Medicare Payment Reform

AOA Federal Priority: Protecting Medicare Patient Access Through Payment Reform

As physicians, doctors of optometry provide the overwhelming share of primary, medical, chronic, urgent and emergency eye health care that America’s traditional Medicare and Medicare Advantage beneficiaries need—from comprehensive eye exams and vision correction treatment to laser surgical procedures and everything in between. Optometrists play an important role in the management of systemic diseases with ocular manifestations, including diabetes, hypertension, cardiovascular disease, autoimmune disease and neurologic disease.

• Doctors of optometry provides more than two-thirds of all primary eye and vision health care in the U.S., as well as covered medical eye care physician services to nearly 7 million Medicare beneficiaries annually.
  
  
• Today, approximately 34,000 optometrists are enrolled as Medicare physicians, serving patients in nearly 10,000 communities across the country. In roughly half of those communities, local optometrists are the only eye doctors available.

While doctors of optometry appreciate Congress taking repeated action to avert statutory Medicare payment cuts, Congress can and must do more to address the growing threat to access stemming from years of Medicare pay failing to keep up with the cost of providing care, as well as increasing Medicare Advantage abuses.

The AOA and other leading physician organizations urge lawmakers to support legislation that links Medicare physician payment to the Medicare Economic Index and advances needed Medicare Advantage reforms that hold plans accountable for limiting care and threatening access.

ISSUE BRIEF    ACTION CENTER

The Case for Reform: Why It Matters

Medicare patients depend on optometry: Doctors of optometry provide essential primary, medical, chronic, urgent and emergency eye health care to nearly seven million Medicare beneficiaries each year.

• Medicare pay is falling behind: Unlike hospitals, hospice providers and ambulatory surgical centers, doctors of optometry and other physicians do not receive automatic annual inflationary updates under Medicare. Adjusted for inflation, Medicare physician payments declined by 33% from 2001-2025.
  
  
• Rising costs threaten access: Years of stagnant Medicare payment have failed to keep pace with the increasing cost of providing care, placing additional strain on optometry practices and threatening patient access to essential eye health services.
  
  
• Medicare Advantage abuses are growing: Medicare Advantage enrollment has rapidly increased, with 55% of all Medicare enrollees covered by a Medicare Advantage plan. As these plans grow, many are increasingly deploying tactics that reduce reimbursement, delay payments and create barriers to needed care.
  
  
• Payment delays hurt patients and practices: Medicare Advantage plans have implemented systems that can drastically delay payment for care already provided, contributing to hospitals, provider groups and larger health systems dropping out of Medicare Advantage contracts.
  
  
• Supplemental vision benefits create confusion: Although nearly all Medicare Advantage plans include a vision benefit, only 54.3% of beneficiaries were aware they had vision coverage. AOA survey data also found that 96% of responding doctors of optometry have had to address Medicare Advantage patients who were angry or unhappy with their coverage and benefits.
  
  
• Coverage challenges delay care: In the AOA survey, 92% of responding doctors of optometry indicated that Medicare Advantage contracting and coverage challenges have led to patients delaying needed medical eye care.

Legislative Action: What AOA is Doing

The AOA is urging Congress to advance bipartisan reforms that protect patient access, strengthen physician payment stability and rein in Medicare Advantage abuses.

• The Strengthening Medicare for Patients and Providers Act, H.R. 6160, would permanently link Medicare payment for doctors of optometry and other physicians to the Medicare Economic Index, helping ensure payment keeps pace with the rising cost of providing care.
  
  
• The Prompt and Fair Pay Act, H.R. 4559, would require Medicare Advantage plans to reimburse doctors of optometry and other health care providers at least at the same rate as traditional Medicare and help stop plans from needlessly delaying payments for needed care already provided to patients.

The AOA will continue working with physician organizations and lawmakers to ensure Medicare payment policy reflects the essential role doctors of optometry play in caring for America’s seniors and protects patient access to timely, local eye health and vision care.

Questions? Please direct questions regarding the AOA’s federal priorities to our Federal Advocacy Team.

Medicare Payment Reform Resources