Does MetroPlusHealth cover vision care?

Yes, MetroPlusHealth offers a variety of plans for individuals and families that include dental and vision:

1. Marketplace Plans
   Marketplace plans include a wide variety of comprehensive health plans for individuals and families with great benefits and services, including vision care, and at very competitive prices.

2. Essential Plan
   The Essential Plan covers emergency, preventive, and routine vision care, including a vision examination, and prescribed lenses and frames.

Accessing Vision Services

If you need to find or change a participating ophthalmologist please call the number on your ID card or visit our website.

3. Medicaid Managed Care
   Medicaid Managed Care vision care includes:

• Services of an ophthalmologist, ophthalmic dispenser and optometrist, and coverage for contact lenses, polycarbonate lenses, artificial eyes, and or replacement of lost or destroyed glasses, including repairs, when medically necessary. Artificial eyes are covered as ordered by a plan doctor or specialist.
• Eye exams, generally every two years, unless medically needed more often
• Glasses (new pair of Medicaid approved frames every two years, or more often if medically needed)
• Low vision exam and vision aids ordered by your doctor
• Specialist referrals for eye diseases or defects

4. Medicare Products

MetroPlus Advantage Plan (HMO D-SNP) – Medicare-covered eye exams, including diagnosis and treatment of diseases and conditions of the eye. This benefit can be combined with your Medicaid benefits to provide coverage for additional eyewear, or to purchase eyewear beyond the Medicaid spending limit. MetroPlus Advantage Plan (HMO D-SNP) also covers additional vision care services not covered by Original Medicare. Additional covered benefits include:

Eyewear is covered up to a total of $350 per year for:

• Contact lenses
• Eyeglasses (lenses and frames)
• Eyeglass lenses
• Eyeglass frames
• Upgrades

MetroPlus Platinum Plan (HMO) – Medicare-covered eye exams, including diagnosis and treatment of diseases and conditions of the eye.

MetroPlus UltraCare (HMO D-SNP) – Medicare-covered eye exams, including diagnosis and treatment of diseases and conditions of the eye. Additional covered benefits include:

• We will cover services provided by optometrists, ophthalmologists and ophthalmic dispensers including eyeglasses, medically necessary contact lenses and polycarbonate lenses, artificial eyes (stock or custom made), low-vision aids and low-vision services.
• Coverage also includes examinations for diagnosis and treatment for visual defects and/or eye disease.
• Examinations for refraction are limited to every two (2) years unless otherwise justified as medically necessary.
• Eyewear is covered up to a total of $350 per year for:
• Contact lenses
• Eyeglasses (lenses and frames)
• Eyeglass lenses
• Eyeglass frames
• Upgrades