Medicaid Vision Insurance in Virginia

Medicaid vision insurance in Virginia is available to qualifying applicants who are eligible to receive medical assistance in the state. Virginia Medicaid vision care, also known as medical assistance, is an available benefit under the Department of Medical Assistance Services (DMAS) and the Commonwealth of Virginia. However, Virginia Medicaid vision benefits only include eye examinations once every two years. Additionally, the plan only includes eyeglasses if covered members are 21 years of age or younger. To enroll in VA Medicaid Vision Insurance, qualifying residents simply need to apply for medical assistance by completing an application online, in person, by mail or telephone. Residents who meet Medicaid vision insurance eligibility requirements do not need to complete a separate application for obtaining these benefits. To learn more about the requirements for vision insurance, download our comprehensive guide. To learn more about who is eligible for Medicaid vision insurance in Virginia, review the information below.

Are Virginia Medicaid vision benefits available?

Medicaid vision insurance in Virginia is available as part of the state’s medical assistance program for residents who meet the eligibility requirements of the Medicaid program. Virginia Medicaid vision care is available to qualifying members under the Families & Children (F&C) and Aged, Blind and Disabled (ABD) covered groups. Furthermore, Medicaid vision coverage includes eye examinations once every two years as well as eyeglasses for patients 21 years of age and younger. However, Medicaid vision insurance benefits do not include prescription eyeglasses or eyewear repair if beneficiaries are 21 years of age and older.

While VA Medicaid vision care is available to qualifying residents, patients 21 years of age and older generally need to make a small copayment before undergoing an eye examination. However, members of Medicaid vision insurance are exempt from making a copayment if they participate in a hospice program, are younger than 21 years of age or receive community-based long-term care. Some qualified members of Medicaid vision insurance in Virginia are not responsible for paying any medical assistance enrollment fees or monthly premiums. Additionally, copayments are not a requirement for all types of Medicaid services, including pregnancy-related care and emergency services.

Additionally, Virginia Medicaid vision benefits are available to children 21 years of age and younger under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. Along with Medicaid vision care, EPSDT program participants receive regular medical, vision, dental and hearing check-ups, as well as the treatment and diagnosis of any potential eye issues that may arise over time. To learn more about these Medicaid insurance vision benefits, download our comprehensive guide here.

Virginia Medicaid Vision Insurance Eligibility Requirements

Patients are eligible for Medicaid Vision Insurance in Virginia if they meet state residency, US citizenship and income restrictions for their specific covered group type (such as the F&C or ABD groups). To receive Virginia Medicaid vision care under the F&C group, for instance, applicants must be low-income pregnant women, financially needy children, former foster care residents, or low-income parents or relative caretakers of children from low-income households. To receive Medicaid vision coverage under the ABD group, however, claimants must be low-income and at least 65 years of age or be blind and/or disabled. Furthermore, ABD vision Medicaid benefits are also available to Auxiliary Grant participants, hospice care patients or medically-needy applicants who meet covered group requirements but not income restrictions.

Medicaid vision care is available to all qualifying beneficiaries under the state’s medical assistance program, as long as applicants meet the eligibility requirements for their specific group. To receive full Medicaid vision benefits with eyeglass protection and repair, however, claimants must be 21 years of age or younger. Applicants that learn who is eligible for Medicaid vision insurance in Virginia can make sure that they do no waste time applying for a program that does not suit the needs of their family members and household.

How to Enroll in VA Medicaid Vision Insurance

Since Virginia Medicaid vision care is an included benefit under the state’s medical assistance program, qualifying beneficiaries do not need to complete a separate application if they wish to obtain vision benefits, including coverage for regular eye examinations Instead, patients automatically enroll in Medicaid vision insurance after applying for medical assistance in Virginia. To apply for Medicaid vision care and essential medical benefits, claimants may apply online, in person at a local Department of Social Services (DSS) facility, by mail or telephone. Applicants who learn how to enroll in VA Medicaid vision insurance can make sure that they fill out the application with the correct information to prevent a delay in processing the application.

After applying for Medicaid vision insurance, it is important to contact an eye clinic provider ahead of time to verify whether the office accepts medical assistance. When using Virginia Medicaid Vision benefits, residents must also present their blue and white membership card, as doing so helps the provider to verify a patient’s medical assistance eligibility status. If patients enroll in VA Medicaid vision benefits and a Managed Care Organization (MCO), they must present both membership cards when checking in for an appointment. If patients do not present proof of their Medicaid vision benefits, they may end up receiving a bill from the provider.

To learn more about vision insurance through Medicaid, click here for our comprehensive guide.


Virginia Department of Social Services