About the Data: Medicare

Key points

  • VEHSS includes two datasets containing summary prevalence estimates from Research Identifiable Medicare files: Medicare Fee for Service (FFS) and Medicare FFS+Medicare Advantage (MA).
  • The Medicare FFS dataset includes estimates from Medicare FFS medical claims beginning in 2014.
  • The Medicare FFS+MA dataset includes estimates from combined Medicare FFS claims and MA encounter records beginning in 2021.
  • VEHSS topics: Vision Problems and Blindness, Vision Care Services, Age-related Macular Degeneration (AMD), Cataract, Diabetic Retinopathy (DR), Glaucoma, Other Eye Disorders.
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Where the data come from

Access the data

Explore Medicare FFS and Medicare FFS+MA summary data in the VEHSS Data Explorer. Directly access and download the Medicare FFS and Medicare FFS+MA summary data in the data portal.

The VEHSS analysis of Medicare FFS includes all reimbursed claims for all Medicare beneficiaries enrolled in traditional FFS plans. Medicare FFS+MA includes all patients enrolled in Medicare, including both FFS and MA plans. As of 2020, about half of Medicare beneficiaries were enrolled in MA plans. VEHSS does not separately report data for MA plans alone.

Medicare, including FFS and MA, covers ophthalmologic services for nearly the entire U.S. population aged 65 and older and people younger than 65 who have received Social Security benefits as a result of disability for 24 months; people who have end-stage renal disease and receive dialysis or a kidney transplant; and people who have amyotropic lateral sclerosis (ALS). Like others with a disability, people with U.S.-defined blindness (a best corrected acuity of 20/200 or worse in the better-seeing eye) become eligible for Medicare 24 months after qualifying for federal disability benefits. Medicare FFS does not cover certain services, including optometry care, glasses, or routine eye exams in the absence of a diagnosis. Coverage of these services by MA carriers varies by plan and policy.

Please see the Research Data Assistance Center website for a description of each file.

See Also Download the full Medicare Data Documentation Report
See Also Download the Claims and Registry Data Analysis Plan

Analysis overview

The VEHSS team calculated prevalence of diagnosed eye and vision disorders and the proportion of patients receiving covered eye care services in Medicare claims and encounters based on the presence of ICD-9 and ICD-10 diagnosis codes and CPT procedure codes on any patient claim during the year of observation.

VEHSS reports summary prevalence and counts for the topics and categories listed for each geographic level and stratification factor listed below:

  • National, state, and county

Data definitions

Age Group
  • All ages
  • 0–17
  • 18–39
  • 40–64
  • 65–84
  • 85+
  • 65+
    • Sex
  • Both sexes
  • Male
  • Female
    • Race/Ethnicity
  • All race/ethnicity
  • Asian
  • Black non-Hispanic
  • Hispanic any race
  • North American Native
  • White non-Hispanic
    • Risk Factors
  • Diabetes
  • Hypertension
    • Data Type
  • Crude prevalence

    • A detailed description of the analytical steps is described in the report "VEHSS Claims & Registry Data Analysis Plan."

    Full analysis documentation is included in the "VEHSS Medicare Data Report."

    The VEHSS analysis of Medicare claims is subject to several potential limitations:

    • Diagnosis information included on claims and encounters is intended to justify payment or coverage. Therefore, diagnosis data on claims and encounters data may suffer from bias or limited detail.
    • Medicare FFS does not cover all health care services, such as routine eye exams or optometry care. Medicare patients may receive these services using a different payer, and thus these services are not captured in Medicare FFS claims.
    • Some MA plans may cover some routine eyecare services, but coverage differs by plan and policy.
    • Patients may be insured by multiple insurers, such as a supplemental, Medigap, or Medicare managed care plan. Thus, even normally covered ophthalmology services may not be indicated in Medicare claims and encounters if services were reimbursed by another plan.
    • Many Medicare patients move seasonally. We report patient residence using the last location of observation. This may skew patient numbers towards Sunbelt states.
    • Medicare is not nationally representative for individuals younger than 65 years and includes only persons who are eligible for the reasons listed above. These patients may obtain Medicare coverage due to medical need, such as legally recognized disability, or other specially defined benefit, such as end-stage renal disease. Individuals who become disabled for reasons of blindness cannot be distinguished from others who are disabled unless their visual condition of low vision and blindness is diagnosed in their medical claims.
    • Medicare FFS+MA is a complete population of Medicare beneficiaries, including all beneficiaries younger than 65 and those 65 and older. For those 65 and older, the data exclude people who defer Medicare coverage and services paid out of pocket.
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    Content Source:
    National Center for Chronic Disease Prevention and Health Promotion