Many people are confused about how to get a list of nearby eye doctors that accept Medicaid patients.
Insurance is a complex topic, and adding layers of government rules makes things even more convoluted. Fortunately, there is a simple process to follow.
Please don’t make the common mistake of asking the wrong question: whether a specific vision center takes Medicaid or the state nickname for their program.
Instead, start by verifying coverage in your state and your eligibility for benefits. Skip asking the wrong questions, going straight to your insurance ID card and then the online provider directory.
Finally, call each provider to verify critical details before booking your appointment.
Verify Medicaid Vision Coverage in your State
Before getting a list of local eye doctors accepting Medicaid, the first step is to verify whether your state covers the type of services you need. Vision care can fall into two categories with profound implications on the benefits you might receive.
- Medicaid covers cataract surgery and other medically necessary procedures performed by ophthalmologists across the country as part of its primary mission: health insurance for low-income families
- Medicaid pays for eye exams, glasses, and contacts provided by optometrists when a state approves the benefit as part of its secondary mission: vision care for low-income families.
At least twelve states do not support optometrists and opticians’ vision benefits for detecting and correcting refractive errors. If you live in one of these states without coverage, your list may be of little value.
Medicaid acts like health insurance and supports vision benefits across the country for medically necessary care. Medically necessary means that the service diagnoses or treats an injury, illness, or its symptoms.
An ophthalmologist is a physician who specializes in the diagnosis and treatment of eye disorders with a medical cause. Once diagnosed with one of these conditions, you should be able to generate a list of local ophthalmologists that take your Medicaid plan.
- Diabetic Retinopathy
- Dry Eye Syndrome
- Macular Degeneration
- Ocular Nevis
- Retinal Detachment or Tear
Nearby eye doctors that accept Medicaid and Medicare will further narrow the list because you are adding a parameter. Dual-eligible recipients choose between two types of coverage, which affects the provider specialties you might find.
- Medicare Parts A, B, & D do not cover vision services. However, local ophthalmologists might accept assignment only when treating medically necessary conditions.
- Medicare Advantage Plans (Part C) sometimes include vision benefits, meaning optometrists might participate in-network. Refer to the provider directory (see below) to get a listing.
Confirm Medicaid Pays for the Vision Service
The second step before generating a list of neighborhood eye doctors accepting Medicaid is to confirm whether you are eligible for the specific vision service you need.
You might find a neighborhood provider taking new patients only to find out that you do not qualify for a specific service because your timing is off.
For example, each state sets different parameters about how often you can get an exam to measure refractive errors. Also, your state may have a similar schedule for how often you can get new prescription eyeglasses, frames, or contact lenses.
|Nevada||New Hampshire||North Dakota|
|South Carolina||South Dakota||Utah|
Every Two Years
|Nebraska||New York||North Carolina|
Three Years or More
|Alabama: 3||Kansas: 4||Mississippi: 5|
|New Mexico: 3|
Stop Asking if Vision Centers Take Medicaid
Stop asking whether a specific vision center or other provider accepts Medicaid patients. You are wasting your time. The key to unlocking the answer is right on your insurance ID card. Immediately skip to that step.
The topic is confusing. Many people ask the wrong question, so do not feel bad if you found this article after an online search, including one of these brands.
- Americas Best
- Eyeglass World
- Walmart Vision Center
Most of these brand-name vision centers operate across the country. Each person might get a different correct answer because Medicaid has many unique rules, plan designs, and administrators.
- Each state decides what eye care services to support
- Medicaid has many different plans types
- Managed Care Organizations (MCOs): comprehensive
- Primary Care Case Management (PCCM)
- Prepaid Inpatient Health Plan (PIHP): limited
- Prepaid Ambulatory Health Plan (PAHP): most limited
- Private companies administer plans with unique provider networks
Stop Asking About Medicaid Nicknames
Also, stop asking which eye doctors accept the state-designated nickname for your Medicaid plan. This question, too, is a waste of time. Once again, the key to unlocking the answer is printed right on your insurance ID card. Immediately skip to that step.
Do not feel ashamed if you found this how-to-article after searching online using one of these branded nicknames cooked up by your state. You have plenty of company.
|State||Brand 1||Brand 2|
|Illinois||Medical Card||Illini Care|
|Kentucky||Passport||KY Health Choices|
|New Jersey||NJ Family Care|
|New York||Healthy Choice|
|North Carolina||Health Choice|
Look at Your Insurance ID Card
The only way to generate an accurate list of local eye doctors that accepts Medicaid is to pull out your insurance ID card and look for the name of the private insurance company that administers your plan.
Even though Medicaid is a government program, most states outsource the administrative functions to private insurance companies. For example, you might find one of these familiar brands managing your health, vision, and dental benefits.
- Aetna Better Health: CA, FL, IL, KS, KY, LA, MD, MI, NJ, NY, OH, PA, TX, WV, VA
- Amerigroup: NJ
- Anthem: CA, IN, KY, NV, VA, WI
- Blue Cross Blue Shield: is a national federation of affiliated companies using this trade name, operating in twenty-four states
- Caresource: GA, IN, OH
- Emblemhealth: NY
- Fidelis: NY
- Healthfirst: NY
- Humana: FL, IL, KY
- Meridian: IL, IA, MI
- Metroplus: Five boroughs of NCY – Bronx, Brooklyn, Manhattan, Queens, and Staten Island
- Molina: CA, FL, ID, IL, KY, MI, MS, NM, NY, OH, SC, TX, UT, WA, WI
- MVP: NY, VT
- United Healthcare: Offers plans across the country
- UPMC Health Plan: MD, OH, PA, WV
- Sunshine Health: FL
- Staywell: FL
- Wellcare: AZ, FL, GA, HI, KY, MO, NE, NJ, NY, SC
Your insurance ID card provides the official map of your hidden treasure. On it, you should find a company name and website address. Open a web browser and visit the URL listed on your card.
Go to the Online Provider Directory
The online provider directory published by the private insurance company printed on your insurance ID card is the ultimate authority. Only they can provide an official listing of local eye doctors accepting the Medicaid plan that you have.
Register to create an online profile or log in if you have already done so. Surf over to the provider directory and select the exact plan name (critical). Input your zip code and the type of specialist you need to see.
- Opticians are the least likely to take Medicaid patients because they design, fit, and dispense eyeglasses. Your state may have no coverage or strict limits on how often you can replace an old pair or update a prescription.
- Optometrists are also less likely to take Medicaid because many states limit how often patients can undergo vision exams to detect refractive errors and update prescriptions for corrective lenses.
- Ophthalmologists are more likely to take Medicaid patients throughout the country because they have medical degrees and treat eye diseases that fall into the medically necessary category. Your plan acts like health insurance in these instances.
- Pediatric eye doctors are most likely to take Medicaid patients across the country because the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program requires vision benefits up to age 21. Plus, the same holds for the Children’s Health Insurance Plan (CHIP)
Confirm Details Before your Appointment
Now that you have the official list of local eye doctors who accept the specific Medicaid plan you have, you should contact the provider to confirm several details before booking an appointment. You do not want any nasty surprises.
- Provider directories are not always up-to-date. Call the vision center to verify that they still participate in your plan. Be specific.
- Ask if they are taking new patients covered by Medicaid. Many providers treat a set number of low-income families to serve a public good. However, they often lose money on each individual because reimbursement rates are meager, so they institute a limit.