Lack Of Insurance Exposes Blind Spots In Vision Care
Every day, a school bus drops off as many as 45 children at a
community eye clinic on Chicago’s South Side. Many of them are referred
to the clinic after failing vision screenings at their public schools.
Clinicians and students from the Illinois College of Optometry give the children
comprehensive eye exams,
which feature refraction tests to determine a correct prescription for
eyeglasses and dilation of their pupils to examine their eyes, including
the optic nerve and retina.
No family pays out-of-pocket for the exam. The program bills
insurance if the children have coverage, but about a third are
uninsured. Operated in partnership with Chicago public schools,
the program annually serves up to 7,000 children from birth through high school.
“Many of the kids we’re serving fall through the cracks,” said Dr.
Sandra Block,
a professor of optometry at the Illinois College of Optometry and
medical director of the school-based vision clinics program. Many are
low-income Hispanic and African-American children whose parents may not
speak English or are immigrants who are not in the country legally.
Falling through the cracks is not an uncommon problem when it comes to vision care. According to a
2016 report
from the National Academies of Sciences, Engineering and Medicine, as
many as 16 million people in the United States have undiagnosed or
uncorrected “refractive” errors that could be fixed with eyeglasses,
contact lenses or surgery. And while insurance coverage for eye exams
and corrective lenses clearly has improved, significant gaps remain.
The national academies’ report noted that impaired vision affects how
people experience their world, including normal communication and
social activities, independence and mobility. Not seeing clearly can
hamper children’s academic achievement, social development and long-term
health.
But when people must choose, vision care may lose out to more
pressing medical concerns, said Block, who was on the committee that
developed the report.
“Vision issues are not life-threatening,” she said. “People get
through their day knowing they can’t see as well as they’d like.”
Insurance can make regular eye exams, glasses and treatment for
medical problems such as cataracts more accessible and affordable. But
comprehensive vision coverage is often achieved only through a patchwork
of plans.
The Medicare program that provides coverage for millions of Americans age 65 and older
doesn’t include
routine eye exams, refraction testing or eyeglasses. Some tests are
covered if you’re at high risk for a condition such as glaucoma, for
example. And if you develop a vision-related medical condition such as
cataracts, the program will cover your medical care.
But if you’re just a normal 70-year-old and you want to get your eyes
examined, the program won’t cover it, said Dr. David Glasser, an
ophthalmologist in Columbia, Md., who is a clinical spokesman for the
American Academy of Ophthalmology. If you make an appointment because
you’re experiencing troubling symptoms and get measured for eyeglasses
while there, you’ll likely be charged anywhere from about $30 to $75,
Glasser said.
There are a few exceptions. Medicare will pay for one pair of glasses
or contact lenses following cataract surgery, for example. Some
Medicare Advantage plans offer vision care.
Many commercial health insurance plans also exclude routine vision
care from their coverage. Employers may offer workers a separate vision
plan to fill in the gaps.
VSP Vision Care provides vision care plans to 60,000 employers and
other clients, said Kate Renwick-Espinosa, the organization’s president.
A typical plan provides coverage for a comprehensive eye exam once a
year and an allowance toward standard eyeglasses or contact lenses,
sometimes with a copayment. Also, individuals seeking plans make up a
growing part of their business, she said.
Vision coverage for kids improved under the Affordable Care Act. The
law requires
most plans sold on the individual and small-group market to offer
vision benefits for children younger than 19. That generally means that
those plans cover a comprehensive eye exam, including refraction, every
year, as well as a pair of glasses or contact lenses.
But since pediatric eye exams aren’t considered preventive care that
must be covered without charging people anything out-of-pocket under the
ACA, they’re subject to copays and the deductible.
Medicaid programs for low-income people also typically cover vision
benefits for children and sometimes for adults as well, said Dr.
Christopher Quinn, president of the American Optometric Association, a
professional group.
But coverage alone isn’t enough. To bring down the number of people
with undiagnosed or uncorrected vision, education is key to helping
people understand the importance of eye health in maintaining good
vision. Just as important, it can also reduce the impact of chronic
conditions such as diabetes, the national academies’ report found.
“All health care providers need to at least ask vision questions when providing primary care,” said Block.
