Last Updated on November 9, 2022 by Anne-Sophie Reinhardt
Medicaid programs in different States are not required to pay for glasses. That is why most states only offer eyewear as an optional benefit. However, there are many situations where Medicaid programs will agree to cover new glasses.
Medicaid will pay for glasses for children and young adults, for example. If they are medically necessary by a doctor, Medicaid will cover glasses for adults of all ages. You will have to choose from a limited number of lenses if you are eligible for Medicaid.
Medicaid will cover standard single vision lenses. However, premium lenses will cost extra. Contact your local Medicaid office to determine which eye clinics will accept Medicaid payment for new glasses. Many agencies have online directories to help you locate eyewear providers in your area who accept Medicaid.
Who Qualifies for Eyeglasses Under Medicaid?
Federal law requires that all state Medicaid plans pay for glasses for people under 21 years old. This usually happens under the EPSDT program (Early Periodic Screening, Screening Diagnostic, Treatment). Besides, some states offer eyewear for adults with medical needs. Moreover, Medicaid programs in Mississippi, Minnesota, Alabama and Minnesota provide glasses to all recipients, regardless of their age.
Adults who have had eye surgery can get glasses through the Medicaid programs in Colorado, West Virginia and Oregon. However, Medicaid programs in Nevada or North Carolina do not provide eyewear for adults.
When Does Medicaid Pay for Glasses?
If a doctor considers that glasses are medically necessary, Medicaid will pay for them. Medicaid covers the following aspects: Glass Fittings, Frames, Lenses, Repairs, Replacements
Medicaid typically pays for one pair per year. Even so, if you are under 21 and not eligible for Medicaid, you can purchase two pairs of replacement glasses each year. On the other hand, Medicaid will not replace glasses if the glasses are lost, damaged, stolen, or lost.
What’s The Extent of Medicaid’s Coverage for Glasses?
Each state has its vision benefits. Of course, Medicaid usually covers medically required glasses.
These conditions typically include the treatment of a disease or infection. Some states do not consider glasses medically required but will pay for the cost of the glasses. So, talk to your local Medicaid office about what Medicaid covers for glasses to avoid paying a lot of extra out-of-pocket costs.
Which Lenses that Medicaid cover?
Firstly, you must find out which Medicaid covers which types of lenses if you require a new pair. In general, Medicaid will cover regular single-vision lenses that correct distance and near vision. Medicaid will cover bifocals and trifocals.
However, Medicaid covers only one pair of trifocals or bifocals per year because they are costly. Besides, Medicaid covers single-vision glasses for two per year, as they are relatively inexpensive.
Some lenses are not covered by Medicaid, such as Transition lenses, Oversized lenses, Progressive multifocal, and No-line bifocals or trifocals. Even so, you can still get Medicaid coverage if you want to purchase any of these lenses. Notice that as these are speciality lenses, you may have to pay out-of-pocket expenses.
Which Eyewear Providers Accept Medicaid Cover?
To find a doctor or eyewear provider that accepts Medicaid, the first step is to examine your Medicaid insurance card. You’ll find contact information and the web address for the agency that administers your Medicaid plan on the card.
To find a list of eyewear providers and doctors who accept Medicaid, visit the agency’s website. The website will provide a list of eyewear professionals in your area who accept Medicaid.
The KFF (Kaiser Family Foundation) also offers a Medicaid Benefits Database. This database will help you to understand which eye services are covered under your Medicaid plan, and what limitations apply in each state. The agency that administers your Medicaid plan should confirm any specific details.
How Can You Take Advantage of Vision Benefits Under Medicaid?
If you have vision issues and your Medicaid plan covers glasses, you’ll likely need to get a referral from your primary physician before you can see an ophthalmologist.
Ophthalmologists treat eye conditions by diagnosing and treating them. They can also prescribe eye medication, contact lenses and glasses. You can’t use your Medicaid vision benefits to see an ophthalmologist. These visits are covered under your standard Medicaid insurance, as well as expert medical care.
Meanwhile, your vision benefits can pay for eye exams and diagnoses. You can visit an eye doctor to learn more about how you can use your Medicaid coverage.
Some eye care professionals won’t accept Medicaid as payment. However, they may be able to refer you to others who do. Visit Benefits.gov if you are unable to find an eye doctor who accepts Medicaid. .After you have opened the page, you will be able to filter the information by category (Medicaid and Medicare) in order to find the contact details of nearby eye care professionals.
Does Medicaid Cover Eyeglasses? Yes, but…
The specifics of the Medicaid program and your plan can be confusing about 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.