Need Eyeglasses? Medicaid Has You Covered

Your vision is important, and if you have Medicaid—whether it is Healthy Michigan Plan, Healthy Kids, MIChild, or a traditional Medicaid program—you can get eye exams and glasses.

 

Eye exams are an important part of health care. Routine eye exams can detect vision problems, eye diseases, and other health problems. For routine exams you would typically visit an optometrist. An optometrist performs eye exams to detect both vision and health problems. Optometrists can also provide low vision care, pre- and post-op surgery care, and prescribe glasses and contact lenses.

Eyeglasses, Exams and More

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. [For people 21 years and under, glasses can replaced twice a year if glasses are broken, lost, or stolen--otherwise, the rule is once a year.]
  • Medicaid covers bifocal and trifocals, or for two pair of single vision glasses (near and distance vision) 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 aren’t medically necessary, but you want them, you can pay for them separately.
  • Medicaid Covers safety frames.
  • People that select frames and lenses that aren’t covered must pay the difference in cost.
  • Medicaid also covers prosthetic eyes.

What About Serious Eye Problems? They Are Covered, Too

eyestrain

What if you are concerned about losing vision, eye pain, or other things that may point to a serious eye problem? If you have more serious eye problems (such as cataracts, detached retinas, or glaucoma), you need an ophthalmologist. An ophthalmologist is a medical doctor that specializes in eye and vision care.   Ophthalmologists perform eye exams, diagnose and treat diseases, perform surgeries and prescribe medication, glasses and contact lenses.

An ophthalmologist is seen through your physical health Medicaid benefit, and not your Medicaid vision benefit. To access an ophthalmologist, most of the time you will need a referral from your primary care provider, just as if you needed to see a cardiologist, an allergist, or some other specialist.

NOTE: If you have a Marketplace or employer plan, typically it will cover the medical specialty of ophthalmology (for instance, if you have cataracts), but eyeglasses will only be covered if you have a special vision plan.

How Do I Find A Place To Get My Glasses?

For a listing of Vision Providers that accept Medicaid please call your individual plan or visit them at the web links and follow the instructions provided.

Aetna Better Health Plan

Phone Number 1 866-316-3784 (TTY: 711)

Online: https://www.aetnabetterhealth.com/michigan/find-provider

  •     Click on Medicaid, MIChild, Healthy Michigan Vision
  •    Click on visit VSP
  •   Click on find a doctor 
  •   Enter zip code, city and state
  •   Enter Medicaid for doctor network 
  •   Click Search

 

Blue Cross Complete

Phone Number 1 800-228-8554 (TTY: 711)

Online: http://www.mibluecrosscomplete.com/find-doctor.html

  • Click on find a doctor
  • Click on advanced search
  • Enter city and state or county, township
  • For specialty click on, optometry, optometrist
  • Click submit

 

McLaren Health Plan

McLaren Medicaid

McLaren Healthy Michigan

Phone Number 1 888-327-0671 (TTY: 711)    

Online: http://www.mclarenhealthplan.org/medicaid-consumer/Find-a-Provider-medicaid.aspx

Online: http://www.mclarenhealthplan.org/healthy-michigan-member/Find-a-Provider-medicaid.aspx

  •    Click on specialty type optometry or
  •    Click on county add Washtenaw
  •    Enter zip code
  •    Click find

 

Meridian Health Plan

Meridian Medicaid

Meridian Healthy Michigan

Phone Number 1 888-437-0606 (TTY: 711)

Online: https://corp.mhplan.com/en/member/michigan/meridianhealthplan/benefits-resources/tools-resources/provider-search/

Online: https://corp.mhplan.com/en/member/michigan/healthymichiganplan/benefits-resources/tools-resources/provider-search/

  •    Click on more search options
  •   Enter zip code
  •    Enter results in 30 mile radius
  •    Click on optometry for optometrists
  •    Click search
  •    Click on page number

 

 Molina Health Plan

 Phone Number 1 888-898-7969 (TTY: 711)  

Online: https://providersearch.molinahealthcare.com/Provider/ProviderSearch?

  •   For Cover Plan select Medicaid/Healthy MI Plan/MIChild  
  •    Click search by county
  •    Enter state
  •    Enter county
  •    For the provider type select ancillary
  •    For the specialty select optometry
  •    Click search

 

UNITEDHEALTHCARE PLAN

Phone Number 1 877-892-3995 (TTY: 711) 

Online:   http://www.americhoice.com/find_doctor/first.jsp?xplan=uhcmi&xtitle=Doctor

  •    Scroll to bottom right and select looking for vision benefits tab and click on link
  •    Takes you to VSP site
  •    Click on find a doctor
  •    Enter zip code, city, and state
  •    Enter Medicaid for doctor network
  •    Then click search

-T. South Peterson

 

Other Resources

MIChild is Changing, and It Generally Will Mean Better Coverage for Michigan Kids

Good News: Medicaid Can Be Secondary Insurance

Updated** Medicaid Dental: How to Use it and Where to Go...

Updated** Understanding A Medicaid Deductible, or "Spenddown"

Am I eligible for Medicaid? 

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