What Frames Are Covered Under Medicaid?
Medicaid supplies members with one pair of eyeglasses with standard frames. In some states, Medicaid only pays for a pair of glasses or contact lenses after cataract surgery.
Depending on the state in which the participant is a member of Medicaid, the amount of glasses and the basis for need may vary, as documented by the Kaiser Family Foundation. There are limitations on how frequently an individual can obtain glasses, such as one pair a year, two pairs over 5 years or one pair over a lifetime.
Every state Medicaid program offers a unique coverage program for eyeglasses, some require co-payments, while others pay the entire cost of the glasses with standard frames.
Some states offer a replacement plan for eyeglasses that are lost, stolen or broken, while others do not. Some states require that glasses be purchased from a vendor that agrees to a lowered cost through a volume contract.
The amount covered by Medicaid for the eyeglasses is done so in a fee for service method if there is no reduction in cost agreement in place. The amount not covered is the covered individual's responsibility.
Some states have specific groups that federal law dictates mandatory coverage. These groups often have special conditions and coverage terms in place that differ slightly from the standard plan details.