New research funded through the National Institutes of Health (NIH) and published in Health Affairs has identified a significant number of Medicaid enrollees across the United States who do not have coverage for essential vision care needs.
Let’s start with the basis for this research.
While Medicare is a federal government program with national rules and guidelines, eligibility and coverage policies are determined by each state. This extends to vision care coverage for adults.
- To note: Federal law mandates that children/adolescents are entitled to specific services, including vision.
Give me some numbers.
As of April 2024, over 74 million adults in the U.S. were enrolled in Medicaid—translating to an estimated 18.8% of the population.
Zeroing in on vision:
- An estimated 12 million adults aged 40+ in the U.S. are reported to have vision impairment —including 1 million of that total with blindness.
- Further: Uncorrectable vision impairment impacts 4.2 million adults (aged 40+)—with that number projected to double by 2050.
And on a financial note?
The Centers for Disease Control and Prevention’s (CDC’s) 2017 cost estimates for the U.S. economic burden of vision loss and blindness clocked in at $134.2 billion, which encompassed medical, nursing home, and supportive services as well as lost production and informal care.
That number is expected to increase to $373 billion by 2050.
So with this in mind …
Investigators conducted a comprehensive, state-by-state analysis of 2023-2023 Medicare coverage policies for basic vision services of adults in both fee-for-service and managed care.
What did they discover?
In general that state-level Medicare vision coverage greatly varied—and not for the better.
- A total of 20 states’ fee-for-service policies did not cover glasses
- Out of those 20, 12 states’ policies did not cover eye exams
Plus: A reported seven states did not cover eye exams or glasses under both fee-for-service and managed care policies
- To note: No data was available for Hawaii
Seven states?! Which ones?
Per the analysis, according to the NIH:
- Arizona
- Idaho
- New Mexico
- Oklahoma
- Tennessee
- West Virginia
- Wyoming
Do any states cover annual exams and glasses?
Just eight offer fee-for-service coverage:
- Alaska
- Arkansas
- Kansas
- Nevada
- New Hampshire
- New Jersey
- Ohio
- Wisconsin
What about biannually?
Eighteen! Including:
- Alabama
- California
- Connecticut
- Florida
- Illinois
- Iowa
- Massachusetts
- Michigan
- Minnesota
- Missouri
- Montana
- Nebraska
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Dakota
- Texas
See a map of which states cover eye exams and glasses less frequently than biannually.
And which state was most restrictive in its glasses coverage?
Maine.
The finding: Glasses were covered only once per lifetime, and only for people who required an unusually strong prescription to correct their vision.
Now talk Medicaid enrollee numbers.
The analysis found that 6.5 million Medicaid enrollees (12%) lived in states with no coverage for routine adult eye exams, while 14.6 million (27%) lived in states with no coverage for glasses.
How much would an eye exam cost without insurance?
Based on Medical Expenditure Panel Survey data, an estimated $485 out-of-pocket—”which is more than a third of the monthly income for a single adult living at or below the federal poverty level,” the NIH stated.
So what’s the key takeaway from this?
Study author Brandy Lipton, PhD, noted that the “study clearly shows that there are opportunities to expand coverage of routine vision services at the state level.”
National Eye Institute (NEI) Director Michael F. Chiang, MD, added: This study points to opportunities for expanding coverage to reduce inequities in basic vision care for people with lower incomes.”