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Why Vision Isn’t Covered in Your Health Insurance, and the Inequities It’s Causing

by | Jun 12, 2020 | Eye Health, Patient Resources | 1 comment

Our ability to see is sacred. That’s why Nanodropper is trying to help glaucoma patients preserve their eye health. It’s always a jarring experience when you or a loved one starts to have vision problems. The stories usually have a common theme — going into 9th grade, all of the sudden it was tougher to see the teacher’s writing on the board. Maybe you had to squint to make out the words on that construction sign you drove by. What about black splotches floating in your field of vision?

When these things happen, what do you do? You make a trip to the eye doctor to get it looked at.

After your visit, you check out and they give you the bill. Yikes.

Glasses, contacts, check-ups, and that air puff test to see if you have signs of glaucoma are not cheap! Vision insurance is a premium subscription on top of pricey health insurance, which is why most people choose to pay out-of-pocket or avoid going to the eye doctor altogether.

Have you ever wondered why your vision care is not included in your health insurance, and the inequities in care that is caused by this?

These are murky waters to navigate. That’s why we’ve broken down some of the biggest hurdles to why vision care is so elusive for many. 

An Intro to Eye Care

Most people don’t quite know the difference between optometrists and ophthalmologists. When do you need to see an ophthalmologist instead of an optometrist?

To put it simply…

  • An optometrist (OD), is an eye doctor that can do all the basics for you. Examine, diagnose, and treat your eyes. If you need contacts or glasses, this is who you’ll see. They can also treat uncomplicated cases of eye conditions before you’re referred to an ophthalmologist.

  • An ophthalmologist (MD), on the other hand, is a medical doctor who can perform medical and surgical interventions for all eye conditions. If you need cataract surgery, glaucoma surgery, have a complicated case of eye conditions, or require more specialized eye care, this is who you’ll see. 

 

If you have vision insurance, it typically covers the annual visit with an optometrist, and this acts as the first line of defense in finding the first signs of eye conditions. If you need specialty care, you are referred to an ophthalmologist at which point your medical insurance kicks in. Without the preventative care annual visits, many eye diseases go missed until they have progressed to a more serious state.

Many do go without these annual visits, and insurance is a big reason why.

Vision Insurance in the United States

Back in 1955, according to VSP Global, a group of optometrists started the very first vision insurance group with the “vision to provide access to affordable, high-quality eye care to the world.”

This group was called California Vision Services and had their humble beginnings as a non-profit company in Oakland, California. They grew to become the international corporation known as VSP Global, but this first group of optometrists set the stage for current-day vision insurance.

Your general health insurance plan usually doesn’t offer coverage when it comes to preventative eye health and vision care like when you need a new pair of glasses. As such, you are forced to buy supplemental or stand-alone vision insurance plans, pay out-of-pocket, or simply forgo obtaining vision care. This can be extremely frustrating and debilitating to your eye health. 

Why is this the Case?

Well, it comes back to the division between optometry and ophthalmology.

These separate professions offered separate services, which led to the development of separate payment policies and ultimately separate insurance plans. Due to the multi-payer and privatized evolution of health insurance in the United States, these insurance structures have continued to function largely independently.

It just depends on what your eyes need. 

The Difference?

  • Need to get your annual eye exam or glasses? Get vision insurance or pay-of-pocket.

  • Diagnosed with an eye disease that requires surgery or medication? Most health insurance plans have you covered. 

The Result?

According to a large study, nearly 50 percent of Americans do not enroll in vision coverage — so that routine visit to the optometrist has to be paid out-of-pocket. About 40 percent of adults who do not get their annual vision exam say cost and lack of insurance as the primary reason for not making that appointment. A consumer survey found that nearly 93 percent of respondents said vision coverage benefits are somewhat or very important, and 94.5 percent for general medical insurance.

At face value, this states that almost all Americans think vision insurance is nearly as important as having health insurance, yet half of Americans don’t bother with vision coverage. 

The Problem?

Well, if you don’t see an optometrist for your annual exam, most underlying eye problems will be overlooked, and you will never be referred to an ophthalmologist. Plus, you will never receive the glasses or contacts you need that could make your life clearer and more enjoyable. 

This explains why individuals without vision coverage are typically diagnosed with degenerative diseases like glaucoma and cataracts at an older age and have a higher likelihood of vision loss.

The Inequities within Vision Care

The division between optometry, ophthalmology, payment plans, and ultimately insurance plans, leads to further disparities and inequities among many Americans.

Unfortunately, the added complication and cost of acquiring vision coverage disproportionately affects people who already experience poor health and lower socioeconomic status — “that is, for those who generally need more care but are less able to obtain it,” writes an expansive 2016 National Academy of Sciences study on eye health.  

The inequities begin with those who rely on Medicare or Medicaid, and cascade downward from there. Medicare programs for those 65 and older don’t include routine eye exams, refraction testing or eyeglasses. It will, however, cover tests for higher risk conditions such as glaucoma and cover surgery and medical care related to the issue. People with Medicaid, primarily low-income individuals and families, have trouble getting appointments versus those who have private insurance. That’s because many practices simply don’t take Medicaid.

Regarding race and ethnicity, a recent study in the scientific journal Opthalmology revealed a disturbing trend regarding insurance coverage and disparities in glaucoma care, one of the diseases that should trigger vision insurance benefits: the odds of white Medicaid members having no glaucoma test were found to be nearly 200 percent higher than for those with their own health insurance. For black Medicaid members, the disparity is nearly 300 percent more than those with other insurance.

Less exams mean less insurance claims, but worse care for the patient.

Resources

hough some of this information is unsettling and can be disheartening, Nanodropper is committed to sharing valuable information and resources with the public. Our mission is to serve as many patients as possible by empowering them to take back control of their eye health. There are people and organizations around the world that are dedicating time and resources to help.

The National Institute of Health offers a list of resources for those seeking access to affordable eye care. Lions Club International is a worldwide network of chapters who have dedicated volunteers and locations across America, ready and willing to help. Visit their website to search for a chapter near you.

And the Nanodropper team wants to help as well! We are committed to providing up to date, vital information regarding access to eye health. If you have a specific need that isn’t being met and you don’t know where to turn, email us at info@nanodropper.com. We’re committed to preserving your vision.

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