How To Find Local Eye Doctors Near You That Accept Medicaid

Senior patient getting vision checked by special equipment.


Finding local providers in your area can sometimes be difficult, regardless of which type of insurance plan you have. However, the process can be even more difficult if you have Medicaid. You might find that many providers do not accept Medicaid benefits. Eye care is critical to your overall health care, so you should not skip your routine eye exams. You need to follow the steps outlined in this article to find an eye doctor that accepts Medicaid so you can get the care you need. Different states have different rules regarding covered services, and we will touch on that in this article as well. Keep reading to get all the details!


How To Find A List Of Doctors Near You That Accept Medicaid

Before you get a list of doctors in your area that accept Medicaid, you need to confirm your state’s Medicaid coverage of vision benefits. Since Medicaid is a program funded jointly by the federal government and each state government, the coverage details vary from state to state. First, determine the type of service that you need from your eye doctor. If you need medically necessary treatment for an eye condition, like cataract surgery, these procedures are generally covered by Medicaid in all states. These medically necessary services are performed by ophthalmologists, and the eye care service provided either diagnoses or treats an injury or illness. Once you have been diagnosed with a specific condition, your treatments related to that condition should be covered by Medicaid. Some examples include glaucoma, dry eye disease, cataracts, macular degeneration, and retinal tears and detachments.

If you simply need to visit an optometrist for vision correction through a routine eye exam with eyeglasses or contact lenses, your state might not provide benefits for those services. At least 12 states do not cover all aspects of routine vision care. If you live in one of those 12 states, then you will have no coverage for routine eye exams through the Medicaid program. The remaining 38 states offer some level of vision coverage for vision services through their Medicaid programs.

Once you have determined the type of service you need and whether Medicaid will cover it, you should determine whether you are eligible for the service. Even though your state might cover routine eye exams, you might only be eligible for an exam once every two or three years. You should take a look at your records to determine when your last exam was performed. Use this information to determine your current eligibility for the service that you require.

Now that you know whether or not your service should be covered, you need to determine which provider takes Medicaid. You could attempt to call local providers in your area, but that would be time-consuming and tedious. There is a better way! Simply pull out your Medicaid ID card and examine it. There you will find the name of the insurance company that manages your Medicaid plan. You can use that information to visit the insurance company’s website and find a list of providers in your area. Most plans allow you to search for a provider based on the type of service they provide, so you can limit your search to those providers who specialize in optometry or ophthalmology. Once you find a provider using your insurance company’s online directory, you should give them a call to schedule your appointment and confirm that they accept your Medicaid plan.


Verify Medicaid’s Vision Coverage First

Once you have found a doctor who accepts Medicaid, you will need to verify Medicaid’s coverage of the service that you need to receive. Remember that the specific coverage details of Medicaid vary from state to state. However, there are some general coverage details that are about the same across all states. First, any service that is medically necessary for the treatment of an illness or injury will generally be covered by Medicaid. This includes eye conditions like glaucoma, retinal detachments, cataracts, dry eye syndrome, and others. However, when it comes to routine eye exams and refractive vision correction, things get a little more confusing.

There are some states in which Medicaid does not cover routine eye exams for glasses or contacts at all for adults. For children, Medicaid is required to provide both dental and vision coverage, along with regular health care services, through the EPSDT program. So, children will be able to get eye exams even in states that do not cover the exams for adults. Other states cover these exams, but you may only be eligible for an exam once every two to three years. Finally, the best way to verify coverage is by contacting the insurance company that administers your Medicaid plan. Take a look at your Medicaid ID card and find the insurance company name and phone number. Give them a call, and they can advise you on whether a specific service is covered under your plan. They can also inform you of any applicable copays or coinsurance amounts that might be due. Since Medicaid is designed to help low-income individuals and families, there are generally no copays due.

Remember that there are also big differences between Medicaid and Medicare. Medicaid is designed to help those with a low income, while Medicare is designed to provide health insurance for seniors. Medicare does not cover routine eye exams in any state, and many people receiving Medicare choose to add separate vision coverage to their plan.


Services Available For Medicaid Patients

Closeup of male Ophthamologist smiling at the camera while posing in a room with optic testing equipment.

Each state sets its own rules when it comes to the eye care services that are available to Medicaid beneficiaries. Since Medicaid is a managed care system, these limits are in place to help manage costs associated with the program. Generally, any medically necessary service is always available. These services are typically performed by an ophthalmologist. Examples of these services might be cataract surgery, glaucoma treatment, repair of a detached retina, or treatment associated with dry eye syndrome.

Routine eye exams for vision correction with eyeglasses or contact lenses are not always covered. Some states do not cover these exams at all, while others cover them once every one to three years. If you need to know whether a specific service is covered, you should contact your state Medicaid office or the insurance company that administers your plan. They can answer your questions and let you know whether a specific service will be covered.


Finding Eye Doctors That Accept Medicaid Via Online Directories

There are pros and cons to using online directories to find eye doctors that accept Medicaid. One of the biggest benefits of using an online directory is the fact that it makes your search extremely easy. Most directories allow you to input your ZIP code or address, and the directory will return a list of doctors who are near your location. It also allows you to view all of the details about each doctor in one place, such as their name, address, phone number, and website. These online directories also allow you to filter your search results. For example, you can view only doctors who accept Medicaid or Medicare or doctors who have a particular specialty. Most people find that searching an online directory is one of the easiest ways to find a doctor who accepts Medicaid.

Although there are many great benefits to using an online directory to find an eye doctor, there are also a few drawbacks. First, some online directories are not kept up-to-date. This means that although the directory might list a doctor in your area, that doctor may have moved or no longer be in practice. In addition, they may no longer accept Medicaid. You can help avoid this issue by using the online directory provided by your insurance company instead of using a generic online directory. Lastly, some provider directories allow doctors to purchase premium spots in the directory. You might assume that the doctor is highly rated, but that might not always be the case. When using an online directory, make sure that you check other sources to verify a doctor’s ratings and always call the office to verify that they accept Medicaid.


What Else To Look For In Eye Doctors That Accept Medicaid

Elderly man sitting on a couch while using his mobile phone.

Now that you have found a list of providers that accept your health plan, what else should you look for when choosing your eye doctor? There are several things that you can look for when choosing who you will visit. First, take a look at the online presence of the eye care center or doctor that you are thinking of visiting. Do they have an up-to-date website? If they have no web presence, then they might not have the latest technology in their office either.

Next, take a look at the provider’s presence on social media. You can often find the provider on social media and see photos of their office and staff as well as the latest news from their office. This is a great way to get a feel for how their office operates and whether their style fits your desires. Finally, you should check out online reviews of the provider. You can easily see what other people have to say about their experiences using Google reviews, Yelp reviews, and even posts on social media. You should usually avoid providers with low ratings, and finding a referral from a friend or family member online can be a great way to find a doctor who would be a great fit.


The Bottom Line

If you have health insurance through Medicaid, finding an eye doctor that accepts your insurance can sometimes be difficult. You will want to first verify that the service you need is covered by Medicaid and that you are eligible to receive it. Next, use your insurance company’s online directory to find a list of eye doctors in your area who accept Medicaid. Finally, give your preferred doctor a call to make sure they still accept Medicaid before scheduling your appointment.


Frequently Asked Questions

Are telemedicine/video visits with an eye doctor covered by Medicaid?

Yes, telemedicine visits are covered by Medicaid as long as the service you receive is typically covered during an in-person visit. Medically necessary eye treatment is almost always covered by Medicaid, while routine eye exams are not covered in many states. It is always wise to check with your insurance carrier before scheduling an appointment to ensure that Medicaid will cover the service.


Does Medicaid pay for eye floater surgery?

Yes, Medicaid will typically pay for eye floater surgery. This surgery is usually considered a medically necessary treatment, so Medicaid will assist with the cost of the surgery. Even though Medicaid may not cover routine eye exams in many states, medically necessary services and procedures are always covered by the program.


Does Medicaid pay for glasses?

Whether or not Medicaid pays for glasses depends on the state in which you live. Some states do not provide Medicaid coverage for eyeglasses at all. Other states will cover a routine eye exam and one pair of eyeglasses yearly, while some states only provide this coverage once every two or three years. You can check with your state Medicaid office to determine coverage details for glasses in your area.


Does Medicaid cover eye cataract surgery?

Yes, Medicaid covers cataract surgery as this is considered a medically necessary procedure. Cataract surgery, along with glaucoma treatments, retinal reattachments, dry eye syndrome treatments, and other services, are considered medically necessary for your eye health and overall health. Medicaid will always pay for these types of services in all states. You simply need to find a doctor who accepts Medicaid to perform the procedure. In addition to Medicaid, Medicare covers cataract surgery as well.


Are contact lenses covered by Medicaid?

Contact lenses are usually only covered by Medicaid if they are medically necessary. Even if your Medicaid program provides vision benefits, the standard benefits will typically only cover an eye exam and eyeglasses. Contact lenses are usually not included as part of your Medicaid benefits. However, in some cases, contact lenses might be the only option for the treatment of certain conditions. In that case, your Medicaid will likely cover the contact lenses.