What if you are concerned about losing vision, eye pain, or other things that may point to a serious eye problem? If you have more serious eye problems such as cataracts, detached retinas, or glaucoma , you need an ophthalmologist. An ophthalmologist is a medical doctor that specializes in eye and vision care.
Ophthalmologists perform eye exams, diagnose and treat diseases, perform surgeries and prescribe medication, glasses and contact lenses. An ophthalmologist is seen through your physical health Medicaid benefit, and not your Medicaid vision benefit. To access an ophthalmologist, most of the time you will need a referral from your primary care provider, just as if you needed to see a cardiologist, an allergist, or some other specialist. NOTE: If you have a Marketplace or employer plan, typically it will cover the medical specialty of ophthalmology for instance, if you have cataracts , but eyeglasses will only be covered if you have a special vision plan.
For a listing of Vision Providers that accept Medicaid please call your individual plan or visit them at the web links and follow the instructions provided. McLaren Medicaid. McLaren Healthy Michigan. Meridian Medicaid. Meridian Healthy Michigan. Typically, your income must fall below a certain level to be eligible for Medicaid benefits.
Case in point: Medicare does not normally cover long-term care, but Medicaid does. Many eye care practices accept Medicaid for an eye exam, as long as it falls within the coverage schedule. For instance, if your state covers only one eye exam every three years and you schedule an appointment after two years, that eye exam will not be covered. There are exceptions, such as if you have an underlying condition that qualifies you for more frequent exams.
To find eye care practices in your area that accept Medicaid, use All About Vision's Doctor Locator , which lets you search for eye doctors who accept your vision insurance.
The locator will list eye doctors near you who accept Medicaid; then you can schedule an appointment. Most states also have different copays for children and adults. Depending on the state, your copay also could cover eyeglasses, or there could be a separate fee for your spectacles.
We have strict sourcing guidelines and every page contains a full list of references for transparency. Medicaid coverage of glasses is not required under federal law, though most states offer it as an optional service. Optometry services and eyeglasses are covered by most state Medicaid plans. To find out where you can use your Medicaid coverage to get new glasses, you must consult your individual plan provider.
Online directories are offered by most providers to help you locate eyewear providers that accept Medicaid. Although glasses coverage is not required by Medicaid, there are many situations where Medicaid does cover the cost of new glasses. Children and young adults will always be covered for glasses. They will also be covered for adults of any age if they are deemed medically necessary.
If you qualify for new glasses through Medicaid, you may be limited by which lenses you can select. Standard single vision lenses are typically covered, while premium or specialty lenses will cost you more out of pocket. In states that opt to provide coverage for optometry services, vision prescription eye exams are covered. Other eye exams covered by Medicaid include routine, comprehensive, and contact lens prescription exams when deemed medically necessary. Medicaid provides health and vision coverage for qualifying individuals and their families.
Vision coverage is guaranteed to children and young adults under the age of 21, as well as adults with a medical necessity for vision care. The specifics of Medicaid and your personal plan can be confusing. Consulting with a local Medicaid office and your individual plan provider will clarify the best way for you to take advantage of your Medicaid vision benefits. The amount of vision coverage offered by Medicaid varies by state.
Typically, Medicaid covers the cost of medically necessary vision care. What qualifies as medically necessary also varies by state, but it usually includes diagnosis and treatment of an illness, injury, condition, or disease. Eyeglasses and contact lenses do not always qualify as medically necessary, though many states cover the costs of services related to getting them anyway.
The cost of prescription glasses and basic frames is usually covered, though you must confirm how much coverage your state offers through your individual Medicaid plan provider. Of note, most states do not cover the costs of contact lenses when they are requested only for cosmetic reasons, which is simply because you like the way they look better than eyeglasses.
Some eye conditions qualify people for contact lens coverage. Contact your local Visionworks location to see if your insurance is accepted and if it covers a comprehensive contact lens exam.
Need to know how much is an eye exam without insurance? Contact your local Visionworks location to find great discounts for your comprehensive eye exam. Using an FSA?
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