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Medicaid Eye Exam

Poudre Valley Eyecare accepts Medicaid. We recommend an annual eye exam to ensure eye health.

Vision care is essential to every health care coverage plan. It’s recommended that adults over the age of 55 schedule a routine eye exam with their vision care provider each year. All others should have their eyes checked no less than every 2-4 years. The doctors at Poudre Valley Eyecare truly believe in the importance of early eye disease detection and feel everyone should get their eyes checked on an annual basis, especially if they have a personal or family history of eye problems or disease. Colorado Medicaid patients are eligible for a variety of vision coverage plans depending on age and other qualifying criteria.

Patients may also be eligible for additional benefits if enrolled in another managed care plan.

Does Medicaid cover eye exams in Colorado?

*Please note: Medicaid requirements may change from time to time. This is our understanding of coverage at this point, but we cannot guarantee that it is accurate. If you’d like to know for sure whether you’ll be covered, please give us a call and our staff can give you an up-to-date answer to your question.

Under Colorado Medicaid coverage, children and young adults under 20 years of age who qualify for the Early Periodic Screening Diagnosis and Treatment (EPSDT) Program are provided standard vision benefits, including the following services, and more:

  • Eye exams
  • Eyeglass frames and contact lenses (when medically necessary and prior authorized, unless prescribed for post-surgery vision correction)
  • Replacement or repair of frames or lenses
  • Ocular prosthetics (when prior authorized)

Adults (aged 21+) have fewer benefits than children and young adults. While Medicaid still covers eye exams, it only does so once annually and/or when medically necessary. Similarly, eyeglasses and contact lenses are only covered after surgery for vision correction with prior authorization, regardless of how recent the surgery was.

How often can I get an eye exam with Medicaid?

Coverage for eye exams and general vision care differs state-by-state under Medicaid. Medicaid patients twenty-one years of age or older are eligible for an annual, routine eye exam. Beyond the annual vision examination, patients may also seek care for medical problems relating to the eye such as dry eyes, allergies, headaches, floaters/flashing lights in vision, eye trauma, foreign body in eye, glaucoma care, macular degeneration care, cataract evaluation/treatment and any other acute or chronic medical eye problems. Medicaid will not cover frames or lenses for adult patients.

Children and young adults under the age of twenty are eligible for unlimited eye exam coverage under Medicaid.

Are eyeglasses and contact lenses covered with Medicaid?

Eyeglass and contact lens coverage under Medicaid is dependent on outlying factors and the patient of question. Most commonly, adult Medicaid patients are eligible for eyeglass benefits after receiving eye surgery. They are allowed single or multi-focal plastic lenses and one frame.

Similarly, contact lenses and ocular prosthetics are only covered when medically necessary for  both adults and children.

Eyeglass repair is covered when due to broken lenses or frames, but replacements will be provided when medically necessary should the repairs not be cost-effective. Contact lens supplies and insurance are not covered under Medicaid vision benefits.

Our team at Poudre Valley Eyecare is experienced in a wealth of eyecare services and we proudly work with Medicare and Medicaid patients across the state of Colorado. We’re glad to help you navigate your questions regarding insurance coverage to the best of our ability, but it’s recommended that you visit Colorado’s official state website for more information on Health First Colorado Vision Benefits.

Ready to book your eye exam? Contact our team today and take control of your eye health.

Why Choose Us?

Our advanced technology and individualized care deliver results for patients of all ages. Our routine exams allow us to spot changes in your vision and allow us to treat those changes early. We have a comprehensive understanding of eye care, which means we can treat a wide range of conditions and chronic diseases. Our in-depth routine exams and customized treatment plans set us apart from the rest.