Medicare’s coverage of vision and eye health services is generally very limited to only a few covered services or for beneficiaries who meet certain risk criteria— even as the 2018 Medicare Current Beneficiary Survey indicated that 99.6% of Medicare beneficiaries self-reported having a vision problem such as needing eyeglasses, having trouble seeing, having a diagnosis of legal blindness, needing a visual assistive device, or had cataracts, glaucoma, diabetic retinopathy, or macular degeneration.
Because many aging Americans rely on Medicare for their health needs, Medicare is a logical opportunity to prevent eye diseases from progressing to vision loss or impairment and stemming the costs of addressing vision loss once it has occurred. Medicare has a number of cross-cutting interventions where vision and eye health can be integrated, such as in primary care settings, falls risk assessments, and screenings for modifiable behaviors such as smoking, cognitive decline, and mental and emotional health status. Access to preventive measures such as a comprehensive eye exam (which is suitable to detect disease, determine its state of progression, and provide the most effective treatment) can help older Americans maintain their independence and quality of life while preventing and reducing costs to the patient and the system.
Elevating the role of vision and eye health promotion and disease prevention will help close critical gaps in coverage, address health disparities across populations, and contribute to lower Medicare spending on chronic diseases, hospitalization and readmission, injury and rehabilitation from falls, vision rehabilitation services, and long-term care. Prevent Blindness will continue to advocate to Congress and to CMS to enhance the role of vision and eye health promotion and disease prevention in Medicare.