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Benefits by Service: Eyeglasses (October 2008) Definition/Notes

Note: Totals include 50 states and D.C.

"Benefits Covered" Totals

"Benefits Not Covered" Totals

Is the benefit covered?

Is there a co-payment requirement?

Yes: 15

No: 29

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Alabama
Yes			1 pair eyeglasses/2 years	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN
Alaska
Yes			1 pair eyeglasses/year	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN
Arizona
Yes			Limited to post-cataract surgery items	Fee for service	CN & MN
Arkansas
Yes	$2/dispensing service	2 pair eyeglasses rather than bifocals	1 pair eyeglasses/year, contact lenses limited to post-cataract surgery	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN & MN
California
Yes		Yes	1 pair eyeglasses/2 years, special lenses not covered, interim replacement for lost or broken eyeglasses allowed once in 2 years	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN & MN
Colorado
Yes			Limited to post-surgery lenses and eyeglasses	Fee for service	CN
Connecticut
Yes		Specified services	Special lenses covered when specified criteria met	Fee for service	CN & MN
Delaware
Yes		Yes	Limited to aphakic or bandage lenses following cataract surgery	Fee for service	CN
District of Columbia
Yes	$2/service		1 pair eyeglasses/2 years, minimum diopter correction required	Fee for service	CN & MN
Florida
Yes		Specified items	Eyeglasses, contact lenses and prosthetic eyes for specified medical conditions, 2 pair of eyeglasses/year	Fee for service	CN & MN
Georgia
Yes			Adult coverage limited to nursing facility residents with specific physician order, minimum diopter correction required for initial and replacement eyeglasses	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN & MN
Hawaii
Yes		Contact lenses, visual aids costing more than $50	1 pair eyeglasses/2 years unless vision change exceeding specified diopter criteria is met, special lenses limited by age and medical condition	Fee for service	CN & MN
Idaho
Yes			1 pair eyeglass frames/4 years, minimum diopter correction required for initial and replacement eyeglass lenses; replacement not covered for lost or broken eyeglasses	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN
Illinois
Yes			1 pair eyeglasses/year with specified exceptions	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN & MN
Indiana
Yes			1 pair eyeglasses/2 years, age-specific minimum diopter correction required for initial and replacement eyeglasses	Fee for service	CN
Iowa
Yes	$2/day		1 pair eyeglasses/2 years unless specific criteria met, contact lenses for specified post-surgery conditions, special lenses covered if specified criteria met	Fee for service	CN & MN
Kansas
Yes		Contact lenses	1 pair eyeglasses/4 years, post-cataract surgery lenses and eyeglasses covered for 1 year	Reasonable charge with limits	CN & MN
Kentucky
No
Louisiana
No
Maine
Yes	$.50-$3/day, depending on payment, up to $30/month	Specified items and services	1 pair eyeglasses/lifetime, minimum diopter correction required, contact lenses not covered	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN & MN
Maryland
No
Massachusetts
Yes		Specified services/items including special lenses and low-vision aids	1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions	Fee for service	CN & MN
Michigan
Yes	$2/dispensing service	Selected procedures	1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions, oversized and progressive or transition lenses not covered	Most products, excluding contact lenses, provided by state's volume purchase contractor, dispensing provider paid fee for service	CN & MN
Minnesota
Yes	A - $3/pair, B - $25/pair - See state-specific FN		1 pair eyeglasses/2 years, replaced lost or broken eyeglasses must be identical to originals	Fee for service	A & B - See state-specific FN
Mississippi
Yes	$3/pair		1 pair eyeglasses/5 years	Acquisition cost	CN
Missouri
Yes	$.50-$3/item or service, depending on payment		1 pair eyeglasses/2 years, replacement of lenses only if specified diopter criteria met	Fee for service	CN & MN
Montana
Yes	$2/pair	2 pair eyeglasses rather than bifocals	A - 1 pair eyeglasses/2 years unless post-cataract surgery or minimum diopter correction criteria met B - Limited to post-cataract surgery lenses or eyeglasses and to eyeglasses essential for employment or related to specified medical conditions including diabetes	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	A & B - See state-specific FN
Nebraska
Yes	$2/pair		Minimum diopter correction required for initial and replacement eyeglasses, replacements one/2 years and only if eyeglasses lost or unusable, contact lenses for specified medical conditions	Fee for service	CN & MN
Nevada
No
New Hampshire
Yes			1 pair eyeglasses/year if minimum .50 diopter correction criteria met in both eyes, one repair/year	Fee for service	CN & MN
New Jersey
Yes			1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 19-59	Acquisition cost with ceilings	CN & MN
New Mexico
Yes			1 pair/2 years, replacement of lost or broken pairs only covered for developmentally disabled adults	Acquisition cost with ceilings	CN
New York
Yes		Special lenses and other specified services	1 pair eyeglasses/2 years	Fee for service	CN & MN
North Carolina
Yes	$2/pair and for supplies or repairs costing more than $5	Yes	1 pair eyeglasses/2 years, minimum diopter correction criteria, repairs costing less than $5 not covered	Most products provided by state's volume purchase contractor, dispensing fee paid fee for service	CN & MN
North Dakota
Yes			1 pair/3 years, broken eyeglasses must be repaired if possible, replacement of hard contact lenses allowed only if beneficiary had them prior to Medicaid eligibility	Fee for service for eyeglass frames, acquisition cost for lenses	CN & MN
Ohio
Yes	$1/date of service for dispensing	Specified services, including contact lenses and items from other than state's contractor	1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 21-59, specified diopter criteria must be met	Most products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN
Oklahoma
No
Oregon
Yes		Items from other than state's contractor	1 pair eyeglasses/2 years; contact lenses if specified criteria met; multiple pairs, special lenses and low vision aids not covered	Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, acquisition cost for other items	A - See state-specific FN
Pennsylvania
Yes	$.50-$3/service, depending on payment rate		Adult coverage limited to diagnosis of aphakia	Fee for service	CN & MN
Rhode Island
Yes			1 pair eyeglasses/2 years	Negotiated fee for eyeglass frames, industry provided price list for lenses	CN - see state-specific FN
South Carolina
Yes		Yes	Limited to post-cataract, retinal, corneal or glaucoma surgery lenses and eyeglasses	Most products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN
South Dakota
Yes	$2/lens, frame or repair		1 pair eyeglasses/15 months if minimum diopter correction criteria met, 2 replacement contact lenses/year	Fee for service	CN
Tennessee
Yes			Limited to 1 pair of post-cataract surgery lenses or eyeglasses		A & B - See state-specific FN
Texas
Yes		Yes	1 pair eyeglasses/2 years if minimum diopter correction criteria met	Fee for service	CN & MN
Utah
Yes			A - adult coverage limited to pregnant women, C - coverage limited to post-cataract surgery contact lenses	Fee for service	A & C - See state-specific FN
Vermont
No
Virginia
No
Washington
Yes		2 pair eyeglasses rather than bifocals	1 pair eyeglasses/2 years except 1 pair eyeglasses/year for developmentally disabled	Fee for service	CN & MN
West Virginia
Yes		Specified items and services	1 pair eyeglasses following cataract surgery	Fee for service	A & B
Wisconsin
Yes	$.50-$3, depending on service	Items from other than state's contractor	1 pair eyeglasses/year and 1 replacement/year if eyeglasses lost or broken or if minimum diopter correction criteria met	Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, average acquisition cost for other items	CN & MN
Wyoming
Yes			Limited to post-cataract surgery lenses	Fee for service	CN
American Samoa
Yes					See territory-specific FN
Guam
Yes		Yes	1 pair eyeglasses/2 years if minimum diopter correction criteria met	Fee for service up to $80 maximum	CN
Northern Mariana Islands
Yes		Yes	1 pair eyeglasses/2 years		CN & MN - See territory-specific FN
Puerto Rico
No
Virgin Islands
Yes			Prescription must be written by public health facility physician	Fee for service	CN

Definition/Notes: Link to Eyeglasses Footnote


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