Medicare seniors deserve better coverage for eye care

April 15, 2015
CAC panel discusses importance of comprehensive exams
2015 Congressional Advocacy Conference

AOA hosted officials from the U.S. Senate Special Committee on Aging, AARP—the group now working directly with the White House to plan the upcoming White House Conference on Aging—in a public forum to promote healthier aging by ensuring access to comprehensive eye exams for Medicare seniors.

"As individuals age, they are at greater risk for a significant number of eye diseases."

The forum took place at AOA's 2015 Congressional Advocacy Conference  on April 12. AOA hosted this special session in advance of December's White House Conference on Aging to inform federal agency officials and others of the importance of early and periodic eye exams and follow-up care for Medicare patients.  

In a discussion moderated by Beth Kneib , O.D., a panel of AOA leaders and other aging experts underscored the gaps in eye care to Medicare recipients. A consensus arose that needed reforms could improve access to diagnosis and care. AOA can play a part in this effort, noted panelist Derron Parks, staff director of the U.S. Senate Special Committee on Aging. "Your advocacy is really important for America's future," Parks said.  

Poor vision can lead to injuries

Older patients often have undiagnosed and untreated eye or vision problems, leading to issues such as preventable falls. "As doctors of optometry, we are all aware of the fact that as individuals age they are at greater risk for a significant number of eye diseases such as cataracts, age-related macular degeneration and glaucoma," said AOA President David A. Cockrell, O.D.   AOA maintains that seniors would benefit from greater access to comprehensive eye exams, which could detect risk factors for vision-related complications and prevent hospital readmissions. Doctors of optometry administer at least 70% of eye exams in the United States, Dr. Cockrell said.

"Optometry is often the entry point into the current health care system, making us true primary care providers," explained AOA Coding Expert Rebecca Wartman, O.D., a member of the AOA Third Party Center Executive Committee.

Experts acknowledge gaps in coverage

Medicare, however, doesn't routinely cover comprehensive eye examinations unless a patient has already been diagnosed with a specific medical condition or has a complaint or symptom of an eye problem caused by illness or injury.

In addition, there is currently no defined coverage benefit for low vision, noted Dale Lervick, O.D., a member of the AOA Federal Relations Committee. Without access to this care, seniors don't receive the care, he emphasized.  

AARP recognizes that gaps exist in Medicare benefits—not just with vision-related services, but also for most hearing and dental-related services too, said Deidra Lemons Johnson, the organization's senior advisor for operations, strategy and analytics.     

Medicare should cover vision—including eyeglasses, she said.  

Similarly, Parks said lawmakers needed to take a systemic, comprehensive look at Medicare coverage. "We really need help from associations like [AOA] and AARP ... to identify gaps and create a long-term strategy for Medicare," he said.  

AOA contends that greater Medicare coverage of comprehensive eye exams would result in improved health as well as cost savings. The Affordable Care Act ended up recognizing the importance of ocular health in children, which led to the pediatric vision benefit, Dr. Wartman said. "Why not the elderly?"

CAC panel discusses importance of comprehensive exams

(From left) Rebecca Wartman, O.D., AOA healthy aging expert; Deidra Lemons Johnson, AARP senior advisor; Beth Kneib, O.D., session moderator; Steven A. Loomis, O.D., AOA president-elect; Derron Parks, U.S. Senate Special Committee on Aging staff director; and Dale Lervick, O.D., AOA healthy aging expert; conclude the Health Policy Listening Session: Comprehensive Eye Exams and Healthy Aging.

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