How to Use Medicaid for Glasses: A Guide | NVISION Eye Centers (2022)

Medicaid usually covers the costs associated with purchasing a new pair of glasses, particularly when deemed medically necessary. Children and young adults also get coverage for glasses.

Table of Contents

  • Does Medicaid Cover Glasses?
  • Where Can I Use It?
  • Situations for Coverage
  • Lenses That Are Covered
  • Who Gets Vision Coverage?
  • Getting the Most of Your Vision Benefits

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.

How to Use Medicaid for Glasses: A Guide | NVISION Eye Centers (1)

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.

Does Medicaid Cover Glasses?

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.

(Video) Eye Doctors That Take Medicaid

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. For example, people will be covered for contacts following cataract surgery.

Where Can I Use Medicaid to Get Glasses?How to Use Medicaid for Glasses: A Guide | NVISION Eye Centers (2)

The first step to finding a doctor and eyewear provider to get glasses is to look at your individual insurance card. The contact and website information for the company that manages your Medicaid plan will be on the card.

Visit the company’s website to find an online directory of eye care providers that accept Medicaid insurance plans. By entering your location and the name of your plan, the directory will generate a list of providers in your area that meet your requirements.

To get a general understanding of vision and glasses services covered by Medicaid in your state, explore the Medicaid Benefits Database maintained by the Kaiser Family Foundation. The database can help you better understand what services are typically covered and what limitations to eye services exist in your state. Specific plan details should still be confirmed with your individual plan provider.

In What Situations Does Medicaid Cover Glasses?

Medicaid usually covers the costs associated with purchasing a new pair of glasses, particularly when deemed medically necessary. Children and young adults also get coverage for glasses.

These aspects of eyeglasses are covered by Medicaid:

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

Typically, Medicaid covers the cost of one pair of replacement glasses per year. If you are 21 or younger, you are allowed two pairs of replacement glasses per year. Glasses may be replaced if they are broken, lost, or stolen.

Lenses Covered by MedicaidHow to Use Medicaid for Glasses: A Guide | NVISION Eye Centers (3)

If you need new glasses through Medicaid, it is important to be aware of which types of lenses are covered. Regular single vision lenses are covered by Medicaid, for near and distance vision correction.

If you need bifocals or trifocals, Medicaid will also usually cover the cost. It will generally cover the cost of one pair of bifocals or trifocals, or two pairs of single vision glasses.

(Video) How often can you get glasses on Medicaid?

Lenses that are not covered by Medicaid include:

  • Oversized lenses.
  • No-line bifocals or trifocals.
  • Progressive multifocals.
  • Transition lenses.

If you would like to have any of the above lenses, you can still get them with your Medicaid coverage. You will just have to pay the difference in cost for such specialty lenses.

Additionally, contact lenses are not typically covered by Medicaid. If you want contacts, you will probably have to pay for them out of pocket or with a different supplemental insurance plan. In some cases, contact lenses are covered, but only when they are deemed to be medically necessary.

Does Medicaid Cover Prescription Eye Exams?

Eye exams are an important part of vision health and therefore covered by Medicaid. Some types of eye exams may be covered under your standard health insurance plan.

Medicaid covers many types of eye exams, including exams for vision prescriptions. Eye exams covered by Medicaid include:

  • Routine exams.
  • Comprehensive exams.
  • Eyeglass prescription exams.
  • Contact lens prescription exams (when deemed medically necessary).

Vision tests that are covered through these exams include:

  • Visual field test.
  • Pupil dilation.
  • Color blindness.
  • Glaucoma screening.

Who Does Medicaid Provide Vision Coverage For?

Federal law requires that vision care be provided through Medicaid to children and adults under the age of 21. Regular well visits that include vision screenings help to reduce the occurrence of eye conditions later in life. The idea is that prevention is the best way to keep costs down overall.

How to Use Medicaid for Glasses: A Guide | NVISION Eye Centers (4)

There are no federal regulations, however, that require Medicaid to provide vision care for adults over the age of 21. Standard vision coverage options are offered by each state, though the specific services can vary greatly. It’s important to confirm the specifics of coverage with your state.

Optometry services and eyeglasses are optional benefits under Medicaid. Optional medical services may come with a small copay for the individual. Again, the amount will vary by state.

In order to qualify for Medicaid coverage, you must meet certain requirements. You can qualify for Medicaid based on the following factors:

(Video) Will Medicaid pay for glasses?

  • Income
  • Family size
  • Immigration status
  • Disability
  • Citizenship
  • State residency

If you have questions regarding your eligibility status, you can contact Medicaid directly.

As of October 2019, over 71 million people were enrolled in Medicaid across the country. Over 35 million of those individuals were children enrolled in Medicaid’s Children’s Health Insurance Program (CHIP).

Medicaid provides affordable and essential health care services to individuals and families who may otherwise not be able to afford it.

Differences between Medicaid and Medicare

Both Medicaid and Medicare cover medical costs, but they’re different government programs and have different regulations. Medicare pays medical bills from the money contributed to a trust fund by its beneficiaries.

Regardless of income, Medicare primarily pays medical bills for those who are:

  • 65 years old and older
  • Disabled, regardless of age
  • On dialysis

Patients pay part of their medical expenses through deductibles and other expenses.

In contrast, Medicaid is an aid program meant for those who earn below a certain income level and serves people across all ages. With Medicaid, patients do not pay a part of their costs, though sometimes, a small co-payment is needed.

How Will You Know if You Have Medicaid?

If you want to know whether you have Medicaid and can use it to pay for your eyeglasses, consult your plan provider. You can get his/her contacts on one of the online directories that show you where to get eyewear providers who accept Medicaid.

You can also visit your state’s Medicaid site to check if you qualify for the program then apply to join. Remember that the qualification rules change, so check regularly to know when you are eligible.

How to Take Advantage of Your Medicaid Vision Benefits

If you have Medicaid for vision coverage, it is likely that you will need a referral from your primary care provider in order to see an ophthalmologist

Ophthalmologist visits are usually covered through your standard Medicaid insurance, as care from a specialty doctor. By getting connected with an ophthalmologist, you can take advantage of the eye care benefits offered through Medicaid. This includes exams and assessments for eye diseases and conditions.

(Video) Does Medicare pay for eye exams and glasses?

To get in touch with a local Medicaid office, visit the federal government’s website at Benefits.gov. From there, you can filter information by state and subcategory (Medicaid and Medicare) to find the contact information for a Medicaid office near you.

You can also ask a specific eye care provider for assistance on using your Medicaid coverage. Some providers don’t take Medicaid, but they may be able to refer you to another provider who does.

References

A Beginner’s Guide to Medicaid. Caring.com.

Mandatory & Optional Medicaid Benefits. Medicaid.gov.

Medicaid Benefits: Eyeglasses and Other Visual Aids. Kaiser Family Foundation.

Need Eyeglasses? Medicaid Has You Covered. (November 2016). Health Care Counts.

October 2019 Medicaid & CHIP Enrollment Data Highlights. (January 2020). Medicaid.gov.

When Medicaid Covers Vision Care for Adults. (July 2019). Growing Family Benefits.

What is the difference between Medicare and Medicaid? (July 2021). U.S. Department of Health & Human Services.

The Differences between Medicare and Medicaid. (July 2021). Selecthealth.

(Video) Colorado Springs eye care company offers free glasses to anyone on Medicaid

Who is eligible for Medicaid? (July 2021). U.S. Department of Health & Human Services.

The information provided on this page should not be used in place of information provided by a doctor or specialist. To learn more, read our Privacy Policy and Editorial Policy pages.

FAQs

What is the cheapest place to get an eye exam? ›

Sam's Club, Costco, Target, and America's Best are the cheapest places to get an eye exam.

Does Idaho adult Medicaid cover vision? ›

Vision and Dental (Idaho Smiles)

Children and adults in either the Basic or Enhanced Medicaid plans, as well as pregnant women, are eligible. The benefit includes preventative and diagnostic services (cleanings, exams, X-rays, fluoride, sealants, etc.)

Does Medicaid cover glasses in Texas? ›

Most public health-care plans include policies specifying how much of the cost of eyeglasses and other vision-assistance equipment is covered for children. For example, Texas Medicaid provides one pair of serviceable eyeglasses for a child when glasses are medically necessary.

Does NM Medicaid cover eye exams? ›

What Does NM Medicaid Cover and Cost? New Mexico Medicaid covers medical services, prescription drugs, dental, vision, mental health, long-term care, some home health benefits, and transportation services.

How much do eye exams cost without insurance? ›

The average cost of an eye exam without insurance hovers around $100. But this number can change, depending on who you ask. VSP, one of the most prominent vision insurance providers, lists the national average cost of an eye exam without insurance at around $185.

How can I get my eye prescription without going to the doctor? ›

People can use apps, such as GlassesUSA's app, to find out their eyeglass prescription. Alternatively, for a small fee, some websites offer an online eye exam. This may be more suitable for people who do not have a current prescription.

What does Medicaid cover for eye care? ›

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).

What does Medicaid pay for? ›

Mandatory benefits include services including inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.

What is the highest income to qualify for Medicaid 2022? ›

Income Limit in Most States

Most states — 38 and Washington, D.C. — have the same income limit of $2,523 per month for a single person for most types of Medicaid services. For a married couple, the limit increases to $5,046 in most cases.

Does my Texas Medicaid cover vision? ›

For eyeglasses to be covered by Medicaid, it must be: Medically necessary. Prescribed by a medical doctor (MD), doctor of optometry (OD), or doctor of osteopathy (DO)

Does Texas Star Medicaid cover eye exams? ›

Benefits under STAR

Hospital care and services. X-rays and lab tests. Vision and hearing care. Access to medical specialists and mental health care.

Does Texas Medicaid cover dental and vision? ›

It includes cleanings, fillings, crowns, and root canals and is available statewide. Adults and children can also get Texas Medicaid dental coverage through MCNA Dental. MCNA covers cleanings, exams, X-rays, fluoride, sealants, fillings, extractions, root canals, and dental emergencies.

How often does NM Medicaid cover glasses? ›

(2) Corrective lenses: MAD covers one set of corrective lenses for a MAP eligible recipient 21 years of age and older not more frequently than once in a 36-month period. For a MAP eligible recipient under 21 years of age, one set of corrective lenses is covered no more frequently than once every 12 months.

What services does NM Medicaid cover? ›

These services include physical health, behavioral health, long-term care and community benefits. Eligibility for all Medicaid programs requires that individuals meet certain federal guidelines. These include citizenship, residency and income requirements.

What is Medicaid called in New Mexico? ›

New Mexico Medicaid Definition

In New Mexico, Medicaid is called Centennial Care and is administered by New Mexico's Human Services Department (HSD).

How much are glasses with insurance? ›

A new pair of prescription glasses can cost around $120 a year with insurance.

What does astigmatism do to your vision? ›

Astigmatism is a common eye problem that can make your vision blurry or distorted. It happens when your cornea (the clear front layer of your eye) or lens (an inner part of your eye that helps the eye focus) has a different shape than normal. The only way to find out if you have astigmatism is to get an eye exam.

How much is an eye exam at America's Best? ›

How much does an eye exam cost? At America's Best, eye exams are FREE* with our 2 pairs offers! Exams without a 2 pair purchase are only $59. Schedule an eye exam at America's Best today.

How can I get a prescription easily? ›

You can talk to a physician and receive a diagnosis using technology. If you require medication for your condition, the doctor will send the prescription to the pharmacy of your choice. Then you can pick up the prescription or have it mailed to you.

Do opticians legally have to give you your prescription? ›

Yes, you can take your prescription to another optician and buy glasses from another practice. An optician is obliged to provide you with the written prescription following the eye examination.

Can I access my eye prescription online? ›

Both Opticians and the customer benefit from being able to access prescriptions online due to convenience and time. If you'd like a copy of your eye prescription, all you have to do is send an email over to your optician and request it! Some opticians may be able to send over prescriptions on the same day.

Do you get a free pair of glasses after cataract surgery? ›

Medicare will pay for one pair of post-cataract surgery glasses per lifetime per eye after cataract surgery.

Does Medicaid cover braces? ›

The answer is yes! If braces are deemed medically necessary for your child, Medicaid can assist in getting them. Some orthodontists will offer a no-cost consultation to discuss your child's needs.

Does Medicaid cover dental? ›

Dental services are a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

What are the disadvantages of Medicaid? ›

Disadvantages of Medicaid

They will have a decreased financial ability to opt for elective treatments, and they may not be able to pay for top brand drugs or other medical aids. Another financial concern is that medical practices cannot charge a fee when Medicaid patients miss appointments.

What is the highest income to qualify for Medicaid? ›

Federal Poverty Level thresholds to qualify for Medicaid

For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight. To calculate for larger households, you need to add $4,720 for each additional person in families with nine or more members.

Who pays for Medicaid? ›

The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP).

Does medical check your bank account? ›

Furthermore, a Medicaid agency can ask for bank statements at any time, not just on an annual basis. An important note: For long-term care Medicaid, there is a 60-month look back period (30-months in California).

Which state has highest income limit for Medicaid? ›

The state with the highest income limits for both a family of three and individuals is Washington, D.C. If you live in this area, a family of three can qualify for Medicaid if their income is at 221% of the FPL.
...
Medicaid Income Limits by State 2022.
StateParents (Family of 3)Other Adults
Wyoming54.00%0.00%
49 more rows

What are the qualifications for Medicaid? ›

Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.

What does Medicaid not cover in Texas? ›

Texas Medicaid does not cover adults in poverty without dependent children, unless they have a serious or permanent disability, are elders in poverty, or get temporary maternity coverage that ends 2 months after the birth.

What items are not typically covered by vision insurance? ›

What usually IS NOT covered by vision insurance
  • Eye exams after the first, each year.
  • Additional frames and lenses (unless replacing glasses under warranty)
  • Miscellaneous fees and charges, such as missed appointment fees, charged by your optometrist.
  • Non-prescription glasses, such as those purchased at a drug store.
21 Apr 2022

Do you have to pay back Medicaid in Texas? ›

If you received Medicaid long-term services and supports, the state of Texas has the right to ask for money back from your estate after you die. In some cases, the state may not ask for anything back, and the state will never ask for more money back than it paid for your services.

How much is an eye exam without insurance in Texas? ›

$171-$200 is the average cost of an eye exam without insurance (first visit) $128 for recurring patient visits. $46 for refractive vision tests.

Does Texas CHIP cover glasses? ›

Children's Health Insurance Plan (CHIP)

Children in Texas without health insurance may be able to get low-cost or free health coverage from the Children's Health Insurance Program (CHIP). This program covers doctor visits, prescription drugs, dental care, eye exams, glasses, and more.

What is Texas Star Plus Medicaid? ›

STAR+PLUS is a Texas Medicaid managed care program for adults who have disabilities or are age 65 or older. Adults in STAR+PLUS get Medicaid health-care and long-term services and supports through a health plan that they choose.

Does Texas Medicaid pay for Invisalign? ›

Invisalign. Medicaid does not cover Invisalign and other premium orthodontic options in any state for adults or children. The publically-funded program pays for the least expensive treatment alternative, which is metal braces in most cases.

What is the Medicaid income limit for 2022 in Texas? ›

*If the care recipient has gross countable income greater than $2,523, he or she will be deemed ineligible for Medicaid benefits.

Does Texas Medicaid pay for dental implants? ›

In most cases, Medicaid won't cover dental implants as the program doesn't recognize the procedure as a medical necessity. Instead, Medicaid classifies the dental implant procedure as a cosmetic one that doesn't affect your overall health or wellbeing.

How much does it cost to check up your eyes? ›

Average costs of eye exams

The national average for a vision exam cost is approximately $95. This cost can vary depending on your location, your age, and your medical history. It may range from $50 to $200+.

How much does it cost to check your eyesight? ›

Consultation fees may range from Php 500 to Php 1,500.

How can I save money for an eye exam? ›

5 Strategies For Saving Money At The Eye Doctor
  1. Go to the Right Place. First things first: you need to figure out exactly where you need to go. ...
  2. Purchase Vision Insurance. ...
  3. Shop Around for Glasses. ...
  4. Buy Contacts Online Instead of Through Your Doctor. ...
  5. Search for Discounts.
29 Sept 2020

How much is a pair of glasses? ›

The average cost of glasses without insurance is $242, according to statistics from VSP. That's for frames only. For basic, single lenses, it's $113. That means the total will run you on average about $351 for a complete pair of glasses if you don't have vision insurance.

What does eye check up include? ›

Your eye doctor will test your vision to determine the power required for your eyeglasses as well as check for common eye diseases, assess how your eyes work together and evaluate your eyes as an indicator of your overall health.

Can I check my own vision? ›

There are 3 vision tests that can be done at home: Amsler grid, distance vision, and near vision testing. This test helps detect macular degeneration. This is a disease that causes blurred vision, distortion, or blank spots. If you normally wear glasses for reading, wear them for this test.

Can you test your own vision? ›

Several companies offer tests that you can take on the internet with your computer or smartphone. An online vision test might check: How sharp your vision is. If you have astigmatism, a condition that can make things blurry or stretched.

How do I know if I have 20 20 vision? ›

If you have 20/20 vision, you can see an object that is 20 feet away clearly. The term refers to average, normal vision. If your vision doesn't measure 20/20, you may need to wear contact lenses or glasses to see clearly.

Who has the best prices for prescription glasses? ›

Where to Buy Affordable Eyeglasses
  1. GlassesUSA.com. Limited time offer: Save 65% off frames for eyeglasses and sunglasses with basic Rx lenses + Free shipping to your doorstep. ...
  2. EyeBuyDirect. ...
  3. Zenni Optical. ...
  4. Warby Parker. ...
  5. Eyeconic. ...
  6. Eyebobs. ...
  7. Costco Optical. ...
  8. Sam's Club Optical.

Which is better LensCrafters or visionworks? ›

LensCrafters's brand is ranked #- in the list of Global Top 1000 Brands, as rated by customers of LensCrafters. Visionworks's brand is ranked #- in the list of Global Top 1000 Brands, as rated by customers of Visionworks.
...
LensCrafters vs Visionworks.
25%Promoters
9%Passive
66%Detractors

How do you get glasses when you have no money? ›

Lions Clubs International offers help paying for eye care through its local clubs. Some clubs may also provide eyeglasses. New Eyes provides prescription eyeglasses to children and adults who can't afford them. A social worker or someone at a community health center may be able help you apply.

Is it cheaper to buy glasses or contact lenses? ›

Eyeglasses offer many benefits over contact lenses. They require very little cleaning and maintenance, you don't need to touch your eyes to wear them (decreasing your risk for eye infections), and glasses are cheaper than contact lenses in the long run since they don't need to be replaced as often.

Is it worth paying more for glasses? ›

For most people, hugely expensive eyeglasses are not worth the money; eyeglasses do not have to be $1000 for them to be durable enough to last a few years. The most cost-effective way to buy your eyewear is to buy moderately priced frames and replace the lenses every year using Rx-able's lens replacement services.

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