Find Out About Medicaid Vision Insurance

Medicaid vision insurance is available to low-income families. Medicaid is a jointly funded, federal-state public health program for families and individuals who cannot afford traditional coverage. Vision plans are available to those who have children or disabilities. Not everyone is eligible to apply for Medicaid. This is considered an assistance program for low-income individuals who meet certain eligibility income requirements.

Depending on the state, age may be a factor, as some states do not have coverage for all adults. Even though Medicaid is federally funded, each state determines certain aspects of income level for eligibility. A big benefit to this vision insurance is that there are nominal costs passed on to those who qualify. In most cases coverage is free.

Vision plans under Medicaid is available for children and adolescents. In some cases, low-income seniors may receive vision insurance depending on the state. Vision insurance allows children to get the annual vision screenings to prevent visual impairment.

In most states, eye exams, eyeglass frames and lenses can be fully covered. Each state determines the frequency of these services. Anyone interested in coverage should continue reading to learn more about vision insurance plans and what these plans cover.

Learn About Vision Insurance for Low-Income Families

Vision insurance can sometimes be overlooked, especially for families who cannot afford it. Vision plans should be considered especially for children with disabilities. Eye care insurance allows preventive eye exams to avoid visual impairment.

Medicaid vision insurance plans are available depending on the state in which you live. Exam frequency and eyewear purchase conditions can also vary. Per federal Medicaid rules, all states active in providing this program must offer benefits information to enrollees. Vision is considered a preventive and on-going care measure per Medicaid. Therefore, all enrolled individuals should understand where and when services are available.

You may find you are ineligible for Medicaid eyeglasses due to income level. In the event that this occurs, there are other state and federal partnerships that provide low cost health insurance coverage.

This includes the Children’s Health Insurance Program (CHIP). This program has a considerable amount of income flexibility for children of low-income families that might not otherwise qualify for medical benefits. They also cover preventative care at no cost. Here are some other agencies that assist with free or low-cost eye exams:

  • The AOA foundation
  • The Foundation of American Academy of Ophthalmology
  • Lions Club international

Who can get Vision Insurance?

Glasses insurance should be available in your state. State Medicaid programs must follow federally established guidelines. However, pay attention to their varied costs and eligibility requirements. In order to become eligible, the state Medicaid system bases eligibility through income levels and other factors:

  • Household size
  • Disability, if applicable
  • Family status

In some states, applicants may get Medicare and Medicare vision coverage if they qualify based on income alone. For example, if household income is 133 percent of the federal poverty level, you may qualify. Each state has certain standards that can vary. However, many states expanded their Medicaid coverage.

Even if your state has not expanded their Medicaid program, you should still apply. If Medicaid is not available for you, seek out other programs for vision care that you may be eligible for.

Learn About Coverage Under Medicaid Vision Plans

Medicaid eyeglasses is only one aspect of coverage offered through this federally funded program. Regardless of state, Medicaid guidelines require all children under a certain age to be covered. This includes the following benefits:

  • Diagnosis and treatment for defects in vision, which include glasses insurance.
  • Replacement coverage for lost, broken or stolen glasses.
  • If future vision problems are detected through the annual screening, any and all medically necessary services must be covered.

Even though each state follows certain guidelines, the state typically determines the frequency in which eye exams and glasses insurance can be used. Also, there may be limitations on what glasses or lenses you can purchase depending on price. This would make for limited availability.

Depending on which state you reside in, here are a few things that can be covered:

  • Routine and comprehensive eye exams: This can range state to state, but essentially it should cover traditional vision field tests, dilation or tests for blindness and glaucoma.
  • Glaucoma screenings: If you are a patient that is considered high-risk for glaucoma, this screening could be covered in your vision insurance.
  • Eyeglasses: This includes everything involved with receiving your eyeglasses set, such as frames, lenses fittings, repairs and replacements.
  • Bifocal and trifocals: Vision differs from patient to patient, so Medicaid has opted to cover specialized and progressive lenses.
  • Contact lenses: Medicaid may not cover contact lenses unless they are medically necessary and no alternative treatment is available.
  • Prosthetics: Medicaid vision plans may cover prosthetic eyes.

How to Apply for Vision Insurance

You may be wondering, “Who takes Medicaid for eyeglasses?” In most cases, optometrists and other doctors do. However, it does vary from doctor to doctor and state to state. This does not mean you should not apply for vision insurance. If you are categorized as low income, you should take advantage of this program, especially for your children.

There are a few ways to apply for vision insurance. There is no separate application for vision coverage when signing up for Medicaid benefits. If you apply directly through Medicaid, it should cover your vision application if you are eligible. Here are a few ways you can apply:

  • The Health Insurance Marketplace has an application that can be filed online to obtain different types of health insurance coverage. You will need to select your resident state and fill out the required information to start an account. Remember to have important information readily available to verify your income level and provide household information as necessary.
  • Contact your state Medicaid agency: The government’s Medicaid site will navigate you to the appropriate agency. Once you locate your state benefits, they may offer several different ways to apply. This includes online, in-person or a traditional paper application. You may also need to submit required financial documentation and personal information to determine eligibility.

Once you learn you are eligible, you can then research doctors who take Medicaid vision plans. In most cases, optometrists and ophthalmologist accept Medicaid. However, check with your primary doctor to see if a referral is needed.