Does Aetna Medicaid Cover Glasses

Contact Lenses And Eyeglasses For Accidental Injury

An initial pair of contact lenses or eyeglasses is considered medically necessary under medical plans when they are prescribed by a physician to correct a change in vision directly resulting from an accidental bodily injury. Note: Charges to replace such contact lenses or eyeglasses are not covered under medical plans.

Replacement Eyeglasses Under Plans With A Pediatric Vision Benefit

Some plans include a pediatric vision benefit. Please check benefit plan descriptions. Under these plans, replacement lenses are considered medically necessary for children and adolescents when one or more of the following criteria are met:

How Does Vision Coverage Work With An Aetna Medicare Advantage Plan

An Aetna Medicare Advantage plan with vision benefits may typically work in 1 of 2 ways.

• A network plan has a network of participating vision care providers you may see. The provider submits the claim to Aetna after administering care, and you may be responsible for a copayment or coinsurance.
• A direct member reimbursement plan allows you to see any vision care provider in the U.S. who accepts Medicare. You will pay for your care up front and then submit some information and an itemized receipt to Aetna for reimbursement.

You May Like: How Do I Qualify For Medicaid In Ohio

Aetna Vision: A Good Option For Many Americans

If your employer offers Aetna Vision, or you want to combine your individual insurance with vision coverage options, Aetna is a good choice.

Since they are a large national insurance provider, they work with most national companies, along with many local providers and retailers, so you can get the best service for your eyes. Few providers will be out of network.

If you need both glasses and contact lenses or a second pair of glasses, the discounts through Aetna Vision can add up.

Know Everything Your Vision Plan Covers

Depending on your plan, Aetna Vision Preferred vision insurance generally includes:*

• One eye exam per year with $0 co-pay

• Standard prescription eyeglass lenses at a member cost of $0 to $25 with a frames allowance ranging from $130 to $300

• OR a contact lens allowance from $130 to $150 per calendar year

• Eyeglass lens extras typically require an additional co-pay. For example: Lenses with an anti-reflective coating or made with an above-standard material are usually less than a $100 co-pay. Progressive lenses cost anywhere from $0 to $135

That means if you use your Aetna Vision plan to help pay for prescription contact lenses and want to also buy a pair of eyeglass lenses during the same 12-month period, your allowance will only cover the first type of eyewear purchased .

After you enroll in an Aetna Vision Preferred plan, youll receive a welcome packet in the mail. The packet includes your member ID card, information about your plan and a list of local in-network providers. Once you have your member ID, you can use your ID number to register an account on the Aetna Vision website.

After you create your account, you can log in and access your vision plan documents online. Review them carefully to ensure you get the most out of your benefits.

*Coverage depends on your individual plan. Please see your vision insurance member documents to determine your specific benefits.

SEE ALSO:What is covered by vision insurance?

You May Like: Where Do I Find My Medicaid Number

How Will You Know If You Have Medicaid

If you want to know whether you have Medicaid and can use it to pay for your eyeglasses, consult your plan provider. You can get his/her contacts on one of the online directories that show you where to get eyewear providers who accept Medicaid.

You can also visit your states Medicaid site to check if you qualify for the program then apply to join. Remember that the qualification rules change, so check regularly to know when you are eligible.

Prosthetic Contact Lenses And Eyeglasses For Aphakia

Aetna considers the following features not medically necessary:

Also Check: Dentist In Illinois That Take Medicaid

In What Situations Does Medicaid Cover Glasses

Medicaid will pay the cost of a new pair of glasses for children and people under the age of 21, and in certain areas, eyeglasses are available to everyone.

One of the general conditions is that they are deemed medically necessary.

If you have significant eye issues and require the services of an ophthalmologist, Medicaid will most likely cover you as well. However, the procedure of receiving an exam may change since you must utilize your physical health Medicaid benefit.

Your primary care provider will have all of the answers and can send you to an ophthalmologist if necessary.

Aetna Vision Preferred Website

Once youre a member, you can get details about your vision plan in one place claims updates, coverage entails, exclusive discounts, wellness information and more.

Licensee’s use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.

This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.

Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.

Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled “I Accept”.

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION

U.S. Government Rights

Disclaimer of Warranties and Liabilities.

Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled “I Accept”.

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION

U.S. Government Rights

Disclaimer of Warranties and Liabilities.

Recommended Reading: Do You Have To Reapply For Medicaid Every Year

Therapeutic Hydrophilic Contact Lenses

Therapeutic soft contact lenses or gas-permeable fluid ventilated scleral lenses are considered medically necessary prosthetics under medical plans where used as moist corneal bandages for the treatment of severe ocular surface diseases, including

Corneal bandages are considered experimental and investigational for all other indications.

Note: Liquid bandage scleral lenses are covered under plans that exclude coverage of contact lenses, as these lenses are not primarily for correction of refractive errors.

Note: For scleral lenses for masking irregular astigmatism, see section below.

Replacement lenses are considered medically necessary under medical plans if required because of a change in the patient’s physical condition . Note: Charges to replace contact lenses that are lost, damaged, or required solely due to refractive changes are not covered under medical plans.

Does Aetna Vision Cover Lasik Or Laser Surgery Costs

More and more, vision insurance plans are finding ways to cover some portion of the cost of LASIK. Almost 10 million Americans have undergone this procedure to improve nearsightedness, farsightedness, and astigmatism, so vision insurance providers are finding it practical to offer some coverage for this simple outpatient laser surgery.

Without any vision insurance coverage, LASIK can cost up to $3,000 per eye, so you might pay up to $6,000 to $7,000 to have both eyes corrected.

To offset this cost, Aetna Vision offers 15 percent off retail prices or 5 percent off promotional prices at partnered LASIK vision centers. You can also get similar discounts for photorefractive keratectomy , an older procedure similar to LASIK.

Read Also: What Do I Need To Apply For Medicaid

How Much Does An Aetna Medicare Advantage Plan With Vision Coverage Cost

As with most Medicare Advantage plans, the cost of a Medicare Advantage plan from Aetna may vary according to location, benefits offered and other criteria.

You can use the Medicare Plan Finder tool to see how much an Aetna Medicare Advantage plan with vision benefits might cost in your area.

The following table provides some examples of what you might pay for an Aetna Medicare Advantage plan with vision coverage in Miami-Dade County in Florida and Maricopa County in Arizona.

Aetna Medicare Vision Coverage

What About Standalone Vision Plans From Aetna

If you don’t qualify for a Medicare Advantage plan, you may still receive vision coverage through Aetna from a standalone vision plan.

The Aetna Vision Preferred plan is a vision plan for those enrolled in a group or individual health insurance plan that does not include vision coverage. This plan offers free eye exams and a $130 allowance for frames and contact lenses. Eyeglass lenses cost between $25 and $135 depending on the type of lens desired.

The network of participating providers includes eye doctors all over the U.S. along with retailers such as Lens Crafters, Target, Ray Ban, Glasses.com and ContactsDirect.com. .

Don’t Miss: Obgyn In Baton Rouge That Accept Medicaid

How Can I Find A Top

You can use Zocdoc to find Aetna Better Health Eye Doctors who are highly rated by other patients. These ratings are based on verified reviews submitted by real patients. Every time a patient completes an appointment booked on Zocdoc, theyre invited to review their experience. Each review must comply with Zocdocs guidelines.

Medicare Advantage Plan Types

Medicare Advantage plans may include various types of plan, offering different levels of coverage and availability. The list below looks at these in more detail.

• Health Maintenance Organization plans use a network of healthcare providers, and people can choose a primary care physician to coordinate their care and issue specialists referrals.
• Health Maintenance Organization Point-of-Service plans allow members to use out-of-network care at a higher cost.
• Preferred Provider Organization plans also use a provider network, but members do not need to select a primary care doctor or require specialist referrals.
• Private Fee-For-Service plans have members who pay an agreed amount for care.
• Special Needs Plans are for people with specific disabilities or chronic health conditions or those who have Medicare and Medicaid.

People can find out which Medicare Advantage plans are available in their area by using the governments plan finder tool.

• meal delivery services

Also Check: What Are The Eligibility Requirements For Medicaid In Texas

Scleral Shell Contact Lenses

Scleral shell contact lenses are considered medically necessary under medical plans for the following indications:

Replacement lenses are considered medically necessary under medical plans if required because of a change in the member’s physical condition .

Note: Charges to replace contact lenses that are lost, damaged, or required solely due to refractive changes are not covered under medical plans.

Note: Scleral shell lenses are covered under plans that exclude coverage of contact lenses, as scleral shell lenses are not primarily for correction of refractive errors.

Regular Eye Exams & Necessary Eye Surgeries

Regular annual eye exams with in-network providers cost nothing. If you need additional tests during that exam, there is a small added cost. For example, retinal imaging has a $39 discounted fee if you need this for your eyes health.

You can also get 20 percent off items that are not typically covered by your vision insurance, but that might be necessary for your eyes health.

If your Aetna Vision plan ties into your regular Aetna health insurance, more serious eye diseases like macular degeneration, glaucoma, or cataracts can be treated with this coverage.

Read Also: How Much Do I Need To Make To Get Medicaid

How To Check If You Have Vision Coverage

Details of your Aetna Medicare plans benefits are in your Evidence of Coverage copy. When you buy you plan, youll receive this document, detailing every treatment or diagnostic service covered.

If you have vision coverage, there will be a section on the EOC indicating the specific benefits available. These may include glaucoma screening, routine eye checkups, and therapeutic eyewear like contact lenses, frames and anti-UV glasses.

Its best if you compared the plans before purchasing to pick the option with your preferred coverage benefits. In case your existing plan doesnt cover eye care, you may inquire with Aetna about buying supplemental coverage, such as a Vision Preferred plan.

Does Aetna Medicare Advantage Cover Cataract Surgery

Medicare Advantage plans are required to provide at least the same basic coverage offered under original Medicare. Since original Medicare covers cataract surgery, Aetna Medicare Advantage plans must cover this as well.

Make sure to go to doctors and facilities that are in your plans network to ensure coverage.

Read Also: Will Medicaid Pay For Vyvanse

Does Medicaid Replace Glasses

Medicaid typically replaces glasses, but the frequency with which you may do so is determined by your age and the state in which you live.

Children and young people under the age of 21 can often get two replacements each year. The remainder of Medicaid patients typically receives one replacement each year.

This covers scenarios in which the glasses are broken, stolen, or misplaced. Furthermore, in many jurisdictions, Medicaid will pay for the cost of fixing spectacles.

How To Take Advantage Of Your Medicaid Vision Benefits

If you have Medicaid for vision coverage, it is likely that you will need a referral from your primary care provider in order to see an ophthalmologist

Ophthalmologist visits are usually covered through your standard Medicaid insurance, as care from a specialty doctor. By getting connected with an ophthalmologist, you can take advantage of the eye care benefits offered through Medicaid. This includes exams and assessments for eye diseases and conditions.

To get in touch with a local Medicaid office, visit the federal governments website at Benefits.gov. From there, you can filter information by state and subcategory to find the contact information for a Medicaid office near you.

You can also ask a specific eye care provider for assistance on using your Medicaid coverage. Some providers dont take Medicaid, but they may be able to refer you to another provider who does.

Read Also: New Jersey Medicaid Income Limit

How Can I Make A Same

On average, patients who use Zocdoc can search for an Eye Doctor who takes Aetna Better Health insurance, book an appointment, and see the Eye Doctor within 24 hours. Same-day appointments are often available, you can search for real-time availability of Eye Doctors who accept Aetna Better Health insurance and make an appointment online.

We Accept Most Insurance And Vision Plans Find Your Store And Check Your Plan

Taking care of your eyes is our top priority, which is why our stores accept most insurance and vision plans. If, however, you dont see your vision plan listed, chances are weve got you covered. Learn more about Vision Insurance at Cohens Fashion Optical.

Find your nearest location and check their store page to see which vision plans they accept.

Don’t Miss: Rehabs That Accept Medicaid In Colorado

How Can I Book An Appointment Online With An Aetna Better Health Eye Doctor

Zocdoc is a free online service that helps patients find Aetna Better Health Eye Doctors and book appointments instantly. You can search for Aetna Better Health Eye Doctors by symptom or visit reason. Then, choose your location. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.

What Is Not Covered By Medicaid If You Need Glasses

While the rules and regulations vary by state, you are generally not covered for:

• Transition lenses
• Oversized lenses
• No-line bifocals or trifocals

As usual, check with your doctor or the Medicaid representative in your state and locality to see if these particular lenses are covered by Medicaid. Sometimes they are just partially insured, and you simply need to cover the difference in cost.

Also Check: How To Renew Medicaid Nc

What States Allow Medicaid To Cover Glasses

We said that most states enable Medicaid to pay your glasses and related expenditures, however, this is not the case in all states.

The following states DO NOT allow Medicaid to cover glasses:

• Routine and comprehensive eye exams
• Prosthetic eyes

All of the above-mentioned examinations and products are considered optional, and just a few states permit them. As usual, the best thing you can do is contact your plan assistant and request further information.