Many Medicaid beneficiaries want to know if the program covers vision care. Certain vision services for children are covered in every state, while adult Medicaid vision benefits vary from state to state. Below is a look at how Medicaid covers vision.
Each state must meet a set of minimum coverage standards, including a set list of required benefits. One of those mandatory benefits includes vision care for children under the age of 21. Every state Medicaid program must provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits for children, which includes coverage of eye exams and eyeglasses for qualifying children under age 21.
States can then decide which optional Medicaid benefits will be offered that are in addition to the list of federally mandated benefits. Some states may offer more vision coverage for children than what’s required under federal law.
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Medicaid will typically cover the treatment of eye injuries, diseases, conditions and illness symptoms in adults. But that’s as far as the minimum mandatory coverage requirements extend for adult Medicaid beneficiaries.
Any additional vision coverage is at the discretion of each individual state. Some states may cover the cost of eye exams, eyeglasses and contact lenses. Other states may offer less coverage and some states may offer no coverage at all.
Many state Medicaid programs cover eyeglasses and contact lenses when needed to correct vision problems, but not when only used for cosmetic purposes.
Most states will cover routine eye exams, but covered exams may be less frequent than with other types of health insurance. For instance, a vision insurance plan might cover eye exams every year while a state Medicaid program might cover it once every three years.
Some Medicaid programs include coverage of refraction exams, which test the patient’s ability to see an object at a specified distance.
Some state Medicaid programs may cover the cost of an eye surgery for things like:
Because LASIK eye surgery is not considered medically necessary, it’s rare that Medicaid will pay for it.
Many Medicaid beneficiaries are also eligible for Medicare. And those who are eligible for both programs may be eligible to enroll in a Dual-eligible Special Needs Plan (D-SNP). This is a specific type of Medicare Advantage plan that is tailored to the needs of those on Medicaid and features a $0 plan premium. These plans, like many Medicare Advantage plans, can provide vision coverage such as eye exams, eyeglasses, contact lenses and even LASIK eye surgery.
Contact a licensed insurance agent for help determining if you may be eligible for a Dual-eligible Special Needs Plan and if there are any such plans available in your area.
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Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
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