Does Medicaid Cover Glasses? – Overview
Federal laws do not require state Medicaid programs to pay for glasses. As a result, most states provide eyewear as an optional benefit. However, there are many instances whereby Medicaid programs pay for the cost of new glasses.
For instance, Medicaid pays for glasses for kids and young adults. Medicaid will also cover glasses for adults of any age if they are considered to be medically necessary by a physician.
Note that if you qualify for new glasses under Medicaid, you will be limited to the types of lenses you can pick. For instance, Medicaid will pay for standard single vision lenses, but you will incur out-of-pocket costs if you decide to go for premium lenses.
To find out which eye clinics accept Medicaid as payment for new glasses, you should contact your local Medicaid office. Most agencies offer online directories to help you find eyewear providers near you that accept Medicaid.
Who Qualifies for Glasses Under Medicaid?
The Federal Government requires state Medicaid plans to pay for medically necessary glasses for persons under 21 years. This is usually under the EPSDT (Early, Periodic, Screening, Diagnostic, and Treatment) program. However, some states also provide eyewear for grownups with a medical necessity.
For instance, Medicaid programs in Alabama, Minnesota, and Mississippi provide glasses for all their recipients regardless of age. Medicaid programs in Colorado, West Virginia, and Oregon offer glasses to adults who have undergone eye surgery. On the other hand, Medicaid programs in Nevada and North Carolina don’t provide any form of eyewear to adults.
When Does Medicaid Pay for Glasses?
Medicaid will cover cost of getting new glasses if a doctor considers them to be medically necessary. The aspects of glasses covered by Medicaid include:
- Glass fittings.
Note that Medically usually pays for one pair of replacement glasses per year. However, if you are 21 years and below Medicaid, you will pay for two pairs of replacement glasses per year. Medicaid will pay for replacement glasses only if they are damaged, lost, or stolen.
What’s The Extent of Medicaid’s Coverage for Glasses?
The extent of vision benefits provided by Medicaid varies from state to state. Usually, Medicaid will pay for medically necessary glasses. The conditions that are deemed to be medically necessary also vary from state to state.
These conditions usually include treatment of a disease, infection, or injury. Also, some states don’t consider glasses medically necessary, but they will cover the costs of getting the glasses. To avoid incurring a lot of out-of-pocket expenses, talk to your local Medicaid office to find out what Medicaid will and won’t cover with regard to glasses.
Which Lenses Are Covered by Medicaid?
If you need a new pair of glasses, you must find out the types of lenses covered by Medicaid. Medicaid will pay for regular single-vision lenses, meant to correct near and distance vision.
If you need bifocals or trifocals, no need to worry, Medicaid will also pay for them. Bifocals and trifocals are expensive, so Medicaid only covers one pair per year. For single-vision glasses, Medicaid will cover two pairs per year because they are relatively cheap.
Some of the lenses not covered by Medicaid include:
- Transition lenses.
- Oversized lenses.
- Progressive multifocals.
- No-line bifocals or trifocals.
If you’d like to get any of the above lenses, you can still use your Medicaid coverage. However, you will incur out-of-pocket costs because these are specialty lenses.
Which Eyewear Providers Accept Medicaid Cover?
The first step to finding a physician or eyewear provider who accepts Medicaid is to look at your Medicaid insurance card. On the card, you’ll find the contacts and web address of the agency that manages your Medicaid plan.
Visit the agency’s webpage to find the online directory of physicians and eyewear providers that accept Medicaid insurance plans. When you enter your location and the name of your plan, the website will generate a list of eyewear providers near you who accept Medicaid.
You can also use the Medicaid Benefits database provided by KFF (Kaiser Family Foundation). This database can help you understand the eye services covered by your Medicaid plan and the limitations to these services that exist in the state you live in. However, specific Medicaid plan details should still be confirmed by the agency that manages your Medicaid plan.
How Can You Take Advantage of Vision Benefits Under Medicaid?
If your Medicaid plan has vision benefits and you need glasses, it’s likely that you will need a referral from your primary care physician in order to see an ophthalmologist.
Ophthalmologists are eye specialists who check, diagnose and treat eye problems. They also prescribe glasses, contact lenses, and eye medication.
Unfortunately, you can’t use your Medicaid vision benefit to visit an ophthalmologist. These visits are covered by your standard Medicaid insurance as care from an expert physician. However, you can still take advantage of your vision benefits during your ophthalmologist visits. You can use your vision benefits to pay for exams and diagnosis of eye conditions.
Once you visit an eye care provider, you can ask them for help on how to use your Medicaid coverage. Some eye care providers don’t accept Medicaid insurance plans as payment, but they can refer you to other providers who do.
If you can’t find an eye care provider who accepts Medicaid, visit the federal government’s website Benefits.gov. Once you’ve opened the page, you can filter information by state and category (Medicaid or Medicare) to get the contacts of eye care providers near you.
The specifics of the Medicaid program and your individual plan can be confusing with regard to what will and will not be covered. However, Medicaid will pay for your glasses and the eye exams to confirm that you need glasses. Medicaid coverage varies from state to state, so the best way to find out if your plan covers glasses is to visit your local Medicaid office, and a representative will clarify how you can utilize your Medicaid plan to the fullest.