When someone comes to the Council for any of our vision services, the care they receive is not covered by most insurance, including Medicaid and Medicare. While the Council does work with providers like the Wisconsin Department of Workforce Development and the Office for the Blind and Visually Impaired on a fee for service basis, that covers only a small portion of the people we serve. That means the cost of vision services we provide must either be paid for by the client or absorbed by the Council. This creates an obstacle for both the client and the Council. While the Council does not turn people away due to inability to pay, the lack of insurance coverage may discourage people with limited income from seeking out these important services. It also puts a strain on Council resources.
Outside of direct medical care, such as eye surgery, Medicare has not covered nearly any other eye-related services since it was created almost 60 years ago. That’s largely because vision services, like those offered by the Council, are seen as social care rather than medical services. Medical services are those done by someone with a medical degree, such as a doctor, surgeon, occupational therapist (OT) or physical therapist (PT). Although more and more vision services providers are becoming accredited through the Academy for Certification of Vision Rehabilitation & Educational Professionals (ACVREP) and go through rigorous training, they are still not considered “medical,” and therefore are not covered by insurance. OTs are also able to receive vision rehabilitation training, and they can bill insurance for the vision services they provide. But pathways for OTs and other vision services providers are just now becoming available and are not yet widespread.
A strong argument can be made that vision services are much more than “social” and should be covered by medical insurance. Vision services are preventive care, offering long-term health benefits to people who are blind or low vision. One important example is that orientation and mobility (O&M) helps prevent falls. According to the Centers for Disease Control and Prevention (CDC), Wisconsin had the highest fall death rate among older adults in the United States in 2021, and falls are one of the leading causes of non-fatal injuries for adults 65 and older. People with vision loss are especially susceptible to falls because they may have difficulty seeing stairs and other obstacles. But many falls can be prevented through O&M training. That means those people can avoid lengthy and expensive hospital stays and learn to move through their home and community more safely and independently. This saves the insurance companies money in the long run.
Vision services can also provide better holistic care for people who are blind or low vision than Medicare currently offers. According to the VisionServe Alliance’s National Big Data Report on Working Age Adults, people aged 18-64 with vision loss experience depression at more than double the rate of those without vision loss. Medicaid does cover therapy visits, but most therapists do not understand the complexities of living with vision loss. Vision services, however, can help people navigate some of the underlying causes of depression and give people who are depressed the tools to live an independent life while making vision services more legitimate within the therapy and medical fields along the way.
Other preventive “social” services are covered by Medicare and other insurances. When someone is diagnosed with diabetes, their insurance will cover a diabetes educator to teach them about nutrition, proper exercise, and how to monitor their blood sugar. Medicare will also cover the services of certain social workers who can help people find mental health and medication management services. Medicaid can cover non-emergency medical transportation to help people get to their doctor’s appointments or to certain specialists if they do not have reliable transportation options. All these services are done by people without traditional medical degrees and are covered because they know they will lead people to better health outcomes. Vision services should be treated similarly.
Coverage of vision services by Medicare and other insurance providers would benefit everyone. For insurance companies, coverage of vision services would save money down the road, as the fees associated with these preventative services would mean fewer large medical bills later in life. Vision rehabilitation also saves money for nursing homes and assisted living facilities. Around 65% of people living in these facilities have vision loss, and proper vision rehabilitation skills could prevent people from moving into these facilities earlier than they need. Not only would this help people maintain their independence, but it would save Medicaid from having to pay for these facilities before they are fully needed. For clients, it would mean not having to worry about being turned away from services they desperately need because they are unable to pay. For the Council, it would provide greater financial stability and help validate the value of our work in the lives of people who are blind or low vision.
Coverage of vision services by both public and private insurance providers will not happen overnight. First, social care needs to be recognized as legitimate health care by the medical and insurance fields. Work needs to be done to show exactly how the work done by vision services providers like the Council leads to healthier lives. Second, concrete data showing how vision services are preventive care needs to be gathered and published. While we know through our work that O&M training leads to fewer falls in the home, there is currently little to no data to show to policymakers as evidence that our work leads to better health outcomes and fewer hospital visits. Finally, every option for potential coverage must be explored. It is unlikely that vision services will be covered by Medicare Part B, one of the most popular forms of Medicare. However, there are potential doorways to coverage under Medicare Advantage, which involves private health care plans. While these plans can be more restrictive, they may be a way to bring vision services into the picture and promote coverage for our services.
The Council, along with our partners at the national level, will continue to work hard to ensure everyone who is blind or low vision has access to vision services. Talk with your doctor and insurance provider about the importance of vision services in your life, and how the work of the Council and others in the vision services field keeps you safe, healthy and independent.
