Does Medicaid Cover Vision [Get The Facts]

Many individuals ask if Medicaid will cover the costs of eye issues, eyesight, and eye health, and what the basic guidelines are.

If you’re wondering the same thing, you’ve come to the correct spot since we have all the information and fine print you’ll need for your next doctor’s appointment. 

So, keep reading to find out what your Medicaid will cover and how to get the most of those benefits.

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What is Medicaid?

Medicaid is a financial support program for low-income households in the United States. This government initiative was established to assist low-income persons in receiving adequate medical treatment.

The program pays special attention to children and young adults under the age of 21 since they are regarded as the most vulnerable individuals in need of assistance.

To be eligible for the Medicaid program, you must fulfill specific requirements, which might include:

  • Income
  • Disability
  • Size of a family
  • Citizenship

Every state regulates the laws differently, and each has the authority to increase the benefits as it sees suitable. This implies you should double-check the rules in your country before making a final decision.

In addition, there are two categories of benefits covered by Medicaid:

  • Mandatory – These are the fundamental medical benefits that each state is required to offer to all Medicaid recipients. This covers doctor’s appointments, transportation, laboratory testing, Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT), and other services.
  • Optional – These benefits have been authorized for coverage but are not required. The state is entirely responsible for regulating these benefits.

Does Medicaid Cover Vision?

In general, this is determined by the state in which you reside. As previously said, this is one of the optional advantages that are subject to local rules and regulations, so you must ensure that your state allows them.

Many states pay the bulk of vision-related medical expenditures, although the extent to which these expenses are reimbursed varies by state.

Medicaid is always available to children and young people under the age of 21 for all vision-related tests, glasses, and other services. Keep in mind that Medicaid should pay for all medically required treatments.

However, there is always the matter of what is regarded as required in the first place, therefore we will learn more about this topic.

Who is covered by Medicaid for vision benefits?

According to federal law, all children and people under the age of 21 are eligible for Medicaid vision benefits. This is fantastic news since it encourages prevention at a young age, which will reduce the overall cost of medical assistance in the future.

There is no assurance that Medicaid will cover the expenditures entirely, partially, or not at all for the remainder of the residents over the age of 21. This is why it is essential to contact the agents in your country and inquire about the Medicaid benefits that pertain to you.

What vision benefits does Medicaid cover in every state?

Some vision benefits are available in all states, and here are a few examples:

  • Advantages of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
  • Eye care that is medically required (treatment for injuries, diseases, and conditions)
  • Eye examinations that are medically required

Does Medicaid cover eye exams?

As previously said, this is dependent on the nation in which you live, but in general, most US countries will offer prescription eye tests. 

This includes the following:

  • Routine examinations
  • Comprehensive examinations
  • Exams for eyeglass prescriptions
  • Visual field examination
  • Dilation of the pupils
  • Color blindness
  • Screening for glaucoma

As you can see, Medicaid covers the majority of critical preventative examinations. It is critical to ensure that your state authorizes them and that the examinations are deemed medically essential.

Does Medicaid cover glasses?

Most states allow you to obtain glasses with your Medicaid.

This will cover the majority of expenses, such as:

  • Frames
  • Fittings for glasses
  • Lenses
  • Glasses replacement
  • Repairs

Some specialty lenses and frames may need you to pay the difference out of pocket, but in general, you may get glasses with Medicaid.

Will Medicaid cover contact lenses?

Contact lenses are not usually covered by Medicaid, although there are rare exceptions.

Depending on your state of residency, you may be entitled to contact lenses that are deemed medically essential. This is true after some eye operations but double-check before scheduling an appointment.

Is Medicaid covering eye surgery?

In most situations and most jurisdictions, eye surgery performed by an ophthalmologist is covered by Medicaid. 

These procedures include:

  • Cataracts
  • Glaucoma
  • Vitrectomy surgery
  • Cure for corneal disease
  • Keratectomy (superficial keratectomy)

In most areas, as long as the operation is medically necessary, it will be authorized and paid for by Medicaid.

How to use your vision benefits with Medicaid?

A recommendation from your primary care physician is required to ensure that your doctor’s appointments are covered by Medicaid. They will put you in touch with an ophthalmologist who will check and analyze your eye condition.

You may go directly to the optometrist if you want to obtain new glasses with Medicaid; just make sure they take Medicaid.

Where can you use Medicaid for vision benefits?

On the official Medicaid Website, you can discover a doctor or practice that accepts Medicaid, or you may check your insurance card for further information.

The staff in charge of your medical insurance will have all of the information you require.

For example, Walmart is a popular place to receive Medicaid benefits because they take vision benefits as well.

Final Thoughts

In most areas, Medicaid will pay for your vision benefits even if they are not deemed mandatory. Even better, children and people under the age of 21 are always covered, which can provide excellent preventive measures.

There are a few things to keep in mind. 

Each state has its unique Medicaid requirements, so be sure you are covered. Medicaid will pay the majority of medically required vision tests and treatment; all you need is a referral from your health care physician.

David Duford
Author: David Duford