Care Benefits through Medicaid
covers eye examinations when medically necessary.
No more than one exam per year may be provided unless the
doctor explicitly notes in the patient chart that an additional
eye exam is necessary. Medicaid pays for eye glasses
and for new prescriptions only when they are medically
necessary. Medicaid will NOT replace glasses more
often than once every two years.
or Broken Eyeglasses
Medicaid pays for replacement glasses when the original
glasses are lost or broken beyond repair only for children
from birth through age 20.
does NOT provide replacement glasses when the original glasses
are lost or broken beyond repair and the patient is age
21 or older.
provides replacement glasses when the original glasses are
stolen within two years under two conditions: (1) the Medicaid
recipient must file a report of the theft of the eye glasses
with the local police department and obtain a police case
number as proof a theft report was filed. (2) The recipient
must give the police case number to the eyeglass provider
to prove the theft and explain why more than one pair of
eye glasses is being allowed in the two-year time period.
Replacement glasses due to theft are provided for all ages.
Managed Care Plan Vision Plans
enrolled in a Managed Care Plan (MCP) through Medicaid must
obtain vision care services through the MCP. The MCP
Vision Plan follows Medicaid policy. That is, if a
vision service is a Medicaid benefit, the MCP Vision
Plan must include that benefit.