Age Restrictions and Benefits
Member under the age of 211 vision benefits:
- Eyeglasses every four years without a prior authorization.
- Contact lenses with a prior authorization.
- Additional services are covered with a prior authorization if medically necessary to correct or ameliorate defects.
Members 21 years old and older vision benefits:
The following vison benefits are available for adults 21 and older through Idaho’s Medicaid program. Please note, there are no adult coverages for routine eye exams or eyewear if certain conditions are not met.
- Services to treat acute conditions that, if left untreated, may cause permanent or chronic damage to the eye. (See Appendix A)
One pair of eyeglasses or contact lenses following cataract surgery with prior approval.
Contacts to treat Keratoconus with prior approval.
Contact lenses or eyeglasses when necessary to prevent further degradation of vision due to the existence of a chronic condition listed on Appendix A found in the Eye and Vision Services section of the Idaho Medicaid Provider Handbook. A prior approval request with supporting documentation must be submitted for review.
- Additional services are covered with prior authorization if medically necessary. (IDAPA 16.03.09.880)
1 The Member has not reached 21 years of age on the last day of the preceding month in which materials are requested.