Medicare Services for the Legally Blind

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.

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 isn’t just for people aged 65 and older. It’s for people with disabilities, too.

In 2017, 15% 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.

Original Medicare is made up of two parts — Medicare Part A hospital insurance and Medicare Part B health coverage. Standalone Part D plans provide prescription drug coverage.

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 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.

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% of the approved costs, along with 80% of any lab work or outpatient procedures.

You will pay the other 20% 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% of approved costs if you suffer an eye injury or trauma.

An artificial eye for patients with the 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% of the approved cost, and the Part B deductible applies.

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.

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.

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.

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.

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.