![]() If you are enrolled in an ACCP or MCO, you should call your health plan first with questions about vision care. Other services like glasses, visual aids, and similar materials, are covered directly by MassHealth, and you can use any MassHealth provider to obtain these benefits. If you are enrolled in a MassHealth Accountable Care Partnership Plan (ACPP) or a Managed Care Organization (MCO), medical-related visual services like vision exams will be covered by your health plan and will need to be done by a provider within your ACO’s or MCO’s network. Prior authorization for vision care services To view the prescription eyewear options available through MassHealth, you can visit MassCor Industries - OPTICAL or ask your provider if they hold a copy of the latest catalog that can be used at the time of your appointment. MassHealth does not pay for tinted lenses prescribed only because the member complains of photophobia.Īdditional notes on contact lens coverage: MassHealth pays for hard, soft, or gas-permeable contact lenses if one or more of the following conditions exists: (a) postoperative cataract extraction or (b) keratoconus or (c) anisometropia of more than 3.00D or (d) more than 7.00D of myopia or hyperopia.Īdditional notes on extra or spare eyeglasses: MassHealth pays for an additional pair when one or more of these conditions exist: aphakia,> 7.00D of myopia or hyperopia, or >3.00D of astigma.Īdditional notes on eyeglasses: MassHealth members must choose their frames and lenses from the MassCor Vision Catalog. MassHealth does not pay for more than two screening services in a 12-month period.Īdditional notes for members who need bifocals : MassHealth pays for two pairs of eyeglasses instead of bifocals if one or more of the following conditions exists and is fully documented in the member’s medical record: (a) The member's prescription cannot satisfactorily be made into bifocal lenses or (b) The member has shown an inability to adjust to bifocals or (c) The member has a physical disability or medical condition(for example, severe arthritis) that would preclude or impede adjustment to bifocals or (d) The member's advanced age would make adjustment to bifocals unduly difficult or (e) The member's occupation would make bifocals hazardous or (f) The member has a marked facial asymmetry.Īdditional notes on pink tinted lens coverage: MassHealth covers pink tinted lenses if (a) the member has a pathological or other abnormal condition such as aphakia or (b) the member has habitually worn tinted lenses of this nature, and the prescriber concludes that the member should continue to wear them. ![]() Hard, soft or gas-permeable lenses, if specific conditions are met: see additional notes below for details Ĭoverage/limitations for contact lenses are based on medical necessity-talk to your provider for more information.Īdditional notes on eye exams: These restrictions do not apply if there is a referral from the member's physician or if one of the following complaints or conditions is documented in the member's record: (a)blurred vision (b) evidence of headaches (c) systemic diseases such as diabetes, hyperthyroidism, or HIV (d)cataracts (e) eye pain (f) eye redness (g) eye infection (h) double vision or (i) members receiving long term therapeutic drugs which may cause ocular side effects. Prior Authorization is required if more than one replacement is needed within the time periods noted above.Ī prescription change from a valid provider is required.īenefit coverage/limitations for spectacles are based on medical necessity- talk to your provider for more information.Īn Optometrist or Ophthalmologist can request prior authorization for alternative tint options based on medical necessity. Members 21 years and older: one replacement pair every 24 months without prior authorization Members under 21 years old: one replacement pair every 12 months without prior authorization Members 21 years and older: Requires Prior Authorization if repair is requested within 24 months of when glasses were dispensed. Glasses must be repaired or replaced by the optician who ordered the initial eyeglasses. Member 21 years and older: Once every 24 months ![]() With a prescription that meets certain criteria. Members who need bifocals may be able to get two pairs of glasses instead of bifocals, if certain criteria are met. Members 21 years and older: Once every 24 months Members younger than 21 years old: Once every 12 months Members may be covered for more frequent eye exams with a referral from a physician or if certain medical conditions exist. Members 21 years and older: Once every 24 months (No referral required) Members younger than 21 years old: Once every 12 months (No referral required) ![]()
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