Vision Benefit

Depending on your plan, your vision benefits may include:

• A yearly routine eye exam
• Glaucoma prevention care
• Diabetic eye exams, also called retinal exams
• Glasses and contacts

You can view details about your plan's vision benefits in your Summary of Benefits. 

If you have any questions about your vision benefits, call the phone number listed for vision on the back of your Member ID card. They can review your plan benefits and help answer your vision questions. You can call between 8am and 8pm Monday through Friday.

You can see what's covered by your plan on your Summary of Benefits. Some plans include a dollar amount that you can use towards glasses and contacts.

It's important to make sure that your eye doctor is in your plan network. Using an eye doctor that's in the plan network means lower costs for you. If you see a doctor that isn't in the network, the services might not be covered by your plan, and you may have to pay more out-of-pocket.

To find an in-network eye doctor near you, use the Find a Provider tool. Remember you can also call your vision vendor using the number on the back of your Member ID Card.

You should visit an eye doctor for your vision and eye care. For example, you should visit an eye doctor (also called an optometrist) if you notice a change in your eyesight, you're having problems seeing things or if you have pain in your eyes. The optometrist can do eye exams, prescribe glasses, write prescriptions and diagnose eye issues. The eye doctor can also refer you to a specialist if you need to see one.

During your annual eye exam, your eye doctor will perform different tests to check your vision and look at your total eye health. You should get an eye exam every year. If you have other medical conditions, like high blood pressure or diabetes, your doctor may recommend you have additional eye exams.

Make sure the specialist is in your plan network. To find an in-network specialist near you, Find a Provider tool. Check your Evidence of Coverage to see what special procedures are covered by your plan and how much you may need to pay out-of-pocket.

Your eye doctor may refer you to an eye surgeon for cataract surgery. Ask your doctor to refer you to an in-network surgeon who accepts Medicare.

Your surgeon can talk to you about cost and coverage before your procedure. If you need post-surgical glasses after your cataract surgery, these may be covered by your medical insurance, not your vision benefit.

Your Member ID card is the key to receiving the care you need. Remember to always bring it with you to every appointment. If you have a dual plan that includes both a Medicaid and Medicare card, you will need to bring BOTH cards to your appointments.

You only need to use your health plan Member ID card. There isn't a separate vision card.

You should call your vision vendor if you need to find an in-network eye doctor, have questions about your vision benefits, including covered services and procedures or have general questions about glasses or contacts.