If you rely on Medicaid for healthcare in Colorado, you might be unsure whether your benefits include vision care, especially when it comes to getting glasses. In Colorado, Medicaid typically covers glasses for children and may cover them for adults if they’re deemed medically necessary.
Medicaid & Vision Coverage in Colorado
Medicaid is a state and federally funded program that offers health coverage to low-income individuals and families. While its primary goal is providing access to medical care, Medicaid also includes vision benefits, which can vary by state.
Colorado offers some vision services through Medicaid, but coverage depends on age, needs, and circumstances.
Children & Medicaid Vision Coverage
For those under the age of 21, Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit provides comprehensive vision care. This coverage includes:
- Routine comprehensive eye exams.
- Prescription glasses, including both frames and lenses.
The EPSDT ensures that children have access to regular vision care to address problems early, support healthy development, and reduce the risk of long-term eye issues.
Adults & Medicaid Vision Coverage
For adults enrolled in Medicaid in Colorado, vision coverage is more limited compared to children. Medicaid typically covers:
- Medical Eye Exams: For diagnosing and treating conditions like glaucoma, cataracts, and diabetic retinopathy.
- Post-Surgical Glasses: If the glasses are deemed medically necessary following eye surgery.
However, routine eye exams and glasses are generally not covered for adults unless they fall under a medically necessary category.
Further Coverage Considerations
Here are a few important points to keep in mind regarding Medicaid glasses coverage in Colorado:
Medical Necessity
Medicaid often pays for glasses if they’re deemed to be medically necessary. For example, if post-surgery corrective eyewear is prescribed by an ophthalmologist or optometrist, it may be covered.
Provider Participation
Not all providers accept Medicaid, and even fewer may provide glasses under Medicaid coverage. At Impressive Eyes, we do accept Medicaid, so if your glasses are covered, we can provide them!
Frequency of Coverage
In Colorado, Medicaid vision benefits vary by age. For individuals under 21, coverage includes unlimited eye exams and one frame with up to two lenses per prescription, with replacements or repairs allowed whenever medically necessary, such as when glasses are broken, lost, or the prescription changes.
For adults 21 and over, Medicaid covers one comprehensive eye exam per calendar year. However, eyeglasses or contact lenses are only covered if the patient has had eye surgery and the eyewear is deemed medically necessary. In those cases, adults may receive one pair of glasses (one frame and two lenses) every 24 months with prior authorization.
Why Routine Vision Care Matters
Even if Medicaid doesn’t always cover all the costs of glasses, regular eye care is important for maintaining long-term vision health. Early detection through routine exams helps us monitor your vision for changes and allows us to intervene before issues become more serious.
Routine vision exams can:
- Detect vision changes early, even before symptoms are noticeable
- Identify conditions like glaucoma, cataracts, and macular degeneration in their early stages
- Prevent further complications through timely treatment and follow-up care
- Support academic success and daily comfort in children by catching refractive errors
- Improve overall quality of life through clearer, more comfortable eyesight
Staying proactive about eye health leads to better outcomes and fewer surprises. Whether you’re covered by Medicaid or paying out of pocket, routine vision care is a simple step that pays off in the long run.
Medicaid-Covered Eye Appointments
If your appointment is covered by Medicaid, here’s what to expect:
- Bring the right documents: Make sure to bring your Medicaid card, a valid photo ID, and any prior prescriptions or medical records related to your eye health.
- Comprehensive eye exam: Your visit may include vision testing, an eye pressure check, and a review of your eye health history to screen for conditions like glaucoma, cataracts, or diabetic retinopathy.
- Discuss your needs: Be prepared to share any vision concerns or symptoms you’ve noticed, as well as your work or screen habits. This will help us optimize your care.
- Glasses selection (if eligible): If glasses are medically necessary and covered, you’ll be able to choose from Medicaid-approved frames.
- Coverage and processing: We’ll verify your Medicaid eligibility and let you know what’s fully covered and what, if anything, would be out-of-pocket.
- Next steps: Glasses are usually ready within a few days to a few weeks. If follow-up is needed, we’ll schedule your next visit.
Why Routine Vision Care Matters
Good vision supports your health, confidence, and daily comfort. Even if your Medicaid benefits feel limited, routine eye care is still worth prioritizing. At Impressive Eyes Optical, we try our best to make it easy to get the care and eyewear you need. Our practice is locally owned, supports Medicaid, and offers both personalized services as well as affordable glasses. Book an appointment today and take the next step toward clearer vision and lasting eye health.
