Medicaid and Medicare Adding More Vision Patients




In 2012, optometrists reached $1 billion in reimbursements for the first time under Medicare, according to the U.S. Centers for Medicare & Medicaid Services (CMS). While complete 2012 data is not yet available, CMS also estimates that 32,404 optometrists saw Medicare patients during 2011 and provided more than 11 million services.

These numbers are expected to increase even further as a result of the Affordable Care Act. The Medicaid expansion will increase coverage to millions of low-income Americans. Beginning in January 2014, individuals under 65 years of age with income below 133 percent of the federal poverty level will be eligible for Medicaid. For the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver, and parents of children will be eligible at a uniform income level across all states.

“Millions of Americans who previously fell through the cracks in terms of health care coverage will now be covered through Medicaid,” said Daniel B. Levy, OD, CPHM, chief optometric officer of Avesis.

Celina Burns, president of Davis Vision, predicts Medicaid will be an explosive growth area. “Optometrists need to look at how they view Medicaid,” she said, “because there will be lots more eligibility and the opportunity for vision benefit growth.”

According to a Review of Optometric Business report on “Challenges and Opportunities in the Future of Independent Optometry” sponsored by Vision Source, “The Affordable Care Act will cause a large increase in the population eligible for Medicaid benefits. In 2009, 15 percent of the population, or 48 million people, were covered by Medicaid. This number is projected to increase by 16 million people (another 5 percent of the population) under the more liberal eligibility requirements. Depending on practice location, this could cause a surge in the number of patients with vision benefits.”

Medicare, covering certain preventive services such as glaucoma tests and yearly wellness exams including a vision screening, is also expected to bring in more patients. Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B helps pay for corrective lenses (one pair of eyeglasses or one set of contact lenses). An increasing number of Medicare Advantage enrollees is likely to have a similar impact, increasing the number of patients covered for vision care.

“We’re seeing some increase in Medicare Advantage plans,” said Vincent Hayes, vice president, managed care, Nationwide Vision, “which is positive for the overall industry because they generally do have eye exam and hardware benefit.”

The ROB report predicts more Medicare patients as well: “Aging Baby Boomers will produce rapid growth in Medicare enrollment in the years immediately ahead. Currently there are 51 million Medicare beneficiaries (16 percent of the total population). Medicare beneficiaries will rise to 61 million in 2020 (19 percent of population) and to 70 million in 2025 (21 percent of population).”

However, the report concludes that there will be cost-cutting measures occurring at the same time as the burgeoning rolls of Medicare patients: “In 2012, 13 million Medicare beneficiaries, or 27 percent of total beneficiaries, were enrolled in Medicare Advantage programs, providing a supplement to their government-funded Medicare coverage. Enrollment is increasing 10 percent annually.” ■