Medicaid & Replacement Glasses

It might be surprising, but Medicaid in most states only covers repairing or replacing glasses for patients 20 and under. If an adult aged 21 or older comes in needing repairs, they must pay out of pocket if they have no other insurance. We sometimes see offices try billing Medicaid for replacement glasses on older patients, only to get a denial and ask us what to do.

Unfortunately, since it’s not covered by Medicaid, the patient ends up owing the balance. This is important to keep in mind if your optometry or ophthalmology office sees Medicaid patients as it can help your staff to properly educate them in advance, allowing those patients to make a decision that best fits their financial abilities.

This also helps keep your AR down—unnecessarily billing insurance results in the balance hiding in your insurance AR where it doesn’t belong. Additionally, billing patients after their visit can reduce the likelihood of receiving payment in full (not to mention the cost and time in sending statements) versus collecting the balance upfront. Our team of dedicated billers review claims before filing to catch such errors, preventing lost revenue and increasing your cash flow.

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