Medicaid Eye Glasses Coverage Overview
Yes, Medicaid covers the cost of buying new glasses when they are considered to be medically necessary. Additionally, children and adolescents get coverage for glasses too. However, under federal law, Medicaid is not required to cover glasses. Still, most states offer prescription eyeglass coverage as an add-on service. So, most state Medicaid plans cover the cost of optometry services and the cost of glasses.
Despite not being required to do so, there are many instances where Medicaid covers the cost of new glasses. However, even if you do qualify for new glasses through Medicaid, your choice of lenses may be restricted. Usually, Medicaid will cover the cost of conventional single-vision lenses. If you need specialty or premium lenses, you may have to pay despite Medicaid coverage.
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 is required to provide guaranteed vision coverage for everyone below 21 years old. 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 beneficiaries under 21 years are eligible for eyeglass replacement twice a year if the glasses are broken, stolen or lost. For those over 21 years, the limit of replacing eyeglasses under Medicaid coverage is once a year if the glasses get lost, stolen or broken.
- 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 – If your bifocals don’t work, then Medicaid offers to cover the cost of two different single-vision glasses, one for distance and one for near vision.
- 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 does not cover the cost of buying or fitting no-line, oversized, transitions or progressive multifocal lenses. You must pay the cost from your pocket if you need these specialty lenses.
- 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 the cost of visiting an ophthalmologist. If you suffer from eye pain, vision loss or any other serious eye problem, you will need to 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 to have 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.
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.