Medicare Vision Coverage Update

By Dave Rich

Is Policy Change Likely?

According to a study by University of Michigan Kellogg Eye Center, 92 percent of Medicare beneficiaries use eyeglasses. Despite this overwhelming percentage, Medicare does not cover routine vision care. Meanwhile, the average American spends more than five hours a day staring into a smartphone, and researchers are finding that screen time can possibly cause macular degeneration. So, it’s likely we’ll see these numbers continue to rise across the entire society. 

With an imminent risk of health plans underserving more citizens after retirement, some policy makers are pushing for change. While their push isn’t likely to be enough to enact change just yet, there are other options Medicare beneficiaries can take advantage of now.

A brief history on Medicare and vision benefits

After several failed attempts by presidents to push for government health insurance programs, Medicare for Americans 65 and older became a reality in 1965 when Lyndon B. Johnson signed H.R. 6675 into law. Since then, we’ve seen very few expansions in coverage. Some include opening up Medicare to those under 65 with long-term disabilities and end-stage renal disease; expanding home health and hospice services; and the addition of Part C, Part D and Medigap plans. One such area of expansion that hasn’t previously been considered: routine vision care. That is, until recently. 

In 2019, two bills were introduced that would provide routine eye examinations and contact lens fitting services. Introduced in September, Lower Drug Costs Now Act also includes the establishment of several programs and requirements relating to the prices of prescription drugs, as well as routine hearing and dental care. This bill passed the House; however, with only two Republicans voting in favor, it’s unlikely the Senate will take it up. Introduced In October, the Medicare Vision Act has not moved past the House yet. The Medicare Vision Act only addresses vision care and not hearing or dental. 

What vision options do Medicare beneficiaries have?

Medicare is a powerful health system, but it’s a confusing one. With so many parts and plans it can be difficult to be sure what level of coverage you’re actually receiving. That means, for seniors with vision needs, it’s even more important to do your research and understand your options. Original Medicare coverage provided to you by the government when you turn 65, Original Medicare Part A and Part B, do not cover routine vision care. 

While the above-mentioned bills would be a welcomed solution to helping those who have paid into the Medicare program their entire lives get the comprehensive coverage they deserve as they age, it’s not their only hope. Even if we don’t see vision benefits added to Original Medicare coverage any time soon, there are other options. 

Option 1: Switch from Original Medicare to Medicare Advantage:

When you turn 65, you become eligible for Original Medicare Part A (hospital coverage) and Part B (medical coverage.) You can instead switch to Medicare Part C, a.k.a. Medicare Advantage (MA). MA plans cover the same benefits covered by Original Medicare Parts A & B; however, they usually include additional benefits like vision care and sometimes even hearing, dental and/or prescription drug coverage. Unlike Original Medicare, MA plans are provided by private insurance companies; however, the government still regulates the plans and there are strict enrollment periods.

Option 2: Supplement Original Medicare with a Stand-Alone Vision Plan:

Some beneficiaries purchase a Medicare Supplement insurance, or Medigap, plan to help cover out-of-pocket costs, like copays and deductibles, that Medicare Part A and Part B don’t cover. Like MA, Medigap plans are regulated by the government, but sold by private insurance companies. Unlike MA, Medigap plans do not replace Original Medicare – you keep your Medicare Part A and B if you purchase a Medigap plan. Despite common assumptions, these supplementary plans do not include vision coverage. You can however purchase a stand-alone vision plan from a private insurance company to supplement your Medicare. 

It’s hard to predict what the Medicare landscape will look like in the next couple of decades when today’s workforce begins to retire and our screen time takes an even bigger toll on our eyesight. With that said, no matter the landscape, what is important is that those with vision needs take the time to understand their options – especially those who are older. 

Poor vision can limit physical activity and increase isolation which can further deteriorate health in seniors, and vision care is paramount in extending the years seniors can live independently. This means being able to navigate their surroundings safely, as well as drive themselves to doctor’s appointments and read prescriptions is of utmost importance. With the likelihood of any policy changes happening soon being slim, seniors are left with reviewing options provided by private insurance companies.  

About the Author

 Dave Rich, CEO of Ensurem, has held various positions over his 35-year career in the insurance industry. Experienced in both the home office environment and independent distribution companies, Dave has a unique understanding of home-office decision-making as well as agent and consumer preferences. For the last 10 years, Dave has held the positions of Chief Operating Officer and Chief Marketing Officer of Amerilife Group LLC., one of the largest insurance marketing companies in the country. As Chief Marketing Officer, Dave helped acquire distribution and design unique products in the life, health and annuity marketplace. As Chief Operating Officer, Dave helped facilitate the reduction of expenses while increasing data security by consolidating servers, instituting security protocols and firewall systems. 

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