Medicare/Medicaid

Medicare and Medicaid are two programs funded by the federal government that provide health insurance benefits to people 65 or older, individuals with certain specific disabilities, and people with extremely low incomes. Income requirements for the program can vary from state to state, but most of them are based on federal poverty guidelines. Because they cover some vision expenses, these programs fall under vision insurance plans.

In 2010, the maximum annual income for an individual to qualify for Medicaid was $10,830, while the income for a family of four was limited to $22,050. These numbers are higher in Hawaii and Alaska.

Vision insurance coverage offered under Medicare and Medicaid plans can vary from state to state. While eye injuries and surgeries are usually covered through the medical parts of Medicare and Medicaid, glasses and eye exams may not be, depending on the state and the plan. Most states do provide some regular eye exam and prescription glasses benefit for children under 21. Some others offer similar benefits for adults. Other states cover eye exams but not the costs of prescription glasses for people over the age of 21 years.

The frequency of eye exams and the amount of glasses benefit offered vary from state to state as well, but is generally every two to three years. In some cases, individuals are required to choose glasses from a specific group of approved frames because the state will have a deal with an approved contractor to lower the cost of glasses.

Contact lenses are generally not covered under Medicare or Medicaid unless they are required for medical reasons after cataract surgery. In some states, there is no coverage for eye exams and eyeglasses at all, or only if required after surgery. There can also be additional fees charged on top of the Medicare or Medicaid benefit for some vision-care costs.

Any individual or family with the need for vision benefits who is on Medicare or Medicaid should check the local regulations to determine what is and is not covered by the plan. People who qualify for Medicare may be able to purchase a supplemental vision insurance policy that will provide more or broader coverage than that available through Medicare alone. In some cases, these types of supplemental insurance policies can be purchased through groups, such as the AARP .

Last Updated: 02/26/2013

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