Medicare Resists Calls to Provide Eyecare Coverage

Medicare does not pay for eyeglasses, including specialized vision aids for the legally blind. Courts have issued mixed rulings on what Medicare should pay for, but so far agency officials are not budging.

MADELEINE BRAND, host:

This is DAY TO DAY, from NPR News, I'm Madeleine Brand.

ALEX CHADWICK, host:

And I'm Alex Chadwick. An increasing problem for aging Baby Boomer Americans: poor vision. Macular degeneration, glaucoma and diabetes are some of the causes. There are new high tech devices that can help, but who's going to pay for them? NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO reporting:

Most people who are legally blind have some vision left. At the Columbia Lighthouse for the Blind, in Riverdale, Maryland, there's a room with rows of computers and video monitors that enlarge text. They're devices that can help people who've have lost most of their vision use the little vision they have left.

Ric Cruz teaches people how to use these devices.

Mr. RIC CRUZ (Columbia Lighthouse for the Blind): It's a pair of head mounted binoculars. It has two small screens that when you put them on it gives you the equivalent watching a 50-inch screen. Big vision right in front of your eyes.

SHAPIRO: People take these to football games, concerts or movies. They use them to watch television or simply to read. It's a spin-off of NASA's space technology, the space-age name the Geordi after Geordi LaForge of Star Trek.

Mr. CRUZ: He was a blind member who wore a funky pair of glasses. And he could see through them. So they named these after him Geordi.

SHAPIRO: So these are like Geordi's glasses?

Mr. CRUZ: Actually these are much bigger than Geordi. Because Geordi was in the future, so his stuff was much smaller.

SHAPIRO: And that's one thing that's clear from all the new devices here. Things are getting smaller, better and a lot is getting invented. Bobby Bobo(ph) works with Cruz. He says demand for technology like this will keep growing.

Mr. BOBBY BOBO: Our population is becoming more and more elderly, and as you become older you have vision issues, and people want to be able to lead a normal life.

SHAPIRO: Not many people use these devices now. In fact on this morning, there are no clients at the technology center. The problem is, these devices cost too much, a thousand dollars, a couple thousand or more. Sometimes a state program or an employer, usually a big one, will pay to keep someone working. One important insurer won't pay for these devices: Medicare, the health program for the elderly and disabled.

Mr. LAWRENCE WILSON (Medicare Representative): The eyeglass exclusion we believe applies broadly to vision care devices that use a lens.

SHAPIRO: That's Lawrence Wilson with Medicare. It's never covered regular eyeglasses, except in a few special cases. And it counts the low vision aids as a kind of eyeglass.

Mr. WILSON: This is a position that the agency has taken for a very, very long time. And now what we'd like to do is just ensure that it is clear to the public and others.

SHAPIRO: Make it clear, because some recent court rulings question why Medicare won't pay for low vision aids. So Medicare has proposed a rule that would specify they're in the same category as eyeglasses. There is a public comment period on the proposal until the end of this month.

Among those objecting to the proposed rule is Mark Richert of the American Foundation for the Blind.

Mr. MARK RICHERT (American Foundation for the Blind): This proposed rule rather astonishingly says that it will be in place and applied to all technologies in the future, regardless of technological advancement or innovation. So they really propose in this rule to slam the door not on existing devices, but anything that uses a lens to magnify a visual image.

SHAPIRO: Richert figures there are about six million people on Medicare right now, who could benefit from these devices. But that would cost hundreds of millions of dollars. So the question remains, who'll pay for this stuff in the future?

Back at the Columbia Lighthouse for the Blind, Ric Cruz thinks there's a hint from Star Trek. Did Medicare pay for Geordi's stuff?

Mr. CRUZ: Oh, I think Starfleet paid for his.

SHAPIRO: Joseph Shapiro, NPR News.

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