Does Medicaid Cover Glasses [Get The Facts]

In most cases, Medicaid will cover the cost of glasses if they are medically required, although this requirement varies by state. According to the regulation, medically required spectacles include the diagnosis and treatment of a sickness, accident, disease, or condition.

As usual, the best thing you can do is check with your local Medicaid providers and see whether the glasses are covered by Medicaid.

In what situations does Medicaid cover glasses?

Medicaid will pay the cost of a new pair of glasses for children and people under the age of 21, and in certain areas, eyeglasses are available to everyone.

One of the general conditions is that they are deemed medically necessary.

If you have significant eye issues and require the services of an ophthalmologist, Medicaid will most likely cover you as well. However, the procedure of receiving an exam may change since you must utilize your physical health Medicaid benefit.

Your primary care provider will have all of the answers and can send you to an ophthalmologist if necessary.

What states allow Medicaid to cover glasses?

We said that most states enable Medicaid to pay your glasses and related expenditures, however, this is not the case in all states.

The following states DO NOT allow Medicaid to cover glasses:

• Arizona
• Colorado
• Delaware
• Hawaii
• Louisiana
• Oklahoma
• Oregon
• Tennessee
• Virginia
• Washington
• West Virginia
• Wyoming

If you live in one of the states on the list, you will have to pay for the glasses yourself. 

If you are not in one of the aforementioned states, you will have access to one or more glasses, as well as extra eye exams.

What will Medicaid cover if you need glasses?

Depending on the state in which you live and receive Medicaid, you may be eligible for one or more of the following:

• Frames
• Glasses fittings
• Lenses
• Replacement glasses
• Repairs

Most of the time, the lenses are the most perplexing thing that Medicare may support. You should keep in mind that most of the time, Medicaid will fund standard single vision lenses for distant and near vision correction.

Even bifocals and trifocals are covered by Medicaid in certain areas, but you should check with your local representative to be sure.

What else is covered by Medicaid?

Medicaid may cover the following in some states:

• Glaucoma screenings
• Routine and comprehensive eye exams
• Safety frames
• Prosthetic eyes

All of the above-mentioned examinations and products are considered optional, and just a few states permit them. As usual, the best thing you can do is contact your plan assistant and request further information.

Does Medicaid replace glasses?

Medicaid typically replaces glasses, but the frequency with which you may do so is determined by your age and the state in which you live.

Children and young people under the age of 21 can often get two replacements each year. The remainder of Medicaid patients typically receives one replacement each year.

This covers scenarios in which the glasses are broken, stolen, or misplaced. Furthermore, in many jurisdictions, Medicaid will pay for the cost of fixing spectacles.

Where can you use Medicaid to get glasses?

The next step in getting new glasses is to choose an eye doctor. This implies you should verify your insurance card and call the business in charge of your Medicaid plan.

They will be able to give you a list of available doctors who take Medicaid at their offices, from which you can select the finest one for you.

Does Medicaid cover contact lenses?

Many people think that if Medicaid covers glasses, it will pay for contact lenses as well, but this is not necessarily the case. Contact lenses are not usually covered by Medicaid, but if they are deemed medically essential, they may be.

This need is determined by your local regulations, but for example, if you just underwent cataract surgery.

What is not covered by Medicaid if you need glasses?

While the rules and regulations vary by state, you are generally not covered for:

• Transition lenses
• Progressive multifocal
• Oversized lenses
• No-line bifocals or trifocals

As usual, check with your doctor or the Medicaid representative in your state and locality to see if these particular lenses are covered by Medicaid. Sometimes they are just partially insured, and you simply need to cover the difference in cost.

Final Thoughts

Medicaid is a fantastic way to obtain the medical care you or your family members require. Because children and young adults are favored in most states, the odds are much better for them.

As you can see, even if you require glasses, Medicaid will cover the whole cost in the majority of states. However, even if your lenses and frames exceed the Medicaid limit, you can simply pay the difference.

Prices for glasses vary by state, as do Medicaid restrictions, so as usual, we urge you to consult with your local Medicaid contact person for additional information.

Author: David Duford