Colorado Medicaid Eye exam Summit County

Medicaid covers your vision

Colorado Medicaid

  •  What is the Colorado Medicaid Vision Services Benefit? 
    • Vision services covered by Colorado Medicaid differ between children and adults. If you are enrolled in a managed health care plan, you may have additional benefits not listed below. 
  • Who is eligible? 
    • Children (age 20 and under): The Early Periodic Screening Diagnosis and Treatment (EPSDT) Program provides vision benefits such as standard eyeglasses, replacement or repair of frames or lenses, contact lenses (must be medically necessary and prior authorized unless provided for vision correction after surgery), Ocular prosthetics (when prior authorized), and eye exams.
    • Adults (age 21 and older): Medically necessary eye examinations, eyeglasses and contact lenses ONLY following eye surgery (do not require prior authorization, and surgery may have been performed at any time during the patient’s life). 
  • What services are available? 
    • Eye Examinations, child – no limitation – $0 
    • Standard eye glasses, adult – after eye surgery only, limited to single or multi-focal clear plastic lenses and one standard frame – $0 
    • Standard eye glasses, child – limited to single or multi-focal clear plastic lenses and one standard frame – $0 
    • Contact lenses – only covered when there is a medical reason; requires prior authorization – $0
    • Ocular prosthetic – requires prior authorization

CHP+ and Colorado Access

CHP+ covers and eye exam for children, but often has a co-pay.  The Co-Pay is usually listed on the insurance card and is usually around $10.  There are different versions of CHP+ but there is often an allowance for glasses where they are covered if you choose frame and lens options within that allowance.  

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