63% of Americans lack vision insurance, and Medicaid in 20 states covers zero eyeglass costs for adults

Approximately 63% of Americans -- roughly 210 million people -- have no vision insurance, and among the 80+ million Medicaid enrollees, 14.6 million (27%) live in states that provide no coverage for eyeglasses, while 6.5 million (12%) have no coverage for even routine eye exams. Why it matters: uninsured adults pay $485+ out of pocket for a basic eye exam and glasses, so for a single adult at the federal poverty level ($15,060/year), one pair of glasses costs more than a third of one month's income, so 25% of adults report forgoing routine eye care due to cost, so preventable conditions like glaucoma and diabetic retinopathy go undiagnosed, so these individuals eventually present to emergency rooms with advanced vision loss that is far more expensive to treat and often irreversible. The structural root cause is that the Affordable Care Act mandated pediatric vision coverage as an Essential Health Benefit but explicitly excluded adult vision care, and vision has historically been siloed from medical insurance as a separate 'voluntary' benefit category, meaning employers can choose not to offer it and state Medicaid programs can exclude it without federal penalty.