Does Medicaid Cover Eye Exams? – Overview
Essentially, Medicaid is the state-administered program that provides health insurance to low-income individuals.
If you fall into the low-income category, you can apply for Medicaid and get coverage for your eye exam.
Treatment at a doctor’s office, which includes eye exams, will be covered by Medicaid as long as it’s related to your medical care.
Medicaid will cover treatment for glaucoma, cataracts, and other diseases that can impair vision. However, if you have an eye exam to get contacts or eyeglasses, Medicaid may not cover it.
What Does Medicaid Pay For?
Medicaid pays for many services related to the diagnosis and treatment of vision problems, including:
An annual eye exam
Eye surgery to correct vision problems
How Medicare Works for Eye Care
Medicare will not cover the cost of eye exams for seniors who do not have cataracts or glaucoma. That means that those fully covered by Medicare should still be prepared to pay for exams.
One way to help avoid the cost is to select a provider with an on-site lab so you can get your glasses while you’re there (saving you time and money).
A better option may be to apply for supplemental insurance through your local state Medicaid program. Most states offer some coverage for eye exams, but the amount of coverage varies widely by state and, in some cases, by county.
In any case, it is typically significantly less expensive than having to pay out of pocket.
Furthermore, even if your state doesn’t have an optometry program specifically designed to help with eye care costs, they may still be able to direct you toward other programs.
That said, it is important to know who is eligible for Medicaid when it comes to eye exams, so here you go.
Who Qualifies for Medicaid Eye Exams?
Medicaid is an entitlement program that covers low-income individuals and families who meet state-specific eligibility requirements such as:
You may qualify for a Medicaid eye exam if you meet the following requirements:
- You are age 19 or over.
- Your gross income is less than $1,821 per month.
- You have not had an eye exam in the last three years, or if your most recent eye exam was over a year ago.
- You do not have a medical condition that prevents you from having an eye exam, such as diabetes, glaucoma, or cataracts.
- You do not have insurance that provides prescription eyewear, or it does not cover eyeglasses and contact lenses, or you do not have insurance, but your income is too high to qualify for Medicaid (this amount varies by state).
- You are a U.S. citizen or legal immigrant and live in the United States
Applicants must meet specific income requirements before receiving coverage for their eye exams.
For example, applicants must meet specific income limits in some states based on the number of people living in their households.
For example, in Florida, an applicant must earn less than $907 per month ($10,836 per year) before getting coverage for their eye exams.
On the other hand, if you live in a state that allows you to qualify for Medicaid based on income alone and under 21 years old, you must have at least one vision exam every year.
If you are above the age of 21 years or older, you must have a vision exam every 24 months.
However, if your state requires vision exams based on income, your eligibility will depend on how much money you make each month.
If you are blind or visually impaired, your Medicaid program will provide eye exam services to you regardless of your income.
Does Medicaid Cover Eye Exams?
Medicaid does not cover eye exams unless you are a child. You must have your eyes examined every one to two years.
If you wear glasses, have them reviewed annually for the first three years after you get them, and then once every two years. Your eyes should be examined every year if you wear contact lenses.
Medicaid does cover eye exams for low-income individuals. However, you do have to meet particular requirements to be eligible.
If you cannot pay for glasses or contact lenses, Medicaid will cover them.
In addition, if you have trouble seeing and need eye exams more frequently than every two years, Medicaid will help with that as well.