For the last 15 years, my family has purchased an individual health insurance policy. Individual plans, as opposed to employer-based insurance, usually don’t cover vision. We could buy a separate vision policy, but in an average year the premiums would cost more than our annual eye exams, glasses and contacts combined.
Even Medicare doesn’t pay for routine eye exams and corrective lenses, except one pair after cataract surgery.
Of course, eye diseases and injuries (your mother always told you not to run with pointy objects, didn’t she?) are covered as medical care.
But I’ve always wondered why screening exams for vision are not covered. Rather than pay expensive out-of-pockets prices, many people forgo routine eye exams that can find common conditions such as age-related macular degeneration (AMD) and glaucoma.
AMD, the deterioration of the central part of the retina, causes severe vision loss, mostly in patients over 60. WebMD writes “Early detection of AMD is very important because there are treatments that can delay or reduce the severity of the disease.”
Glaucoma, nerve damage caused by increased pressure in the eye, affects 2.5 million Americans and is considered the leading cause of vision impairment and blindness. WebMD states “Finding and treating glaucoma early is important to prevent blindness.”
With both diseases, once you experience the vision problems that lead you to make an appointment with an eye doctor, the damage is irreversible.
Related: WebMD has a great online tool called Spotting Vision Problems that allows you to “see” what your vision would be like with different eye conditions such as cataracts, glaucoma or AMD.
The United States Preventive Services Task Force (USPSTF) gives glaucoma screening an I (inadequate) recommendation. In other words, there is simply not enough research upon which they can base an opinion.
The American Academy of Opthalmology (AAO) has its own Preferred Practice Patterns Guideline, and recommends adults over the age of 40 have their eyes checked every one to three years.
In 2008, the Centers for Disease Control (CDC), using data from its Behavioral Risk Factor Surveillance System (BRFSS), concluded that:
- Lack of vision insurance impedes eye care utilization, which, in turn, may irrevocably affect vision.
- Vision insurance for preventive eye care should cease to be a separate insurance benefit and should be mandatory in all health plans.
The AAO and the American Optometric Association (AOA) were hoping that the Department of Health and Human Services (HHS), as it fine-tuned Obamacare’s “preventive services” and “essential benefits,” would include vision care for adults as well as children.
It didn’t. (Perhaps the AAO needs to hire a better lobbyist?)
I admit I am not a fan of mandates and have questioned some of the “essential benefits” selected by HHS. Nevertheless, I consider my eye health to be important enough that I will continue to pay the outrageous out-of-pocket costs to make sure my eyes are healthy, and that any problems are detected early enough to be treated effectively and less expensively.