Health First Colorado Vision Benefit
What is the Health First Colorado Vision Services Benefit?
Vision services covered by Health First Colorado (Colorado's Medicaid Program) differ between children and adults. Please see the “Who is eligible” section for more information. If you are enrolled in a managed health care plan, you may have additional benefits not listed below.
Who is eligible?
- Children (age 20 and under): The Early Periodic Screening Diagnosis and Treatment (EPSDT) Program provides vision benefits such as standard eyeglasses, replacement or repair of frames or lenses, contact lenses (must be medically necessary), ocular prosthetics, and eye exams.
- Adults (age 21 and older): Annual eye examinations, with eyeglasses and contact lenses covered ONLY following eye surgery. Does not require prior authorization, and surgery may have been performed at any time during the patient’s life.
What services are available?
|AVAILABLE BENEFIT||BENEFIT LIMITATION||COST|
|Eye Examinations - Adult||Annual||$2 co-pay|
|Eye Examinations - Child (birth to 18)||No limitation||$0|
|Eye Examinations - Child (19 to 20)||No limitation||$2 co-pay|
|Eyeglasses - Adult||After eye surgery only, limited to single or multi-focal plastic lenses and one frame||$0|
|Eyeglasses - Child (birth to 20)||Limited to single or multi-focal lenses and one frame||$0|
|Contact Lenses||Only covered when there is a medical reason||$0|
|Ocular Prosthetics||When medicially necessary||$0|
|Low Vision Aids - Child (birth to 18)||No limitation||$0|
|Low Vision Aids - Child (19-20)||No limitation||$0|
- Contact lens supplies and contact lens insurance are not benefits.
How often can glasses be replaced or repaired?
- Repair of eyeglasses is covered only when due to broken frames or lenses.
- Replacement glasses shall be provided when medically necessary or when the glasses are damaged to the extent that repairs are not cost effective.