Volume 11  No. 1

 January 2007        

MAIN UPDATE

In Solidarity for Peace, Bread and Justice!

A Joint Project of Maine Equal Justice and the Maine Association of Interdependent Neighborhoods

Frequently Asked Questions
Coverage for Eyeglasses, Lens and Vision Services

Maine has two programs to help people with vision problems. One program is the MaineCare program. The other program is the Medical Eye Care Benefit program.

Each program has different rules for who is eligible. Each program also covers different things. Part 1 will talk about MaineCare coverage and Part 2 about the Medical Eye Care Benefit Program.

Part 1: MaineCare

Does MaineCare cover routine eye exams?

  • If you are under age 21, MaineCare pays for one routine eye exam per year.
  • If you are over age 21, MaineCare will pay for one routine eye exam every two years.
  • For persons living in an Intermediate Care Facility for the Mentally Retarded, MaineCare covers a routine eye exam every year.

What if I need to see the eye doctor for a problem?

MaineCare will pay for more eye exams, testing, etc., if medically necessary. If you end up needing to go to a specialist, MaineCare will pay. However, you may need a referral from your Primary Care doctor before you can see a specialist. (You don’t need a referral for the routine eye exam.)

Does MaineCare cover contact lenses?

  • If you are under age 21, MaineCare will pay for contact lenses for certain types of eye conditions. MaineCare will pay for one replacement lens per eye per year.
  • If you are over age 21, MaineCare does not pay for contact lenses.

Does MaineCare pay for eyeglasses?

  • If you are under age 21, MaineCare will pay for eyeglasses if your vision meets certain standards. Your eye doctor can also ask for exceptions to the standards. This is called “prior authorization.”
  • If you are over age 21, MaineCare will only pay for eyeglasses if the power of the eyeglasses needed are equal to or greater than 10.00 diopters.

How often can I replace the eyeglasses that MaineCare pays for?

  • If you are under age 21, then MaineCare will pay for replacement eyeglasses as needed.
  • If you are over age 21, then MaineCare will only pay for one pair per lifetime! MaineCare will pay for some repairs.

Will I have to pay anything for my eyeglasses?

If you are over age 21, you may have to pay a co-payment. The co-payment won’t be more than $3.00. You will not be charged anything extra for your eyeglasses, even if you get them from someone other than the person who examined your eyes.

What happens if I need special lenses or glasses?

Your eye doctor can ask MaineCare for “prior authorization” for special lenses or frames.

How can I find out more about this program?

You can call MaineCare Member Services at 1-800-977-6740.

Go to program rules

Part 2: Medical Eye Care Benefit Program

Who is eligible for the Medical Eye Care Benefit program?

This program is for people with serious vision problems. The two serious problems are:

  1. An eye disorder that, if left untreated, may progress to blindness; or
  2. Corrected eye vision which has acuity of 20/70 or worse in the better eye.

How does a person apply for this program?

Applications for this program are made by contacting:

Medical Eye Care Benefit Program
Office of MaineCare Services
Department of Health and Human Services
442 Civic Center Drive
11 State House Station
Augusta, ME 04333-0011

(207) 287-2033

Are there financial rules for the program?

Yes. A person can be on Supplemental Security Income (SSI) or have income below 80% of the State’s current median income. In 2006 that amount was $21,314 for a single person, and $40,987 for a family of four.

What does the program pay for?

This is a partial list of what is covered.

  • Treatment to prevent blindness
  • Contact lenses for people with certain conditions
  • Yearly eye exams for those with Type I or 2 diabetes
  • Eyeglasses
  • Some prescription drugs to treat the eye-related disorder
  • Vision testing for certain conditions, such as glaucoma
  • Special lenses
  • Post-operative care

How do I know which services will be covered?

The State must pre-approve all services under the program. Your eye doctor will work with the program to get things covered.

Do I have to pay anything for these services?

There are small co-payments for some of the services.

How can I find out more about this program?

Call the Medical Eye Care Benefit program at: (207) 287-2033

Go to program rules

MAIN Update Table of Contents | MAIN Home Page | MEJP Home Page