Common Questions
Does Medicaid Cover Vision Benefits?
- January 12, 2024
Many Medicaid beneficiaries want to know if the program covers vision care. Certain vision services for children are covered in every state, while adult Medicaid vision benefits vary from state to state. Below is a look at how Medicaid covers vision.
Does Medicaid cover vision care for children?
Each state must meet a set of minimum coverage standards, including a set list of required benefits. One of those mandatory benefits includes vision care for children under the age of 21. Every state Medicaid program must provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits for children, which includes coverage of eye exams and eyeglasses for qualifying children under age 21.
States can then decide which optional Medicaid benefits will be offered that are in addition to the list of federally mandated benefits. Some states may offer more vision coverage for children than what’s required under federal law.
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Does Medicaid cover vision benefits for adults?
Medicaid will typically cover the treatment of eye injuries, diseases, conditions and illness symptoms in adults. But that’s as far as the minimum mandatory coverage requirements extend for adult Medicaid beneficiaries.
Any additional vision coverage is at the discretion of each individual state. Some states may cover the cost of eye exams, eyeglasses and contact lenses. Other states may offer less coverage and some states may offer no coverage at all.
You should review your state’s Medicaid vision coverage or contact your state Medicaid program directly for more information about Medicaid vision coverage.
Does Medicaid cover eyeglasses and contact lenses?
Many state Medicaid programs cover eyeglasses and contact lenses when needed to correct vision problems, but not when only used for cosmetic purposes.
Does Medicaid cover eye exams?
Most states will cover routine eye exams, but covered exams may be less frequent than with other types of health insurance. For instance, a vision insurance plan might cover eye exams every year while a state Medicaid program might cover it once every three years.
Some Medicaid programs include coverage of refraction exams, which test the patient’s ability to see an object at a specified distance.
Does Medicaid cover eye surgery?
Some state Medicaid programs may cover the cost of an eye surgery for things like:
- Glaucoma
- Cataracts
- Blocked tear duct
- Detached retina
- Vitrectomy
- Lazy eye or crossed or walled eye
- Floaters
- Nodular degeneration
- Corneal disease
- Surfer’s eye
Because LASIK eye surgery is not considered medically necessary, it’s rare that Medicaid will pay for it.
Vision coverage through Medicaid and Medicare
Many Medicaid beneficiaries are also eligible for Medicare. And those who are eligible for both programs may be eligible to enroll in a Dual-eligible Special Needs Plan (D-SNP). This is a specific type of Medicare Advantage plan that is tailored to the needs of those on Medicaid and may include benefits not found in Original Medicare.
Contact a licensed insurance agent for help determining if you may be eligible for a Dual-eligible Special Needs Plan and if there are any such plans available in your area.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
