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Keeping Your Family’s Vision Healthy with Medicaid Benefits

by Youth Vision

Keeping Your Family’s Vision Healthy with Medicaid Benefits

Reviewed By Dr. Jodi Kuhn

Reading time: 5 minutes

For families relying on Medicaid, using its vision benefits is a powerful way to safeguard the future of their loved ones.

Vision care is about more than just clear sight—it greatly enhances school performance, work productivity, and overall quality of life.

Medicaid empowers families to access high-quality care, demonstrating that dedication to health transcends financial barriers. 

Medicaid makes this possible by opening the door to essential vision services that keep your family’s eyes healthy and their lives vibrant.

Key Takeaway

Medicaid provides essential vision services for children and adults, including routine eye exams and eyeglasses, with tailored benefits for each group.

Does Medicaid Cover Eye Exams?

Yes! Medicaid provides comprehensive vision services for eligible children and teens through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

These include routine eye exams for kids, coverage for eyeglasses, and specialty eyewear if needed.

For adults, Medicaid includes annual eye examinations, with eyeglasses or contact lenses only covered following eye surgery. 

Medicaid’s vision benefits not only ensure your family has access to necessary eye care but also promote early detection of potential eye health issues, helping to prevent long-term problems.

Routine eye exams for kids are covered without limitations, and adults are eligible for annual exams. 

Benefits of Eye Exams for Kids

An eye exam for kids is more than just checking for blurry vision.

It detects refractive errors, visual acuity problems, and visual impairment. If your child struggles with schoolwork or sports, an eye exam can uncover hyperopia (farsighted vision) or gradual vision loss that is easy to address with the right tools.

These benefits ensure that children are equipped for success both inside and outside the classroom.

Why you should schedule a kids vision test:

  • Visual field and acuity: Assess your child’s ability to see clearly at various distances, ensuring they have no obstacles to learning or play.
  • Identify refractive errors: Discover if they need single vision lenses, multifocal contact lenses, or specialty eyewear tailored to their needs.
  • Detect visual impairments early: Prevent permanent vision loss by catching problems like lazy eye, cataracts, or other eye conditions that could progress over time.

With Medicaid’s vision benefits, your child can receive routine exams, eyeglasses vision benefits, and even replacement glasses if needed.

Repair of eyeglasses is covered when due to broken frames or lenses, and replacement glasses are provided when medically necessary or if damage makes repairs not cost-effective.

Contact lenses are covered only if medically necessary, ensuring children have access to tools that best meet their unique needs.

Vision Coverage for Adults

Adults can access annual eye examinations, with eyeglasses or contact lenses covered only following eye surgery. 

These benefits not only improve quality of life but also support health concerns tied to aging, such as cataract surgery, diabetic retinopathy management, or loss of vision due to other medical conditions.

Key benefits of vision coverage for adults include:

  • Annual eye exams: Regular check-ups to ensure overall eye health and early detection of conditions.
  • Eyeglasses after surgery: Coverage includes single or multi-focal plastic lenses and one frame, ensuring proper vision correction following surgery.
  • Eye surgery for medical needs: Includes procedures like cataract surgery and treatments for conditions that impair vision.
  • Routine care to prevent eye disease: Protect against gradual vision loss with preventive exams and access to eye care providers who specialize in a range of conditions.

Medicaid allows families to choose from trusted eye care providers and ensures access to high-quality care, regardless of their financial circumstances.

These services also reduce disparities in vision care access, ensuring every adult has the opportunity to maintain their eye health.

Breaking Down Medicaid Vision Benefits

Available BenefitBenefit LimitationCost
Eye Examinations – AdultAnnual$0
Eye Examinations – Child (birth to 18)No limitation$0
Eye Examinations – Child (19 to 20)No limitation$0
Eyeglasses – AdultAfter eye surgery only, limited to single or multi-focal plastic lenses and one-frame$0
Eyeglasses – Child (birth to 20)Limited to single or multi-focal lenses and one-frame$0
Contact LensesOnly covered when there is a medical reason$0
Ocular ProstheticsWhen medically necessary$0
Low Vision Aids – Child (birth to 18)No limitation$0
Low Vision Aids – Child (19 to 20)No limitation$0

Medicaid benefits are designed to support families, whether they are low-income, have specific medical needs, or simply want to take proactive steps in their health.

How to Access Medicaid Vision Care

Taking advantage of Medicaid’s vision benefits is simple. 

Start by contacting your primary care provider or finding an eye care provider in your area who accepts Medicaid.

If you are searching for an eye doctor that accepts Medicaid, we can help! At Youth Vision, we accept Medicaid and are committed to delivering exceptional care for families.

Whether it’s routine eye exams, eyeglasses for kids, or other vision services, we are here to help. Remember, Medicaid coverage varies by state, so it’s a good idea to confirm what’s available in your region.

For families in Colorado, you can trust our eye doctors to provide comprehensive care for all ages:

📍Denver: 1400 Grove Street, Denver, CO 80204, (303) 825-2295

📍Aurora: 14251 E. 6th Avenue, Aurora, CO 80011, (303) 343-3133

📍Thornton: 550 E. Thornton Parkway, Suite 240A, Thornton, CO 80229, (303) 953-8801

📍Hampden: 7400 East Hampden Ave. Unit C1, Denver, CO 80231, (720) 866-9906

Learn more about eye health on our blog! Here are a few articles that you may find interesting:

🔗 How To Spot Vision Problems in Kids: 7 Signs To Watch For

🔗 Anisometropia: Understanding and Managing Unequal Vision

🔗 Eye Strain & Headaches? Time To See an Optometrist!

🔗 Amblyopia and Its Impact on Children’s Vision