Department of Public Health and Human Services

Home » Montana Healthcare Programs » Medicaid » Eyecare

Main Content

Eyecare

Vision

Adults with Standard Medicaid Benefits

  • One eye exam every 12 months for adults age 21 and over, unless vision changes significantly, or for treatment of eye disease.

Children age 20 and under

  • One eye exam every 12 months for children ages 20 and under, unless vision changes significantly, or for treatment of eye disease, or when otherwise medically necessary.

Eyeglasses

Eyeglasses are provided through a contract with Classic Optical Laboratories, Inc. Medicaid will only pay for your children’s eyeglasses if they are available under the Classic Optical Laboratories, Inc.contract. When ordering eyeglasses from the eyeglasses provider, make sure the provider carries eyeglasses available under the Classic Optical Laboratories, Inc. contract. If you choose non-Classic Optical Laboratories, Inc. frames or lenses, you will be responsible for the amount due.

Adults with Standard Medicaid Benefits

  • Adults can receive one pair of eyeglasses every 12 months.  Eyeglass providers display frames approved by Medicaid available to members for selection.  These are the frames Medicaid will reimburse for.  The frames have a 12 month warranty.
  • Adults that break the frames must bring their broken frame into the dispensing provider for the contractor to repair, if possible.
  • Adults that lose their eyeglasses within 12 months of initial dispensing of them, Medicaid will not cover another pair.  If the adult’s lenses are broken or unusable, the member is eligible for replacement lenses only after the first 12 months from initial dispensing have elapsed.

Children age 20 and under

  • Children can receive one pair of eyeglasses every 12 months or more often if medically necessary and within established guidelines of the amount of change in the prescription.

Additional eyeglass features

  • Medicaid does not cover most add-on features to eyeglasses, such as photo-grey or transition lenses and polycarbonate material.  There are some exceptions for children age 20 and under when it has been determined  medically necessary to have Medicaid reimburse for such add-on features

What if my provider does not have Classic Optical Laboratories, Inc. frames?

Ask your eyeglass provider for a referral to a Classic Optical Laboratories, Inc. frame provider or search for an optician here.