Losing your vision can be frightening at any age. But as you get older, certain eye diseases become increasingly common. In fact, most cases of blindness in the U.S. occur in those aged 65 and over.
Medicare beneficiaries are most commonly senior citizens receiving Social Security retirement benefits.
The good news is that if you're considered legally blind, you may qualify for Medicare coverage even if you're not yet 65. While navigating Medicare can be complicated for anyone, there are some key benefits and programs you should know about as someone with a visual disability.
In this post, we’ll explain:
- What causes vision loss later in life
- How to qualify for Medicare if you’re legally blind
- What parts of Medicare help cover services and treatment for eye diseases
- Additional coverage options like Medicare Advantage, C-SNPs and D-SNPs
- And more!
Our goal is to help you understand the Medicare benefits available to those legally blind and receiving Social Security Administration disability benefits.
What Causes Vision Loss As We Age?
A number of eye conditions become more common as we get older:
- Diabetic retinopathy
- Macular degeneration
- Retinal detachment
In fact, over 4.2 million Americans aged 40 and over have low vision or legal blindness. And nearly two-thirds of those who are legally blind are seniors suffering from age-related eye diseases.
The Social Security Administration defines legal blindness 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."
So if your best eye is unable to be corrected to 20/200 vision or you have less than 20-degree visual field, you are considered legally blind.
Qualifying for Medicare Before Age 65 Due to Disability
One way you may qualify for Medicare coverage earlier than age 65 is if your visual disability makes you eligible for disability benefits.
The two main programs are:
- Social Security Disability Insurance (SSDI) - For those who have worked and paid Social Security taxes long enough to qualify. If approved for SSDI due to your blindness, you're automatically enrolled in Medicare after receiving benefits for 24 months in addition to your Social Security disability benefits.
- Railroad Retirement Board (RRB) Disability - For railroad workers totally and permanently disabled from all regular work. After 24 months of RRB disability benefits, you qualify for Medicare.
So in summary, if your low vision or blindness is disabling enough to meet Social Security or RRB disability criteria, you can get Medicare in 25 months even if you're not yet 65.
And the good news - you may be able to work some while on disability as long as your monthly income remains under certain limits. The current 2023 limit is $2,460 per month.
Enrolling in Medicare Coverage - Parts A & B
Medicare Part A covers hospital insurance and Part B covers outpatient services. Enrollment in Original Medicare (Parts A and B) happens automatically after you've received disability benefits for 24 months.
You'll be sent a Medicare card in the mail before your 25-month disability anniversary. Part A is free for most people, while Part B has a monthly premium.
Additional parts of Medicare that you must enroll in separately include:
- Part C (Medicare Advantage) - Private insurance plans that offer the same coverage benefits to Parts A and B. Many include extra benefits like vision coverage.
- Part D - Prescription drug plans to help cover medications.
You can sign up for Part C and D during your 7-month initial enrollment period when you first qualify for Medicare. If you miss this window, you can enroll during the annual open enrollment from October 15 to December 7 each year, with coverage beginning January 1.
And remember, you can request Medicare information in accessible formats like braille and audio recordings to assist with vision disabilities.
What Does Medicare Cover for the Legally Blind?
While Medicare doesn't pay for routine vision exams and glasses, it does help cover diagnosis and treatment for certain eye diseases that can cause blindness.
Medicare Part A helps pay for inpatient hospital care if you need eye surgery or treatment. You'll owe deductibles and coinsurance.
Part B provides:
- Coverage for exams to diagnose and treat eye conditions like macular degeneration, glaucoma, cataracts.
- 80% of costs for eye-related outpatient procedures and doctor visits. You'll be responsible for the other 20% unless you have additional coverage from a Medicare Supplement Plan or some Medicare Advantage plans.
- Eyeglasses after cataract surgery with an implanted intraocular lens.
Part D prescription plans may help cover eye drops, medications, and injections used for certain eye diseases if they are part of prescription drug coverage on the plan's approved drug formulary.
Most Durable Medical Equipment for Sight Impaired is Not Covered
Unfortunately, Medicare does not cover many routine vision care services and low-vision devices for the blind such as:
- Routine eye exams and glasses
- Contact lenses
- Magnifying devices
- White canes
- Lensed Devices
- and most low-vision aids
Medicare Advantage Plans
Although Original Medicare does not cover routine vision care, many Medicare Advantage (Part C) plans offered by private insurers do.
Medicare Advantage (also called Part C) plans are an alternative to Original Medicare. They are offered by private insurance companies approved by Medicare. Medicare Advantage plans are required to cover all the same services as Original Medicare, but many offer extra benefits too.
These can include vision, dental, hearing, prescription drugs, and more.
Medicare Advantage plans often have provider networks, so you'll need to use doctors in their network to get the full benefits.
You still have Medicare if you join a Medicare Advantage plan, but get your coverage through the Medicare-approved private insurer. Many people like Medicare Advantage plans because they can provide more benefits than Original Medicare in one bundled plan.
Benefits covered may include:
- Routine eye exams and glasses
- Contact lenses
- Cataract surgery
- Eye injections
- Vision-related medical supplies
Some Advantage health care plans have extra benefits for those with chronic conditions like legal blindness. These Chronic Special Needs Plans (CSNPs) are designed to provide focused care. Check with your licensed insurance agent if there are any qualifying Medicare CSNP health insurance plans in your area.
Dual Eligible Special Needs Plans (D-SNPs) - The Medicare & Medicaid Combo
Are you currently on or eligible for Medicaid? If yes, you may be able to receive even more Medicare benefits!
What is Medicaid?
Medicaid provides health coverage to eligible low-income Americans. It is jointly funded by state and federal governments. Medicaid services cover a range of health services, including doctor visits, hospital care, preventive screenings, prescription drugs, and more.
Each state has its own eligibility standards and determines which optional benefits are included. While Medicare is primarily for seniors 65 and over, Medicaid aids people of any age meeting income requirements.
The D-SNP Medicare Plan
Let's say you qualify for both Medicare coverage and Medicaid. In that case, you may be eligible for a D-SNP, a Medicare Advantage plan tailored to those with both Medicare and Medicaid.
As a legally blind individual with both Medicare and Medicaid, the potential benefits of enrolling in a D-SNP plan may include:
- $0 premiums
- Little to no copays
- Exclusive Special Enrollment Periods to make changes
- Transportation to medical appointments
- Vision, dental, and hearing benefits
- OTC drug coverage
- Prior authorization assistance
- Potential Additional Financial Assistance Benefits
D-SNPs can provide specialized coverage and coordination of benefits. So check if you qualify.
Get a Free Medicare Consultation
We hope this overview gives you a better understanding of the Medicare benefits available to those with legal blindness. Navigating your options can be difficult, but the licensed agents at EASY Insurance Plans are here to help!
Contact us today to discuss your Medicare questions. We offer FREE consultations and guidance to help you find the right Medicare coverage.
Additional Resources for the Visually Impaired
In addition to Medicare coverage, there are also many resources available specifically for those with vision disabilities:
- BlindShell USA - BlindShell USA offers a mobile phone specifically designed for the site loss community.
- The Free White Cane Program - The National Federation of the Blind provides free white canes to those who qualify by submitting an application.
- Talking Books Library - The National Library Service for the Blind offers free audiobooks and braille materials by mail.
- Vocational Rehabilitation - State and federal programs provide job skills training, assistive technology, and workplace accommodations for the blind or visually impaired.
- Scholarships - Various nonprofit groups offer scholarships to blind students pursuing higher education.
- Tax Deductions - On federal income taxes, blind individuals get an additional standard deduction. For 2023 it is $1,850 for single filers.
- Service Animal - While not covered by Medicare, some nonprofit organizations can help provide a service animal to assist the blind at reduced or no cost.
- Vision Assistive Equipment - Organizations like the American Foundation for the Blind provide grants and technology resources.
- Support Groups - Peer support groups for the blind and visually impaired are located throughout the U.S. You can access many of these through FindHelp.org
There are many state and national resources dedicated to helping those with blindness and low vision live independently. Be sure to explore what services or benefits may be available to you.