Yes, Home State Health does cover vision care in Missouri, but what you get depends on which plan you’re enrolled in. Adults on the Medicaid managed care plan get a basic eye exam and one pair of glasses every two years. Children get yearly exams, glasses, and medically necessary contacts. Pregnant members qualify for a yearly exam. Ambetter marketplace members get pediatric vision automatically but have to pick a plan with vision added on if they want adult coverage. WellCare Medicare Advantage members get yearly exams plus an eyewear allowance.
Medicaid Vision Coverage for Adults
If you’re 21 or older on Home State Health’s Medicaid plan, your vision benefit follows MO HealthNet rules. You get one comprehensive or limited eye exam for refractive error every 24 months, and one pair of eyeglasses every 24 months.1Home State Health. Home State Health Member Handbook Coverage also includes eye care for trauma, treatment of eye disease or medical conditions, and eye prosthetics.2Home State Health. Home State Health MO Member Handbook
Routine contact lenses are not covered for adult Medicaid members.2Home State Health. Home State Health MO Member Handbook If your glasses are lost or damaged inside the two-year window, replacements may be available under certain conditions, though the member handbook does not spell out what those conditions are.1Home State Health. Home State Health Member Handbook For cost questions, call Member Services at 1-855-694-4663.
Vision Coverage for Children
Children under 21 enrolled in Home State Health Medicaid or Show Me Healthy Kids receive broader benefits than adults, under federal EPSDT rules that fold all vision care into the health plan.2Home State Health. Home State Health MO Member Handbook The Show Me Healthy Kids plan covers routine eye exams, glasses, and contact lenses when medically necessary, and recommends an annual vision checkup.3Home State Health. Show Me Healthy Kids Vision Care No referral from a primary care provider is needed to see an eye doctor.
Replacement eyeglasses are covered when frames or lenses are lost, broken, or medically necessary, and when a child needs them for school.4Home State Health. Show Me Healthy Kids Member Handbook Frames must be sturdy and of good quality, with special frames covered only when medically indicated. Families who choose more expensive frames pay the price difference.5MO Healthy Schools. Home State Health Presentation Benefits for children and pregnant members are provided at no cost.1Home State Health. Home State Health Member Handbook For vision needs beyond the standard benefit, reach Care Management at 1-855-694-4663, ext. 6075125.
Vision Coverage for Pregnant Members
Pregnant members in a MO HealthNet category of assistance get a more frequent exam schedule than other adults: one comprehensive or limited eye exam per year for refractive error, plus one pair of eyeglasses every two years.2Home State Health. Home State Health MO Member Handbook Replacement lenses are available when a prescription changes by 0.50 diopters or more.1Home State Health. Home State Health Member Handbook Home State Health says pregnant members “might be eligible” for vision benefits and asks members to contact Care Management at 1-855-694-4663 to confirm their specific eligibility.6Home State Health. Home State Health Pregnancy Page
Ambetter Marketplace Vision Coverage
Through the Health Insurance Marketplace, Ambetter from Home State Health handles vision differently for kids and adults.
Pediatric vision is built into every Ambetter plan for members 18 and younger. It covers routine eye exams, eyewear, and medical eye care at no charge from in-network providers.7Ambetter Health. Vision and Dental8Centene. Premier Silver Summary of Benefits and Coverage
Adults 19 and older don’t get vision automatically. To have it, you must pick a plan with “+ Vision + Adult Dental” in the name.7Ambetter Health. Vision and Dental When you do, the in-network benefits aren’t subject to a deductible:
- Routine eye exam covered at 100%
- Eyeglass frames covered up to $130
- Single, bifocal, trifocal, and lenticular lenses covered at 100% per pair
- Contact lenses in place of glasses covered up to $130
- Contact lens fitting covered at 100%
- Specialty lens fitting covered up to $50
These benefits aren’t covered out of network.9Ambetter Health. Ambetter Vision and Adult Dental Flyer One thing to know on cost: adult vision isn’t considered an essential health benefit under federal law, so advance premium tax credits can’t be applied to the portion of your premium that covers it.7Ambetter Health. Vision and Dental
WellCare Medicare Advantage Vision Coverage
Home State Health also offers WellCare-branded Medicare Advantage plans in Missouri. Those plans include yearly routine eye exams, glaucoma prevention care, and diabetic retinal eye exams.10WellCare Home State Health. Vision Benefits For eyewear, the Wellcare Dual Reserve (HMO-POS D-SNP) plan provides a combined annual allowance of up to $300 for contacts and glasses.11WellCare Home State Health. Wellcare Dual Reserve Summary of Benefits Allowances and services vary by plan, so check your Summary of Benefits or call the number on your Member ID card for your exact coverage.
Using Your Vision Benefit
Routine vision care is handled through Centene Vision Services, which does business as Envolve Vision.12Centene Vision. Centene Vision Services To find an in-network eye doctor, use the provider search on HomeStateHealth.com, use the “Find an Eye Doctor” tool at Centene Vision, or call the number on the back of your Member ID card.13Centene Vision. Centene Vision Missouri For general questions, Medicaid members can call 1-855-694-4663, and Show Me Healthy Kids members can call 1-877-236-1020.