Does Medicaid cover contact lenses in their health plans?
This question has been dangling in the hearts of many readers. As you read further, you’ll know whether it’s eligible for Medicaid coverage.
Before taking further steps, let’s briefly learn about this insurance scheme.
Contact Lenses Medicaid
People wear contact lenses for several reasons, including aesthetics. It’s part of the essential care you need for your vision.
Adults over 55 are advised to schedule routine eye exams with their vision care provider. Then fellows below the stated age should have their eyes checked at least every 2–4 years.
Most healthcare insurance policies acknowledge the importance of vision care. For that, they include it in their coverage plan.
What’s Medicaid?
This is simply federal health insurance coverage for eligible citizens. The insurance provides low-cost coverage for low-income individuals and families.
Besides income level, other qualifying criteria vary among states in the country. Meanwhile, the federal government stipulates that Medicaid offers vision coverage to beneficiaries aged 21 and below.
Preventive care, such as eye checkups, screenings, and other diagnostics for kids, will be covered by Medicaid. Well-child appointments with extra screenings will not be charged.
The health insurance scheme offers such coverage via the Children’s Health Insurance Program (CHIP).
Does Medicaid Cover Contact lenses for Adults & Minors?
Back to our question: Will this health insurance scheme cover the bills for contact lenses? The answer is yes.
The EPSDT program under Medicaid offers vision benefits such as contact lenses and eye frames. The sole beneficiaries are kids and adolescents aged 21 and below.
However, each state determines how these checkups, prescribed lenses, and eye frames are provided. In some states, contact lenses are included in adult vision benefits.
Other states offer more than that. They have eye frames, screening for glaucoma, necessary contact surgery, and subsidized co-payments.
Meanwhile, some services covered by Medicaid include eye exams, eyeglass frames & contact lenses, and bifocals.
Others are the replacement or repair of frames or lenses, ocular prosthetics, and other medically essential related services.
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More Hints About Eyeglass Repairs
It must be due to broken frames or lenses before receiving coverage for eyeglass or lens repairs.
Then, when the cost of repairs is high, Medicaid can provide you with a replacement. But the program’s benefits may not cover contact lens supplies and insurance.
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Eligibility Criteria for Medicaid Vision Coverage
Although Medicaid coverage is open to all citizens, not everyone is qualified for vision coverage.
Eligibility criteria vary from one state to another. But for the most part, eligible individuals for Medicaid benefits, such as contact lenses, include low-income families and individuals.
Others are pregnant women, children and adolescents (0–21 years), and persons receiving SSI (Supplemental Security Income). Other than these fellows, other patients must sort their contact lenses from their pockets.
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What You Should Know About Medicaid
You need to know certain things about this health insurance concerning contact lenses. This will help you make informed decisions when seeking contact lens coverage.
Now, all eyeglasses must be certified beforehand by Medicaid. Lenses meant for cosmetic purposes will not be covered by health insurance.
However, the scheme can cover both rigid and soft contact lenses. But they often choose the least costly, smooth, or stiff alternative.
Why Does Medicaid Not Cover Contact Lenses for Adults?
As stated, this health insurance doesn’t cover adult prescription contacts in most states nationwide.
Do you desire to find out why? Contact lenses are a far more costly therapy for vision errors than eyeglasses. Yet, people usually enjoy them for aesthetic sake rather than wellness benefits.
However, there are specific limitations to this rule. These items are deemed critical because recipients cannot wear spectacles. They’re also considered prosthetic devices, which fall under insurance.
Finally, contact lenses correct eye conditions that can’t be corrected with spectacles. We refer to astigmatism, anisometropia, high ametropia, aphakia, keratoconus, and keratoconjunctivitis sicca.
What About Serous Eye Problems?
You may want to know whether this health insurance covers severe eye conditions. The answer is yes.
They will cover the expenses of severe vision problems. An eye specialist, such as an ophthalmologist, is best. They will perform eye checkups, diagnose, and treat your eye problems.
You should obtain a letter from your primary care physician before visiting an eye doctor with your Medicaid plan. The same rules apply when visiting other doctors, including dermatologists and cardiologists.
Furthermore, Medicaid may offer full or partial coverage if you need eye surgery. After the surgery, they’ll give you one pair of standard contacts or eyeglasses.
But surgeries to correct refractive errors, such as LASIK, may not be covered by health insurance. The reason is that such operations are deemed elective and not medically necessary.
To reduce expenses for such surgeries, you can buy “gap” insurance or vision coverage in addition to Medicaid. Such policies do offer discounts on corrective eye surgeries.
How Many Times Can I Get an Exam with Medicare?
You want to know how often you can get Medicaid coverage for eye examinations.
Well, eye exams and general vision care differ from one state to another. Patients 21 or older are eligible for annual, routine eye exams.
Outside this, patients may seek medical attention for problems relating to the eye. These include dry eyes, allergies, headaches, eye trauma, floaters, glaucoma care, and macular degeneration care.
Others include cataract evaluation, treatment, and other acute or chronic medical eye conditions.
Children and young adults under twenty-one are eligible for unlimited eye exams under this health insurance coverage.
Finding Eye Specialists Who Accept Medicaid
It’s easy to locate an eye expert who accepts coverage from this health insurance.
Visit the official pages of Medicaid, and you’ll see your state’s Medicare program. Click on it and search the directory to find the specialist that accepts such coverage.
You can also get details about the agency managing your plan. Plus, the directory of participating healthcare providers.
Medicaid is a fantastic health insurance scheme for those with vision conditions.
As you can see above, they provide full or partial coverage for eye treatment, including contact lenses. But you must know that this scheme needs to be more inclusive regarding vision benefits.
You must maintain an open line or talk with your local Medicaid office to get contact lenses if you need their coverage. There, you’ll know what they will and will not cover.