspect, not a supplement, of health care coverage and approaches to ensuring basic health and wellness for all Americans.

Innovations, Treatments, and Therapies

Why It Matters for Vision and Eye Health

Pharmaceuticals, new therapies, and medical devices are essential to treating many eye diseases. Federal policies influence affordability, availability, and innovation—from research to patient access.

Prevent Blindness believes treatment decisions should be made by patients and their providers. Policy should ensure safe, effective, and affordable access while promoting transparency and equity.

Our Advocacy Priorities

  • Protect patient access to sight-saving therapies
  • Promote transparency and affordability in drug pricing
  • Ensure affordability reforms don’t unintentionally limit access
  • Support patient education and shared decision-making
  • Advocate for policies that enhance safety, efficacy, and quality of care around medical devices

Advocacy in Action

Medicaid & the Children’s Health Insurance Program (CHIP)

Why It Matters for Vision and Eye Health

Medicaid and CHIP ensure access to care for millions of children and families. Pediatric vision services are required for children under 21, but adult vision coverage varies by state. CHIP extends coverage to children in families who earn too much to qualify for Medicaid but can’t afford private insurance.

Gaps in accountability and inconsistent benefits across states can leave children without needed screenings or follow-up care. Strengthening these programs is essential to early detection and equitable access.

Our Advocacy Priorities

  • Protect and strengthen pediatric vision benefits under Medicaid and CHIP
  • Support permanent authorization of CHIP to prevent coverage gaps
  • Improve accountability and reporting under Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) to ensure children receive screenings and follow-up
  • Encourage states to integrate vision care into chronic disease and public health programs

Advocacy in Action

Medicaid:

CHIP:

Medicare

Why It Matters for Vision and Eye Health

Nearly 60 million Americans rely on Medicare, yet coverage for vision services remains extremely limited. Without routine eye exam benefits, older adults face preventable vision loss and higher long-term costs.

Step therapy policies in Medicare Advantage plans also delay treatment by requiring patients to try less effective medications first, putting vision at risk.

Our Advocacy Priorities

  • Expand Medicare to include routine eye exams, glasses, and vision care
  • Create coverage pathways for low-vision devices and assistive technologies
  • Eliminate step therapy practices that delay timely treatment
  • Integrate vision health into preventive and aging-related care initiatives

Advocacy in Action

Telehealth and Vision

Why It Matters for Vision and Eye Health

Telehealth expands access to eye care, especially in rural and underserved areas. It supports screening, disease monitoring, and care coordination when in-person care isn’t available.

However, telehealth should complement—not replace—comprehensive eye exams. Policies must ensure equitable access for individuals with limited broadband, low vision, or language barriers.

Our Advocacy Priorities

  • Support telehealth as a complement to in-person care.
  • Expand broadband and accessibility options for patients with vision loss.
  • Ensure audio-only options remain available.
  • Protect quality, safety, and patient choice in telehealth delivery.

Advocacy in Action

Monitor legislation for the opportunity to review and advise on policies, in order to ensure that the right balance between in-person, clinical care and telehealth is implemented as appropriate for the vision and eye care patient.