Your Colorado optometrist may participate in Medicaid and provide eye exams and glasses for your children at no cost to you. Almost 1 of every 4 children in Colorado is insured through Medicaid
Medicaid coverage for vision varies state by state so don’t presume you will have the same benefits when moving. In Colorado there is different vision care coverage for children and adults. Coverage changes have occurred in the last few years, and will continue to change with health care reform. Expansion or cut backs in benefits may occur at any time.
For Medicaid vision coverage in Colorado, childrens vision insurance coverage is defined by age 20 and under. When reaching age 21, Colorado Medicaid considers you an adult and benefits change.
Children are eligible for an eye exam by their optometrist as needed with no co-pay
Contact lens fitting fees entail additional charges above the regular eye examination. These are not covered unless there is an eye disease such as kerataconus and contact lenses are the only way to provide acceptable visual acuity. The actual contact lenses are also not covered unless their is an applicable medical diagnosis. This is not a area where a patient can plead their case. If there are specific medical conditions your eye doctor has to file a form to have your case considered. The review process can take several weeks to several months. It is normally approved if contact lenses are the only way to correct your vision due to a corneal eye disease. Your optometrist may have to submit a form for preauthorization 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 co pay
A standard frame means frames are limited to inexpensive frames. That does not mean they are necessarily low quality. Your optometrist is only allowed a limited reimbursement for the eyeglass frame. Some consumer awareness can be beneficial. For instance, in our office we usually provide a higher quality frame that costs us more but holds up much better for your teen. Some optometrists provide this service and since the added cost is not passed on to you, there is no awareness of the difference. It is unlikely an eye doctors office will provide this information, but usually if the office seems to value you as a client when you call, you can expect better value. Repairs for 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 eyeglasses is not specifically defined as a benefit but may be covered.
Lens treatments such as scratch resistant coatings, antiglare coatings, tints, and thin lens materials are not covered. Scratch resistant coatings are the one option you should purchase. Uncoated prescription eye glass lenses will most likely have scratch marks on them within a day or two of teenager usage. Scratch resistant coatings are not scratch proof but they will certainly extend the usable life of the lenses. There is a way to have thinner, lighter lenses covered for your child. If you request polycarbonate lenses, they will be much thinner and attractive for higher eye glass lens prescriptions, and help your child’s self image. Polycarbonate lenses are usually recommended for children and teens needing eyeglasses due to their extreme impact resistance.
Other services may be available with preauthorization. Vision devices for children that have significant sight loss from eye diseases, some lens treatments, therapy for lazy eye, and other services are sometimes approved. Don’t expect a fast approval, but it is worth the wait when the service ends up being covered.
Adults are entitled to an eye examination with a $2.00 co pay in many cases. Glasses are provided once after some types of eye surgery.
Medicaid is constantly changing and this information is provided as educational, not as representative of current state policy. Different types of programs are available in some areas of Colorado. Eligibility for enrolling in Medicaid and understanding your vision benefits is your responsibility, and the State of Colorado has resources to help you. Thousands of children are eligible for Medicaid coverage in Colorado but are currently not enrolled or covered by any insurance plan. You can help keep your kids healthy by taking the time to enroll them now, and keeping up with annual preventative eye doctor examinations.