Medicare Vision, Dental and Hearing Coverage Bill

Medicare Legislation

The U.S. House has approved legislation that would create new Medicare coverage for refraction and contact lens fittings while providing seniors with an eyeglass and contact lens benefit.

The Medicare Vision Act (H.R. 4665), which passed the lower chamber as part of a larger Democratic legislative package aimed at following through on 2018 campaign promises to address spiraling medication costs, was sponsored by Reps. Kim Schrier, D-Wash., Tom O'Halleran, D-Ariz., Elissa Slotkin, D-Mich., and Suzan DelBene, D-Wash.  

The larger package, the Lower Drug Costs Now Act (H.R. 3), now goes to the Republican-controlled Senate where it faces strong opposition in its current form and remains unlikely to advance without significant changes. The Senate's own prescription drug package-which was a topic of discussion between AOA leaders and Senate Majority Leader Mitch McConnell, R-Ky., in an Oct. 4 meeting—does not include any plan to advance new Medicare vision coverage.  

As both Democrats and Republicans have explored changes to the Medicare program, AOA advocacy volunteers and staff have continued to be an active force in highlighting the important role that annual comprehensive eye exams play in keeping seniors healthy and independent, while also raising concerns about the harmful impact that an underfunded or unworkable Medicare benefit would have on doctors and patients.  

And, as with all Medicare-related bills on track for votes on Capitol Hill, the AOA stands firmly against any and all challenges to optometry's essential and expanding physician role in the program that serves more than 44 million seniors.   

AOA volunteers and staff were pleased to see that the Medicare Vision Act would not allow for benefit administration through stand-alone vision plans and would disallow benefit participation by unscrupulous materials sellers, as was recommended by AOA.  

However, while the AOA continues to work with lawmakers and remains open to finding a workable policy, AOA doctors and staff continue to communicate to Capitol Hill leaders that changes are needed to the Medicare Vision Act before it can advance.  

First, the AOA has made clear that without sufficient physician reimbursement and materials coverage levels the benefit would actually hurt doctors and their patients. While Medicare would ultimately determine reimbursement for refraction and contact lens fittings, concerns remain that payment would be too low and that patient access to care could be diminished.  

Further, as envisioned under the bill, Medicare would devote $85 for an eyeglass frame, $85 for eyeglass lenses, and $85 for a supply of contact lenses every two years. The AOA has raised concerns that this allotment will not be sufficient to cover the needs of seniors, especially for contact lenses.  

The AOA also has made clear to lawmakers that the two-year benefit timeframe envisioned under the bill deviates unacceptably from established care recommendations for annual eye exams for seniors, and-as it now is drafted-is likely to create new levels of patient confusion over materials supplies and access-particularly as it relates to contact lenses and most states allowing no more than a one-year contact lens prescription.  

There are a number of members of Congress who recognize these flaws and are committed to fixing it, including Rep. Bobby Rush D-Ill., who championed an AOA-backed amendment late in the process. The AOA will continue to work with both House and Senate leaders to address these issues. With Senate action unlikely, educating both House and Senate members on this legislation will be a top priority heading into 2020.

To help ensure that every U.S. House member and senator hears from doctors of optometry and students about the AOA's legislative priorities, please speak out through the AOA's Online Legislative Action Center or contact AOA's advocacy team to arrange a meeting with your federal elected officials.