AOA advocacy helps shape new U.S. House bill to expand essential eye health and vision coverage for Medicare beneficiaries

July 1, 2021
The AOA continues to be at the forefront of discussions with lawmakers over the makeup of new legislation that would grant all traditional Medicare beneficiaries a new refraction and materials benefit.
Senior Eye Exam

Seniors stand to gain a significant benefit with legislation before Congress that would add new coverage for refraction and materials to the list of comprehensive eye health and vision care that America’s doctors of optometry provide to millions of Medicare beneficiaries each year.

Introduced June 28 in the U.S. House by Reps. Kim Schrier, M.D., D-Wash.; Tom O’Halleran, D-Ariz., Elissa Slotkin, D-Mich.; and Suzan DelBene, D-Wash.; H.R. 4187, the Medicare Vision Act of 2021, would expand Medicare Part B coverage to include coverage for routine vision care services and materials for the program’s 60 million seniors and younger people with disabilities. This expansion would not only realize the preventive health benefits afforded by routine eye care, including the early detection of systemic disease, but also help seniors retain their sight and independence through affordable vision coverage.

“The Medicare Vision Act is designed to provide a needed expansion of essential eye health and vision care for Medicare beneficiaries, and the AOA proudly supports it,” says AOA Immediate Past President William T. Reynolds, O.D. “The AOA salutes the health policy leadership of Reps. Schrier, O’Halleran, Slotkin and DelBene, and their efforts to keep doctor-patient decision-making at the center of health care and especially in the Medicare program.”

Medicare currently does not provide coverage for annual, comprehensive eye exams—only covering a complete exam if a medical condition is found—and typically requires beneficiaries to pay 100% of costs for eyeglasses or contact lenses, creating conditions wherein many seniors either delay or completely forgo the annual eye exams they need. Medicare Advantage plans may provide some of these benefits; however, this coverage costs seniors extra and many plans feature practices that are harmful to doctors and patients.

With significant input from the AOA spanning nearly two years, H.R. 4187 would: 

  • Expand Medicare Part B coverage to include annual refraction and contact lens-fitting services.
  • Ensure direct administration of the benefit by Medicare, keeping abusive vision plans from subcontracting to provide the benefit.
  • Provide coverage up to $100 for one pair of eyeglasses or a one-year supply of contact lenses each year.
  • Require that the materials benefit be administered by Medicare’s Durable Medical Equipment program, helping to keep unscrupulous materials sellers from taking advantage of seniors and taxpayers.
  • Provide a pathway to coverage for critical low-vision aids often necessary given the complex medical needs of an aging population.

“We want to make sure that seniors can live independently for as long as possible. An important factor of independent living is making sure that they can see well enough to drive to appointments, walk safely around the house and carefully read prescriptions,” Rep. Schrier notes in a statement. Read what other members of Congress had to say about H.R. 4187.

Adds Rep. Schrier, a pediatrician with 20 years of experience serving northwest Washington families: “The pandemic has made it harder to access support or assistance for those who need it. As a doctor, I am concerned about the number of older Americans who haven’t had an eye exam in more than a year and might have undiagnosed eye conditions, like macular degeneration or glaucoma. People with poor vision can suffer from decreased physical activity and increased social isolation, which can lead to deteriorating health. Expanding access in Medicare to cover vision services and low vision aids will ensure that both older Americans and young Americans with disabilities have access to affordable care.”

Over a third of Medicare beneficiaries have vision problems, yet more than half (57%) fail to receive a yearly eye examination. Such is the case, the AOA is a leading proponent of H.R. 4187, providing specific policy recommendations focused on optometry’s essential role in meeting needs of Medicare patients and the importance of the doctor-patient relationship in delivering healthy outcomes. As recently as last month, optometry’s advocates championed the necessity of a new Medicare vision benefit in more than 300 virtual meetings with members of Congress during the 2021 Virtual AOA on Capitol Hill, May 23-25. And there’s clear evidence that optometry’s voice is being heard.

With a Senate version of the Medicare Vision Act of 2021 possibly forthcoming in the weeks ahead, key members of Congress are already discussing potential language, including Sen. Bernie Sanders, I-Vt., who recently voiced his support for expanding Medicare to include vision coverage.

Expanding affordable access to eye care services

Too many American seniors are going without needed eye and vision care because Medicare does not cover annual, comprehensive eye exams, which are an important part of ensuring that seniors see their best, prevent falls, stay independent and maintain their quality of life. But when Congress first took up this issue, the AOA diligently provided input to ensure the benefit expansion accomplished what it purported to provide.

In December 2019, House Democrats fulfilled a campaign promise by approving a drug pricing bill that included provisions to create new Medicare vision, dental and hearing coverage. However, the AOA warned that original iteration fell short of what was necessary as it included restrictive coverage of refractions and contact lens fittings, and a two-year exam benefit. The Senate version of the bill did not include the Medicare coverage expansion, but the AOA remained involved in conversations moving forward.

Now, with reintroduction of the House bill in the current Congress, the AOA is poised to fend off insurers and other payers who may try to gain control of this new benefit.

“The AOA will continue fighting for our rightful seat at the table as Congress over the next few weeks and months considers the creation of a new refraction and materials benefit under traditional Medicare,” noted Deanna Alexander, O.D., AOA Federal Relations Committee member, during the Virtual AOA on Capitol Hill.

“We know that our combined advocacy will be key to getting this potential benefit right, especially considering that some insurers and other payers are already trying to gain control of it, impose restrictions on the professional judgement and authority of doctors, and segment vision from overall patient health.”

Build support for the Medicare Vision Act

The AOA urges the profession’s support of this priority legislation that stands to help seniors affordably access the level of eye health and vision care necessary to keep them living full, healthy and independent lives. Here is how you can act: 

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