When Medicaid Covers Eye Exams
Medicaid sometimes covers eye exams for adults. The reasons for the visual testing and your state of residence determine whether your plan will honor claims and how frequently.
Finding a local eye doctor that accepts Medicaid could prove challenging due to the low reimbursement rates and varying levels of coverage.
- Medicaid acts as health insurance with relatively uniform benefits across the country for medically necessary eye care.
- Medicaid acts as vision insurance with widely varying benefits state-by-state when measuring refractive errors.
Is Eye Care Covered By Medicaid
You are here: HomeIs Eye Care Covered By Medicaid?
Medicare-Medicaid can be an incredible resource that saves you thousands of dollars on medical costs.
But, like all health care services, it has its limitations and cutoffs for what it covers and doesnt cover.
This begs the question, does Medicaid cover your eye care? Are you able to go to the eye doctor if an ocular condition arises while you are under Medicaid?
The answer to this question is more complicated than just a simple yes or no. The truth is, the availability of eye care under Medicaid is dependent on a lot of external factors like where you live, what medical condition you suffer from, and whether your optometrist accepts Medicare.
With that being said, what scenarios would warrant Medicaid being able to cover your eye care?
Who Qualifies For Medicaid In Lousiana
In Louisiana, many citizens qualify for and use Medicaid benefits. According to the Department of Health, you qualify for Louisiana Medicaid if you receive Supplemental Security Income from the Social Security Administration or receive financial aid from the Office of Family Support through the Family Independence Temporary Assistance Program . While Medicaid is traditionally reserved for lower-income citizens, you may also qualify for benefits in our state if you:
- Are disabled according to the Social Security Administrations definition
- Have corrected vision no better than 20/200
- Are a low-income parent of children under age 19
- Are a child under age 19
- Are pregnant
- Receive Medicare coverage and are low-income, or
- Are aged 19 to 64 years old, have a household income under 138% of the federal poverty level, doesnt already qualify for Medicaid or Medicare and meet citizenship requirement
If you have questions about qualifying or applying for Louisiana Medicaid, call your local Medicaid office. You can also visit the Louisiana Department of Healths website for more information.
Don’t Miss: Vermont Medicaid Dental Fee Schedule
Nc Medicaid Managed Care Excluded
- Some beneficiaries will remain in NC Medicaid Direct, which is the fee-for-service program. This is how you receive health care services now. This means you cannot choose a health plan and you do not need to choose a new PCP unless you want to change to your current PCP. You will stay in NC Medicaid Direct if you:
- Receive Family Planning Medicaid, Refugee Medicaid, Foster Care/Adoption Medicaid , or must meet a deductible before getting Medicaid benefits
- Are part of the Health insurance premium payment or Program of all-inclusive care for the elderly programs, or
- Have both Medicare and Medicaid or receive long-stay nursing home services,
- Receive Innovations Waiver services, Traumatic Brain Injury Waiver services, or Community Alternatives Program for Children or Community Alternative Program for Disabled Adults services.
Use The Links Below To Start Your Search
Doctor.com can help you find a Optometrist who accepts Medicaid insurance in North Carolina. Doctors of optometry are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify Related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Don’t Miss: Does Family Planning Medicaid Cover Mammograms
Does Medicaid Cover Prescription Eye Exams
Eye exams are an important part of vision health and therefore covered by Medicaid. Some types of eye exams may be covered under your standard health insurance plan.
Medicaid covers many types of eye exams, including exams for vision prescriptions. Eye exams covered by Medicaid include:
- Routine exams.
- Glaucoma screening.
Lenses Covered By Medicaid
If you need new glasses through Medicaid, it is important to be aware of which types of lenses are covered. Regular single vision lenses are covered by Medicaid, for near and distance vision correction.
If you need bifocals or trifocals, Medicaid will also usually cover the cost. It will generally cover the cost of one pair of bifocals or trifocals, or two pairs of single vision glasses.
Lenses that are not covered by Medicaid include:
- Oversized lenses.
- Progressive multifocals.
- Transition lenses.
If you would like to have any of the above lenses, you can still get them with your Medicaid coverage. You will just have to pay the difference in cost for such specialty lenses.
Additionally, contact lenses are not typically covered by Medicaid. If you want contacts, you will probably have to pay for them out of pocket or with a different supplemental insurance plan. In some cases, contact lenses are covered, but only when they are deemed to be medically necessary.
Also Check: New Mexico Medicaid Provider Portal
What Are Eye Doctors That Accept Medicaid
The best way to find an optometrist or ophthalmologist who accepts Medicaid payments is to search the Physician Care page on Medicare.gov, the U.S.governments official Medicare website. To conduct a search, type the city, state, ZIP code and specialty into the search fields. This brings up local area eye doctors. Look for a graphic box with the letter m in the middle, which indicates that the doctor accepts Medicaid.
Eye doctors who potentially accept Medicaid may also be found by visiting the eye care professional reference section of the National Eye Institute website. Although the National Eye Institute doesnt recommend specific doctors, it does give useful information and medical organization links. Featured reference sites include The American Academy of Ophthalmology, The American Optometric Association, the International Society of Refractive Surgery and The American Medical Association. Patients can search these sites to find local eye doctors within a 25 mile radius. It may be necessary to contact doctors individually and ask about Medicaid acceptance.
Eye doctors may be included on a list of doctors provided upon Medicaid enrollment. Other ways to find an eye doctor that accepts Medicaid is to ask family and friends who they recommend. Family care physicians may also be a source of recommendations.
Nc Medicaid Managed Care Exempt
Some beneficiaries can choose to stay in NC Medicaid Direct. This means you are not required to choose a health plan and a PCP. NCDHHS – Division of Health Benefits will send you a letter that tells you if you have the choice to enroll. You have the option to choose a health plan if you:
- Are a federally-recognized tribal member or individual eligible for services through Indian Health Service .
- Need certain services to address needs related to developmental disability, behavioral health or traumatic brain injury. BH covers MH and SUD
If you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now:
- Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received ,
To find a doctor, go to Find a provider.
You May Like: What Is Family Planning Medicaid Nc
Looking For An Optometrist Or Ophthalmologist
You can use this tool to find eye doctors near you that participate in our network.
You can also use this tool to see if your current optometrist, ophthalmologist or vision center is one of the 95,000 locations in the Humana network.
Our network includes optometrists, ophthalmologists and popular retail vision centers, so you can find an eye doctor near you, with office hours that work for you.
You can learn more about how we build the network here., PDF opens new window
What Will Medicaid Cover
- Medicaid covers both routine and comprehensive eye exams which can include a variety of testing such as visual field test, pupil dilation, color blindness, glaucoma, and many others.
- Medicaid covers glaucoma screenings for people at higher risk for glaucoma.
- Medicaid covers eyeglasses that includes the frames, lenses, fittings, repairs and replacements of glasses.
- Medicaid covers bifocal and trifocals, or for two pair of single vision glasses if bifocals don’t work. Over-sized lenses, no-line, progressive multi-focal and transitions are not a covered Medicaid benefit. However, if you want to buy these, you can pay for the additional costs.
- Medicaid only covers contact lenses if they are considered medically necessary and if there is no other alternative treatment. If they arent medically necessary, but you want them, you can pay for them separately.
- Medicaid Covers safety frames.
- People that select frames and lenses that arent covered must pay the difference in cost.
- Medicaid also covers prosthetic eyes.
Read Also: Eye Doctors In Traverse City That Accept Medicaid
How Often Does Medicaid Pay For An Eye Exam
States are required to adhere to the recommended schedule for child and adolescent vision and hearing screenings.
All screenings must meet a certain standard of medical practice, which is determined by a credible pediatric health organization, such as the American Academy of Pediatrics.
For adults over age 21, the frequency of covered eye exams depends on which state you live in. On average, an eye exam is covered approximately every two or three years.
To get the most accurate information for your states Medicaid practices, contact a Medicaid representative in your states designated region.
TIME FOR AN EYE EXAM UNDER YOUR STATE’S MEDICAID PROGRAM? Find a local eye doctor who accepts Medicaid coverage.
Schedule an exam
How To Get A List Of Local Eye Doctors That Accept Medicaid
Many people are confused about how to get a list of nearby eye doctors that accept Medicaid patients.
Insurance is a complex topic, and adding layers of government rules makes things even more convoluted. Fortunately, there is a simple process to follow.
Please dont make the common mistake of asking the wrong question: whether a specific vision center takes Medicaid or the state nickname for their program.
Instead, start by verifying coverage in your state and your eligibility for benefits. Skip asking the wrong questions, going straight to your insurance ID card and then the online provider directory.
Finally, call each provider to verify critical details before booking your appointment.
Read Also: Nursing Homes In Huntsville Al That Take Medicaid
Confirm Medicaid Pays For The Vision Service
The second step before generating a list of neighborhood eye doctors accepting Medicaid is to confirm whether you are eligible for the specific vision service you need.
You might find a neighborhood provider taking new patients only to find out that you do not qualify for a specific service because your timing is off.
For example, each state sets different parameters about how often you can get an exam to measure refractive errors. Also, your state may have a similar schedule for how often you can get new prescription eyeglasses, frames, or contact lenses.
In What Situations Does Medicaid Cover Glasses
Medicaid usually covers the costs associated with purchasing a new pair of glasses, particularly when deemed medically necessary. Children and young adults also get coverage for glasses.
These aspects of eyeglasses are covered by Medicaid:
- Replacement glasses
Typically, Medicaid covers the cost of one pair of replacement glasses per year. If you are 21 or younger, you are allowed two pairs of replacement glasses per year. Glasses may be replaced if they are broken, lost, or stolen.
Also Check: Assisted Living Facilities In Arkansas That Accept Medicaid
Does Walmart Optical Accept Medicaid All About Walmart Optical
Walmart offers a range of services. From beauty needs to automotive. However, its no big surprise that the giant retailer also offers optical services like eyeglasses, contact lenses, and eye check-ups by a licensed optometry doctor.
Many people have discovered the cost-effectiveness and convenience offered by Walmart vision center for their eyes and vision care. This has made them choose it over other optical centers.
Although eye treatment is quite expensive, this has made many people go for insurance covers. The insurance covers help them to pay their bills.
Medicaid is one of the most used insurance programs in the US. It provides health coverage to millions of American people. For those who are still wondering whether Walmart accepts Medicaid or not, here is your response.
Does Walmart optical accept Medicaid?
Yes, they do accept Medicaid. Some Walmart Vision centers do accept Medicaid, while others do not. However, the vision benefits do vary from MCO to MCO, and some offer richer benefits. MCO is the company on your insurance card.
Jacqueline W Muller Md
Dr. Jacqueline Muller is the leading dry eye specialist in New York City. She has been practicing ophthalmology for more that 26 years and has been given numerous awards for her expertise, as well as having been featured on NBCâs The Today Show. She is the founder and primary surgeon at the Dry Eye Treatment Center in New York and also has affiliations with the New York-Presbyterian Hospital-Columbia and Cornell, the Lenox Hill Hospital.
Dr. Mullerâs educational background is outlined below:
â Graduated with her medical degree in 1989 from the Weill Medical College at Cornell University with honors in medicine and surgery
â Completed an internship in internal medicine at the the Greenwich Hospital Association at the Yale School of Medicine
â Completed the Lancaster Ophthalmology Program at Harvard University
â Completed her first residency in ophthalmology in 1993 at the New York Hospital – Cornell University Medical Center
â Attended a fellowship in cornea, refractive, and anterior segment surgery at the Manhattan Eye, Ear, and Throat Hospital in 1994
Dr. Mullerâs practice offers the following services:
â Dry eye treatment
â Styes and chalazia
â Neurotrophic keratitis
â Lasik, PRK, and Lasek surgeries
â Ocular rosacea
â Environmental allergies
â Meibomian gland dysfunction
764 Park Avenue
You May Like: Medicaid Doctors In Raleigh Nc
Who Does Medicaid Provide Vision Coverage For
Federal law requires that vision care be provided through Medicaid to children and adults under the age of 21. Regular well visits that include vision screenings help to reduce the occurrence of eye conditions later in life. The idea is that prevention is the best way to keep costs down overall.
There are no federal regulations, however, that require Medicaid to provide vision care for adults over the age of 21. Standard vision coverage options are offered by each state, though the specific services can vary greatly. Its important to confirm the specifics of coverage with your state.
Optometry services and eyeglasses are optional benefits under Medicaid. Optional medical services may come with a small copay for the individual. Again, the amount will vary by state.
In order to qualify for Medicaid coverage, you must meet certain requirements. You can qualify for Medicaid based on the following factors:
- State residency
If you have questions regarding your eligibility status, you can contact Medicaid directly.
As of October 2019, over 71 million people were enrolled in Medicaid across the country. Over 35 million of those individuals were children enrolled in Medicaids Childrens Health Insurance Program .
Medicaid provides affordable and essential health care services to individuals and families who may otherwise not be able to afford it.
Look At Your Insurance Id Card
The only way to generate an accurate list of local eye doctors that accepts Medicaid is to pull out your insurance ID card and look for the name of the private insurance company that administers your plan.
Even though Medicaid is a government program, most states outsource the administrative functions to private insurance companies. For example, you might find one of these familiar brands managing your health, vision, and dental benefits.
- Aetna Better Health: CA, FL, IL, KS, KY, LA, MD, MI, NJ, NY, OH, PA, TX, WV, VA
- Amerigroup: NJ
- Anthem: CA, IN, KY, NV, VA, WI
- Blue Cross Blue Shield: is a national federation of affiliated companies using this trade name, operating in twenty-four states
- Caresource: GA, IN, OH
- Staywell: FL
- Wellcare: AZ, FL, GA, HI, KY, MO, NE, NJ, NY, SC
Your insurance ID card provides the official map of your hidden treasure. On it, you should find a company name and website address. Open a web browser and visit the URL listed on your card.
You May Like: Who Is Not Eligible For Medicaid
Scott Stuart Weissman Md
Dr. Scott Weissman is an ophthalmologist with over 38 years of experience treating patients for all different kinds of eye-related issues. At his private practice in New York City, he provides everything from routine eye care and eyeglass prescription exams to advanced surgical treatment of serious eye disorders. Dr. Weissman has been a pioneer of refractive surgery innovations in New York and has become one of the primary authorities in ophthalmology in the United States.
Dr. Weissmanâs education is listed below:
â Received his medical degree from the Albert Einstein College of Medicine in 1983
â Completed a residency at the Nassau University Medical Center in 1984
â Completed his first residency in ophthalmology in 1987 at the Brookdale Medical Center
â Attended a fellowship in 1989 in corneal and inflammatory eye disease at the University of California in San Francisco
Dr. Weissmanâs patients appreciate his professional, respectful manner as well as his thoughtful suggestions and prescriptions. He is attentive and easy to talk to, and his patients say that both he and his staff are efficient and helpful.
Dr. Weissman offers the following services at his private practice:
â Refractive surgery
â Contact lenses
â Eye exams
â Vision correction
â Blepharitis treatment
â Dry eyes
â Computer eye strain
Midtown East, New York, NY 10017