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What’s covered

One routine eye exam per year by a provider, ophthalmologist or optometrist is covered by Molina Healthcare. Molina Healthcare covers one pair of eye glasses (frames and lenses) every two years.

Members 21 years of age and older are limited to replacement eyeglasses when medically necessary. Members 20 years of age or younger have no restrictions on replacement eyeglasses.

As an additional benefit, Molina Healthcare provides a $40 credit to use toward your eyeglasses benefit (lenses and frames) per year, for Members who choose frames outside of the approved options.

Member Handbook

It tells you what you need to know about your Molina Healthcare HealthChoice Illinois plan. Member Handbook

How do Members get care?

Molina Healthcare partners with Avesis to provide you with covered vision services. To find a provider, ophthalmologist or optometrist who can provide you with covered eye care services, visit our online provider directory.

Medi-Cal

Vision benefits covered by L.A. Care for Medi-Cal members include: 

• Routine eye exams once every 24 months
  • Additional or more frequent eye exams are covered if medically necessary for members, such as those with diabetes
• Eyeglasses (frames and lenses) are covered once every 24 months with a valid prescription
• Replacement eyeglasses within 24 months with a change in prescription or if eyeglasses are lost, stolen, broken (and cannot be fixed) and it is not the member’s fault. Members must provide a note that tells how the eyeglasses were lost, stolen, or broken 
• Low vision devices for those with vision impairment that is not correctable by standard glasses, contact lenses, medicine, or surgery that interferes with a person’s ability to perform every day activities (i.e., age-related macular degeneration)
• Medically necessary contact lenses
  • Contact lens testing and contact lenses may be covered if the use of eyeglasses is not possible due to eye disease or condition (i.e., missing an ear). Medical conditions that qualify for special contact lenses include, but are not limited to, aniridia, aphakia, and keratoconus

To find out more about eye exams or vision care coverage, call Vision Service Plan (VSP) at 800-877-7195 (TTY 1-800-428-4833). No-cost interpreting services, including American Sign Language, are available. 
 

L.A. Care Covered™ and L.A. Care Covered Direct™

L.A. Care Covered™ and L.A. Care Covered Direct™ provides vision coverage for members up to the age of 19 through VSP. Coverage includes 

• One routine eye exam per year
• One (1) eyewear prescription (one pair of glasses or contact lenses) each year   

Copays do not apply to these services. Laser vision procedures are not covered. To locate a participating provider, call VSP at 1-800-877-7195. You can also review the Evidence of Coverage (Member Handbook) for L.A. Care Covered™ and L.A. Care Covered Direct™  or call L.A. Care Covered Member Services at 1-855-270-2327 (TTY: 711) for more coverage details.
 

PASC-SEIU Plan

There is currently no coverage for routine vision services of any kind. Call our Member Services Department at 1-844-854-7272 if you have any questions.
 

Cal-MediConnect

As a Member of L.A. Care Cal MediConnect Plan you are covered for a variety of Vision services including:

• One (1) routine eye exam every year,
• Up to $200 for eyeglasses (frames and lenses) or up to $200 for contact lenses every two years. 

The plan will pay for outpatient doctor services for the diagnosis and treatment of diseases and injuries of the eye. For example, this includes annual eye exams for diabetic retinopathy for people with diabetes and treatment for age-related macular degeneration. For people at high risk of glaucoma, the plan will pay for one glaucoma screening each year. 

To find out more about vision care covered through L.A. Care Cal MediConnect, please review your L.A. Care Cal MediConnect Plan Member Handbook or call Member Services at 1-888-522-1298 (TTY: 711) 24 hours a day, 7 days a week, including holidays.

Does Medi

Does Medi

Is an ophthalmologist covered by Medi

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