Colorado Medicaid Eye Care Benefits: 6 Things You Need to Know About Your Eye Care
Your Colorado optometrist can participate in Medicaid and provide eye exams and glasses for your children at no cost to you. Nearly 1 in 4 children in Colorado is insured through Medicaid. Since many children are covered by Medicaid, there are six points to understand.
- Medicaid vision coverage varies from state to state, so don’t assume you will have the same benefits when you move to Colorado from another state. There are different types of vision care coverage for children and adults. Changes in vision care benefits have occurred in recent years and will continue to change with health care reform. Expansion or reduction of benefits can occur at any time. Medicaid is a program administered by the state in collaboration with the Federal Government. States may vary coverage policies to some extent. The state of Colorado has its own plan. An example of the differences is coverage for adults. Adults have a $ 2.00 copay for eye exams and limited benefits for glasses. Many states have full coverage for adults.
- For Medicaid vision coverage in Colorado, vision insurance coverage for children is defined as age 20 and under. When you turn 21, Colorado Medicaid considers you an adult and benefits change. Children are eligible for an eye exam by their optometrist as needed with no copayment.
- Contact lens fitting fees incur additional charges on top of the regular eye exam. These are not covered unless there is an eye disease that deforms the cornea. Contact lenses may be the only way to provide acceptable visual acuity. Actual contact lenses are also not covered unless there is an applicable medical diagnosis. This is not an area in which a patient can make his case. If there are specific medical conditions that require contact lenses, your eye doctor must submit a form for your case to be considered. The review process can take from several weeks to several months. Typically approved if contact lenses are the only way to correct your vision due to corneal eye disease. Your optometrist may need to submit a prior authorization form more than once to communicate the need for special consideration, so you will need to be patient.
- A standard eyeglass frame and lenses are covered with no copayment. A standard framework means that the frameworks are limited to inexpensive frameworks. That does not mean that they are necessarily of low quality. Your optometrist can only make a limited reimbursement for the eyeglass frame. Repairs to broken frames or lenses are a benefit, and a replacement frame is provided if the frame cannot be repaired. While this is not necessarily an unlimited benefit, it can be used more than once if your child is prone to breaking glasses. Loss of glasses is not specifically defined as a benefit, but may be covered.
- Lens treatments such as scratch resistant coatings, glare-free coatings, tints, and thin lens materials are not covered. Scratch resistant coatings are the only option you should buy. Prescription glasses that do not have a scratch coating will likely have scratch marks within a day or two of use by teens. Scratch resistant coatings are not scratch proof, but they will certainly extend the life of the lenses. There is a way to cover the thinnest and lightest lenses for your child. If you order polycarbonate lenses, they will be much slimmer and more attractive for taller eyeglass lens prescriptions, and will help your child’s self image. Polycarbonate lenses are generally recommended for children and teens who need glasses due to their extreme impact resistance.
- Other services may be available with prior authorization. Vision devices are sometimes approved for children with significant vision loss due to eye disease, some lens treatments, lazy eye therapy, and other services. Don’t expect a quick approval, but it’s worth the wait when the service ends up being covered.
Medicaid is constantly changing and this information is provided for educational purposes, not as representative of current state policy. There are different types of programs available in some areas of Colorado. Eligibility to enroll in Medicaid and understand your vision benefits is your responsibility, and the State of Colorado has resources to help you. Visit the State of Colorado website at: www.colorado.gov/hcpf [http://www.colorado.gov/hcpf]. Thousands of children are eligible for Medicaid coverage in Colorado, but are not currently enrolled in or covered by any insurance plan. You can help keep your children healthy by taking the time to enroll them now and keeping up with your annual preventive eye exams.
