Does Medicaid Cover Glasses? - Grants for Medical

Medicaid Eye Glasses Coverage Overview

Yes, Medicaid covers the cost of buying new glasses when they are considered medically necessary. Additionally, children and adolescents get coverage for glasses, too. Under federal law, Medicaid is required to cover glasses for beneficiaries under 21 years old but not for adults unless deemed medically necessary. Still, most states offer prescription eyeglass coverage as an add-on service. Many state Medicaid plans offer coverage for optometry services and glasses, particularly for children and when medically necessary for adults.

Despite not being required to do so, there are many instances where Medicaid covers the cost of new glasses. However, even if you qualify for new glasses through Medicaid, your choice of lenses may be restricted. Usually, Medicaid will cover the cost of conventional single-vision lenses. You may have to pay despite Medicaid coverage if you need specialty or premium lenses.

Medicaid Coverage for Optometry Services in the US

States that offer coverage for Optometry services under Medicaid pay for prescription eye exams. In addition, these Medicaid plans also offer coverage for contact lens prescriptions and comprehensive eye testing if medically necessary. Medicaid offers extensive vision coverage for eligible individuals and families.

Every Medicaid program must provide vision coverage for beneficiaries under 21 years old as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service. It also provides significant vision coverage to adults when vision care is considered to be necessary for medical reasons.

It is advised to consult with your local Medicaid office and your plan provider to clearly understand the exact Medicaid benefits for vision care.

Here is a list of optometry services covered by Medicaid:

Eye exams – Medicaid offers coverage for routine and comprehensive eye exams. These may include different tests, such as color blindness, pupil dilation, visual field tests, glaucoma, etc.
Eyeglasses – Medicaid covers the cost of buying frames and lenses. It also offers coverage for fittings, replacements, and repairs. For instance, Medicaid coverage for eyeglass replacement frequency for beneficiaries under 21 years can vary by state, but generally, replacements are provided if glasses are broken, stolen, or lost. Coverage for replacing eyeglasses for beneficiaries over 21 years under Medicaid varies by state and is generally only provided when medically necessary.
Safety frames – Medicaid coverage also includes the cost of buying and maintaining safety frames for prescription eyeglasses.
Prosthetic eyes – Medicaid also covers the cost of prosthetic eyes when deemed medically necessary.
Glaucoma testing – Medicaid coverage also includes the cost of screenings for individuals at higher risk of glaucoma.
Bifocals/Trifocals – Medicaid covers bifocal and trifocal lenses when prescribed rather than providing two separate pairs of single-vision glasses.
Contact lenses – Medicaid will only cover the cost of contact lenses when they are considered medically necessary and there is no other treatment option.

Now that you know the extent of Medicaid coverage for optometry services, here is a list of vision care aspects that Medicaid does not cover:

Specialty lenses —Medicaid generally does not cover the cost of elective or cosmetic features in lenses, such as no-line or progressive multifocal lenses, unless deemed medically necessary. If you need these specialty lenses, you must pay the cost from your pocket.
Specialty frames – Medicaid does not cover the cost of designer or non-standard frames and lenses. You will need to pay the cost out of pocket.

Medicaid Coverage for Eye Problems

Medicaid medical benefits include coverage for visiting an ophthalmologist when eye care is medically necessary. If you suffer from eye pain, vision loss or any other serious eye problem, you must see an ophthalmologist.

They can test and treat a number of severe eye problems, such as glaucoma, detached retinas, cataracts, etc. These professionals are trained to perform different vision and eye tests. They can diagnose the eye problem and prescribe medications or use surgical treatment, contacts, and glasses to treat the issue.

You don’t need special Medicaid vision benefits to see an Ophthalmologist. If you experience eye problems, you must visit your primary care provider, who will refer you to the best ophthalmologist under the Medicaid program.

However, if you have an employer or marketplace plan, then it usually covers ophthalmology services. However, you will need a special vision plan to have coverage for glasses.

Where to Get Glasses Under Medicaid

You must visit the insurance company’s website to find the best place to get glasses under your insurance coverage. Here, you will find an online directory of vision care providers in the Medicaid network.

Simply enter the name of your Medicaid insurance plan and your location, and the directory will provide a list of eligible eye care providers in your area.

Conclusion

Medicaid covers glasses for Medicaid beneficiaries under 21 years old. Most states also provide coverage for comprehensive eye care, including routine and advanced eye exams. If you need to get prescription glasses under Medicaid, talk to your primary care provider and request a referral to a Medicaid-eligible eye care provider near you.