Medicaid can pay for eyeglasses, but it does depend on your age and where you live. Even though the dollars come from federal funds, each state runs its own Medicaid program with its own rules. States run Medicaid through their department of health and human services or social services divisions.
Some Adults Excluded
The federal government requires states to provide coverage for medically necessary eyeglasses to patients under 21, but not to those over that age. Some states do: as of 2014, Colorado, Oregon and West Virginia did it for adults who had undergone eye surgery. Alabama, Minnesota and Mississippi are among the states that will pay for all Medicaid participants, regardless of age, while North Carolina and Nevada are among the states that won't. Go to Benefits.gov and select "Medicaid/Medicare" under "Browse by Category" to find your state's eligibility standards.
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Care for Your Glasses
The caps on the number of glasses Medicaid will pay for vary by state. For instance, if you're an adult in Mississippi, you get one pair every five years. Children can get two per year unless a doctor says there's a need for more. Connecticut has no limits for those under 21, but adults can get just one pair every two years. States set their own rules for acceptable replacement reasons. Some possible reasons include broken, lost or damaged glasses, a change in vision and an allergic reaction to the current pair.
No Coverage for Style
Medicaid pays for what's necessary to preserve or improve sight, but it has no time for fashion statements. Don't expect benefits for tinted lenses not justified by a medical diagnosis. Engraving, multifocals and replacements for a different color or style are also not covered. Also, unless they're needed to correct vision and the user has no other options, Medicaid won't cover safety, sports or reading glasses.
Getting the Glasses
Exact state rules vary, but a doctor must prescribe the eyewear and get prior authorization from Medicaid. States such as Minnesota use specific suppliers, which means the pair has to be on the Medicaid list. Co-payments only apply to adults and differ by state. For instance, Mississippi charges $3, while Colorado charges nothing.
- North Carolina Department of Health and Human Services: Division of Medical Assistance: Routine Eye Examination and Visual Aids
- Colorado Department of Health Care Policy & Financing: What is the Colorado Medicaid Vision Services Benefit?
- Alabama Medicaid Agency: Medicaid Covered Services and Co-Payments
- West Virginia Department of Health & Human Resources: Bureau for Medical Services: Services Covered By Medicaid
- Nevada Division of Health Care Financing and Policy: Welcome to Nevada Medicaid and Nevada Check Up
- Oregon Health Plan: Benefits: Frequently Asked Questions
- Pennsylvania Code: 05 Pa. Code Section 1147.21 -- Scope of Benefits for the Categorically Needy
- Mississippi Medicaid: Services
- Minnesota Department of Human Services: Minnesota Health Care Programs -- MHCP Provider Manual
- Connecticut Department of Social Services: Medical Care Administration: Connecticut Medicaid -- Summary of Services
- Benefits.gov: Medicaid/Medicare
- Medicaid.gov: Medicaid Benefits
- Medicaid.gov: Early and Periodic Screening, Diagnostic, and Treatment