Low vision aids and devices go beyond traditional eyeglasses and contact lenses to enhance visual functioning beyond correctable refractive error. Low vision devices are typically prescribed and designed to meet the needs of the individual who relies the device to perform daily activities of independent functioning, such as reading labels on medicine bottles, deciphering contrast on steps and sidewalks, or moving from light to darkness such as entering a low light interior from a bright sunny day. Examples of low vision assistive devices and technology include hand-held monitors, video monitors, magnifiers, minifiers, prisms, head-borne devices, and other technologies that alter or enhance image size, contrast, brightness, color, or directionality of an object to enhance its visibility to the user.
Medicare Coverage of Low Vision Devices
Traditional Medicare (Parts A and B) currently has limitations on what visual devices are covered, with the exceptions being for those that are determined “medically necessary.” Since 1965, Medicare has not broadly allowed for coverage of eyeglasses, contact lenses, or low vision aids and devices. However, this was not outlined in statute until 2008 when the Centers for Medicare and Medicaid Services (CMS) codified a provision to exclude from Medicare coverage for eyeglasses, contact lenses, and low vision aids such as corrective or assistive devices and technologies for use with low vision conditions—regardless of medical necessity from genetic conditions, developmental issues, disease, or injury.
This so-called “lens exclusion” means that beneficiaries who need these aids must pay for them wholly out of pocket—even if they are prescribed by a physician. While Medicare Advantage plans tend to cover some low vision devices and services, the out-of-pocket cost to the beneficiary for these devices may pose an additional barrier to care that could diminish quality of life, make activities of daily living harder to maintain, advance additional vision loss, and increase the likelihood of poor health outcomes associated with vision loss and eye disease.
Prevent Blindness believes that access to low vision aids and devices is crucial for beneficiaries who have low vision or visual impairment to achieve better health outcomes, live independently, work, care for their loved ones, engage in civic functions, and perform everyday activities. As such, our advocacy efforts include working with Congress and the Administration to encourage reversing this overly broad lens exclusion and creating a pathway to coverage for individuals who need these devices to function and live independently and productively.