Medicare Services for the Legally Blind
Medicare provides screenings and treatment for several eye conditions that can lead to blindness, including macular degeneration and glaucoma. If you are visually impaired and collect Social Security disability benefits for at least 24 months, you are automatically enrolled in Medicare.
What Causes Blindness and Low Vision?
More than 4.2 million Americans age 40 and older are either legally blind or have low vision, according to the Centers for Disease Control and Prevention.
Blindness can affect people of all ages. But older people are at the highest risk for developing severe eye diseases.
Age demographics about people with vision loss are limited but it’s estimated that two-thirds of the legally blind are seniors who lost their vision as a result of age-related eye disease.
- Diabetic retinopathy
- Other retinal disorders, such as Stargardt disease and rod-cone dystrophy
- Macular degeneration
The Social Security Administration defines the term legally blind as: “Vision (that) can’t be corrected to better than 20/200 in your better eye, or if your visual field is 20 degrees or less in your better eye for a period that lasted or is expected to last at least 12 months.”
Medicare for People on Social Security Disability
Medicare isn’t just for people age 65 and older. It’s for people with disabilities, too.
In 2017, 15 percent of all Medicare beneficiaries were younger people with disabilities, according to the Kaiser Family Foundation.
Several health conditions — including low vision and blindness — can qualify you for Medicare disability before age 65.
If you have received Social Security disability income for 24 months, you are automatically enrolled in Medicare — regardless of your age.
Whether you qualify for Medicare due to age or disability, the benefits are the same.
Or you can sign up for a Medicare Advantage plan. This is a bundled all-in-one alternative to Original Medicare. These plans are administered by private insurance companies that contract with the Centers for Medicare & Medicaid Services, or CMS.
Medicare Advantage plans must offer the same benefits as Original Medicare, but often include other coverage such as dental and hearing.
Medicare Part B Low Vision Services
Medicare only provides coverage for services it deems medically necessary. Routine eye exams and glasses aren’t covered under Original Medicare.
However, treatment and screenings for several eye diseases that can cause blindness or jeopardize your vision are covered.
- Diabetic retinopathy
- Detached retina
- Macular degeneration
Medicare Part B covers visits to an ophthalmologist or other vision specialist to treat these conditions.
This doesn’t mean the services are free, though.
Medicare will pay 80 percent of the approved costs, along with 80 percent of any lab work or outpatient procedures.
You will pay the other 20 percent and the Part B deductible applies.
A Medigap supplement insurance plan can help cover these costs. You may also pay less if you’re dual eligible for Medicaid.
Drugs or eye drops may be prescribed to treat certain eye conditions, such as glaucoma. Your Medicare Part D plan usually provides coverage for this, but your out-of-pocket costs will depend on your Part D plan’s formulary.
Medicare will also cover 80 percent of approved costs if you suffer an eye injury or trauma.
An artificial eye for patients with absence or shrinkage of an eye due to a birth defect, trauma or surgical removal is also covered. It is considered a piece of durable medical equipment, so you will owe 20 percent of the approved cost, and the Part B deductible applies.
Medicare Offers Accessible Options for the Visually Impaired
In 2016, three blind beneficiaries partnered with the National Federation of the Blind to sue CMS. They alleged that the federal agency failed to provide meaningful and equal access to Medicare information in accessible formats.
The effort was successful. In 2018, a settlement was reached, requiring CMS to set up processes that allow beneficiaries to make a single request and receive all Medicare communications in an accessible format.
If you have low vision, you can request Medicare information in large print, braille, audio and electronic formats.
- Providing accessible, fillable forms for beneficiaries on Medicare.gov.
- Giving beneficiaries who request accessible formats more time to respond to CMS communications.
- Creating a plan to promote the availability of accessible Medicare materials.
- Training employees on compliance with Section 504 of the Rehabilitation Act of 1973.
- Testing to ensure that information on Medicare.gov is accessible.
- Providing popular CMS publications in accessible e-book formats.
- Allocating special staff to coordinate and support CMS’ accessible Medicare communications.
To request Medicare publications in accessible formats, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Or email AltFormatRequest@cms.hhs.gov.
Remember, if you request information from CMS in an alternative format, you won’t be disadvantaged by any additional time it takes the government to provide it to you.
For more information about accessibility and nondiscrimination, visit the Medicare website.
What Medicare Doesn’t Cover
Not all eye conditions can be prevented, treated or cured.
When vision loss is permanent, you will require services or equipment to help you adapt and retain your independence.
- Visual aids, such as electronic magnifiers and video monitors
- Special software that enlarges computer text or reads text out loud
- Transportation services
- Assistive tools, such as large print calendars and talking watches
- Rehabilitation services to teach you daily living skills, such as cooking and how to use a white cane
- Vocational services to help make your workplace more accessible or train you in a new career
Efforts to Expand Medicare Coverage of Low Vision Devices
Low vision devices, such as high-power magnifiers and video monitors, can greatly improve independence and safety for the visually impaired.
Yet, in 2008, CMS created a new rule that excludes any device with a lens from Medicare coverage.
Nonprofit organizations, such as the American Foundation for the Blind, continue to fight this rule. They want low vision aids to be considered durable medical equipment that’s eligible for Medicare reimbursement.
However, Congressional action is required to revise this exclusion.
The American Foundation for the Blind continues to lobby federal lawmakers to reintroduce legislation for a fiscal study that analyzes the impact of including low vision devices as durable medical equipment under Medicare Part B.
The most recent bill, HR 4129, was introduced by Democrat Congresswoman Carolyn Maloney in 2019. The bill failed to make it out of committee.
State Services for the Visually Impaired
Each state administers programs for the blind and visually impaired. These departments match you with the resources you need. Names can vary by state.
For example, in Michigan, the Department of Labor and Economic Growth administers the Michigan Commission for the Blind, while in Florida, the Division of Blind Services is overseen by the state’s Department of Education.
These statewide departments contract with local agencies to offer services and training in your community.
Enhanced Vision, a company that provides information and products for the visually impaired, offers a comprehensive state-by-state list of low vision agencies.
These agencies are state or federally funded, so many services are free for those who qualify.
However, funding for visual aids and equipment may be more limited for older blind adults compared to young working adults who enroll in vocational rehabilitation programs.
- National Library Services for the Blind
- Each state offers special library and literary services for the visually impaired, including braille and talking books that can be sent to your home postage-free. Some libraries also offer large-print books and described DVDs. You can visit the Library of Congress’ website for a state-by-state list of participating libraries or call 1-888-657-7323 to connect with the library service in your area.
- Free White Cane Program
- The National Federation of the Blind distributes free white canes to those who qualify. You can apply for one by completing an online form here.
- American Council of the Blind’s Resource List for Older Adults
- This page offers a comprehensive list of different agencies and programs across the country to assist older, visually impaired adults. It also includes a list of places to purchase visual aids and equipment.
- Blind Rehabilitation Services for Veterans
- The Department of Veterans Affairs provides a wide range of blind and vision rehabilitation programs to eligible veterans, including independent living skills classes, adaptive technology and vocational training. This care is organized by case managers known as Visual Impairment Services Team, or VIST, coordinators. You can find a VIST coordinator near you by calling the VA’s Blind Rehabilitation Service Program office at 202-461-7317 or visit their website for more information.
- Additional Tax Deduction Benefits for the Blind
- In 2020, a single blind person can take an additional deduction of $1,600 on top of the standard deduction afforded to everyone else when he or she files federal taxes. If you are also 65 years or older, you qualify for a separate additional deduction. To qualify as blind, you must get a certified statement from an eye doctor confirming that you can’t see better than 20/200 in your best eye with glasses or contact lenses, or your field of vision is 20 degrees or less. If your vision isn't likely to improve, make sure your doctor notes this. Refer to IRS Publication 501 Dependents, Standard Deduction, and Filing Information or ask a tax professional for help.
20 Cited Research Articles
- Centers for Disease Control and Prevention. (2020, June 12). Vision Loss and Age. Retrieved from https://www.cdc.gov/visionhealth/risk/age.htm
- Centers for Disease Control and Prevention. (2020, June 3). Common Eye Disorders and Diseases. Retrieved from https://www.cdc.gov/visionhealth/basics/ced/index.html/
- Reinberg, S. (2020, March 12). Rising Number of Older Americans at Risk of Vision Loss. Retrieved from https://www.usnews.com/news/health-news/articles/2020-03-12/rising-number-of-older-americans-at-risk-of-vision-loss
- Social Security Administration. (2020). If You’re Blind Or Have Low Vision — How We Can Help. Retrieved from https://www.ssa.gov/pubs/EN-05-10052.pdf
- Congress.gov. (2019, July 31). H.R.4129 - Medicare Demonstration of Coverage for Low Vision Devices Act of 2019. Retrieved from https://www.congress.gov/bill/116th-congress/house-bill/4129/text?format=txt&r=6&s=1
- National Federation of the Blind. (2018, April 23). Medicare Information to Become Accessible to Blind Beneficiaries. Retrieved from https://www.nfb.org/about-us/press-room/medicare-information-become-accessible-blind-beneficiaries
- Centers for Medicare & Medicaid Services. (2018, April). Medicare Vision Services. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/VisionServices-FactSheet-ICN907165TextOnly.pdf
- American Federation for the Blind. (2017, October 5). Takeaways from "Medicare Should Pay for Low Vision Devices: Views Through Different Lenses" Teleseminar. Retrieved from https://www.afb.org/blog/entry/takeaways-medicare-should-pay-low-vision-devices-views-through-different-lenses
- Kaiser Family Foundation. (2017). Distribution of Medicare Beneficiaries by Eligibility Category. Retrieved from https://www.kff.org/medicare/state-indicator/distribution-of-medicare-beneficiaries-by-eligibility-category-2/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
- American Foundation for the Blind. (2013, January). Special Report on Aging and Vision Loss. Retrieved from https://www.afb.org/research-and-initiatives/aging/special-report-aging-vision-loss
- American Council of the Blind. (n.d.). Are You a Senior Citizen Struggling with Vision Loss? Retrieved from https://www.acb.org/are-you-senior-citizen-struggling-vision-loss
- American Foundation for the Blind. (n.d.). Medicare, Medicaid, and Social Security Policy. Retrieved from https://www.afb.org/blindness-and-low-vision/your-rights/medicare-medicaid-and-social-security
- Benefits.gov. (n.d.). Independent Living Services for Older Individuals Who Are Blind. Retrieved from https://www.benefits.gov/benefit/643
- Centers for Medicare & Medicaid Services. (n.d.). Medicare Rights & Protections. Retrieved from https://www.medicare.gov/Pubs/pdf/11534-medicare-rights-and-protections.pdf
- Enhanced Vision. (n.d.). Low Vision Resources by State. Retrieved from https://www.enhancedvision.com/low-vision-resources.html
- Mayros, R. (n.d.). A History of Medicare Reimbursement for Vision Rehabilitation Professionals – Part I. Retrieved from https://visionservealliance.org/uncategorized/a-history-of-medicare-reimbursement-for-vision-rehabilitation-professionals-part-i/
- Medicare.gov. (n.d.). Accessibility & Nondiscrimination Notice. Retrieved from https://www.medicare.gov/about-us/accessibility-nondiscrimination-notice
- National Federation of the Blind. (n.d.). Free White Cane Program. Retrieved from https://www.nfb.org/programs-services/free-white-cane-program
- VisionServe Alliance. (n.d.). Working to Achieve Medicare Coverage of Low Vision Devices. Retrieved from https://visionservealliance.org/tag/medicare-reimbursement/
- U.S. Department of Veterans Affairs. Visual Impairment Services Team (VIST) Coordinators. (n.d.). Retrieved from https://www.prosthetics.va.gov/blindrehab/VIST.asp