Does Medicaid cover eye exams and glasses?
Last verified:
For children, yes, including glasses; for adults, only where the state chooses, and many limit it to one exam and one pair every year or two. Federal rule: optional for adults.
What federal law says
Eyeglasses are an optional benefit under 42 CFR 440.120(d), defined as lenses, including frames, and other aids to vision prescribed by a physician skilled in diseases of the eye or an optometrist. Optometrist visits fall under other licensed practitioner services, also optional.
States that cover adult vision commonly pay for a routine exam every one or two years and a basic pair of glasses from a contracted supplier, with frames limited to a standard selection. Medical eye care, such as treatment for glaucoma, cataracts or diabetic retinopathy, is a physician service and is covered everywhere regardless of the vision benefit.
Expansion adults are covered under an alternative benefit plan built on the essential health benefits, which include pediatric vision but not adult vision, so being in the expansion group does not by itself add glasses.
Children under 21
EPSDT requires vision services for anyone under 21, including diagnosis and treatment of defects in vision and eyeglasses.
What to ask your state plan
- Ask whether the plan's vision benefit is 'routine' (exam plus glasses) or 'medical only'; the answer decides whether glasses are covered.
- A diabetes diagnosis makes a dilated eye exam a medical service, covered even where routine vision is not.
- Find your state's agency, program name and phone on Medicaid by state.
Related questions
Common questions
Does Medicaid cover eye exams and glasses?
For children, yes, including glasses; for adults, only where the state chooses, and many limit it to one exam and one pair every year or two.
Does Medicaid cover vision exams and glasses for children?
EPSDT requires vision services for anyone under 21, including diagnosis and treatment of defects in vision and eyeglasses.
How do I find out whether my state's Medicaid covers vision exams and glasses?
Three places. Your plan's member handbook or benefit summary, which lists the covered services and limits; the state Medicaid agency's provider manual for the service, which is public and states the medical-necessity criteria; and the member services line on your card, which can run a coverage check for a specific procedure code. Our state pages list each agency's phone and portal.
Sources
- 42 CFR 440.120 (prescribed drugs, dentures, prosthetic devices, eyeglasses)
- medicaid.gov: EPSDT (children under 21)
- 42 CFR 440.347 (essential health benefits in alternative benefit plans)
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