当医疗补助支付账单时：双重资格 Medicare 参保人的常规视力福利、眼科服务使用与眼镜支出
When Medicaid Pays the Bill: Routine Vision Benefits, Eye Care Use, and Eyeglasses Spending Among Dual-eligible Medicare Enrollees
NBER Working Papers · 2026 · [{"name": "Michel H. Boudreaux", "affiliation": []}, {"name": "Brandy Lipton", "affiliation": []}, {"name": "Melissa McInerney", "affiliation": []}]
中文摘要
视力问题在 Medicare 受益人中普遍存在，其中大多数人患有可治疗的疾病，包括未矫正的屈光不正和白内障。然而，传统 Medicare 并不覆盖常规眼科检查或眼镜，而 Medicare Advantage 的补充视力福利通常设有较低的年度限额。我们考察了 Medicaid 常规视力福利对同时符合 Medicare 和 Medicaid 资格的成年人——这一人群视力障碍、发病率和残疾率均较高——的影响。利用 2002—2019 年 Medicare Current Beneficiary Survey 数据并采用双重差分设计，我们估计 Medicaid 常规视力福利增加了过去一年的眼科检查、眼镜购买以及 Medicaid 在眼镜上的支出，同时降低了自付支出。我们还发现了提示性证据，表明这些福利对 Medicare Advantage 眼镜支出存在溢出效应，这与 Medicaid 常规视力保障促使拥有补充视力福利的 Medicare Advantage 参保人额外购买眼镜的情况相一致，尽管估计幅度较为有限。
Abstract
Vision problems are prevalent among Medicare beneficiaries, with the majority having treatable conditions including uncorrected refractive error and cataracts. However, traditional Medicare does not cover routine eye exams or eyeglasses, and Medicare Advantage supplemental vision benefits often include low annual limits. We examine the effects of Medicaid routine vision benefits among adults dually eligible for Medicare and Medicaid, a population with high rates of vision impairment, morbidity, and disability. Using 2002-2019 Medicare Current Beneficiary Survey data and a difference-in-differences design, we estimate that Medicaid routine vision benefits increase past-year eye exams, eyeglasses purchases, and Medicaid spending on eyeglasses while reducing out-of-pocket spending. We also find suggestive evidence of spillovers to Medicare Advantage spending on eyeglasses, consistent with Medicaid routine vision coverage inducing additional eyeglasses purchases among Medicare Advantage enrollees with supplemental vision benefits, although estimates are modest.