Medicare-Medicaid can be an incredible resource that saves you thousands of dollars on medical costs.
But, like all health care services, it has its limitations and cutoffs for what it covers and doesn’t cover.
This begs the question, does Medicaid cover your eye care? Are you able to go to the eye doctor if an ocular condition arises while you are under Medicaid?
The answer to this question is more complicated than just a simple yes or no. The truth is, the availability of eye care under Medicaid is dependent on a lot of external factors like where you live, what medical condition you suffer from, and whether your optometrist accepts Medicare.
With that being said, what scenarios would warrant Medicaid being able to cover your eye care?
While Medicaid will most likely not pay for routine or annual eye exams, they will pay for exams that they deem medically necessary, according to their written policies.
In most cases, medically necessary conditions to which Medicaid will cover an eye exam include pre-existing conditions or anything that has symptoms that would prompt you to visit the doctor.
Medicaid will most likely ask for proof of diagnosis by an optometrist or at least require that a diagnosis of some sort be performed before they cover the visit.
Common medically necessary eye exam examples could include:
- Diabetic retinopathy
- Macular degeneration
- Dry eye syndrome
- Retinal detachment
- Other forms of physical trauma to the eye
Before making an eye appointment, unless the appointment is an emergency, it is prudent to contact your Medicaid representative and verify that you will be covered.
Medicaid can pay for prescriptions under most circumstances, as well as contact lenses.
They handle the financial reimbursement of frames in a similar fashion to their policy on eye exams, wherein your prescription must be prescribed by an optometrist for a medically necessary cause.
This means that Medicaid will most likely only cover prescription frames or contacts that are used to correct vision due to accidents, trauma, or disease.
It’s important to note that Medicaid will most likely not cover surgery that is used to enhance or improve the vision of an adult.
This means that surgery to correct conditions like myopia, hyperopia, or astigmatism, or any condition that a refractive lens prescription can fix, will likely not be covered.
However, Medicaid will most likely approve the coverage of cosmetic surgery that restores the normal appearance of a patient after an accident or disease has caused disfigurement.
There is a list of serious, non-deforming conditions and diseases that Medicaid would approve coverage of, to include:
- Pneumatic Retinopexy
- And many other similar, often vision-threatening, diseases.
While Medicaid certainly isn’t a catch-all, it does a lot to help you protect your eyes.
It’s amazing to think that Medicare covers so many different situations regarding your eyes, and that’s only one facet of the many other operations, procedures, and appointments that they cover for other parts of the body.
If you are planning to use Medicare-Medicaid to cover your next eye appointment, prescription, or surgery, it is paramount that you maintain good communication with your Medicaid representative as to what they will and will not cover, so that Medicaid can take the best possible care of you as you take the next step in caring for your vision.