Colorado Medicaid Vision Care Benefits – 6 Things You Need to Know About Your Eyecare

Your Colorado optometrist may participate in Medicaid and provide eye exams and glasses for your children at no cost to you. Almost 1 of every 4 children in Colorado is insured through Medicaid. Because so many children are covered under Medicaid there are six points you need to understand.

  1. Medicaid coverage for vision varies state by state so don’t presume you will have the same benefits when moving to Colorado from another state. There are different types of vision care coverage for children and adults. Changes in eye care benefits have occurred in the last few years, and will continue to change with health care reform. Expansion or cut backs in benefits may occur at any time. Medicaid is a state run program run in cunjunction with the Federal Governement. States can vary the coverage policies to some degree. The state of Colorado has it’s own plan. One example of the differences is adult coverage. Adults have a $2.00 co-pay for eye exams and limited benfits for eyeglasses. Many states have full coverage for adults.
  2. For Medicaid vision coverage in Colorado, children’s vision insurance coverage is defined by age 20 and under. When reaching age 21, Colorado Medicaid considers you an adult and the benefits change. Children are eligible for an eye exam by their optometrist as needed with no co-pay.
  3. Contact lens fitting fees entail additional charges above the regular eye examination. These are not covered unless there is an eye disease that warps the cornea. Contact lenses may be the only way to provide acceptable visual acuity. The actual contact lenses are also not covered unless their is an applicable medical diagnosis. This is not a area where a patient can plead their case. If there are specific medical conditions requiring contact lenses your eye doctor has to file a form to have your case considered. The review process can take several weeks to several months. It is normally approved if contact lenses are the only way to correct your vision due to a corneal eye disease. Your optometrist may have to submit a form for prior authorization more than once to communicate the need for special consideration, so you will need to have some patience.
  4. A standard eyeglass frame and lenses are covered with no co pay. A standard frame means frames are limited to inexpensive frames. That does not mean they are necessarily low quality. Your optometrist is only allowed a limited reimbursement for the eyeglass frame. Repairs for broken frames or lenses are a benefit, and a replacement frame is provided if the frame cannot be repaired. While this is not necessarily an unlimited benefit, it can be used more than once if your child is prone to breaking glasses. Loss of eyeglasses is not specifically defined as a benefit but may be covered.
  5. Lens treatments such as scratch resistant coatings, glare free coatings, tints, and thin lens materials are not covered. Scratch resistant coatings are the one option you should purchase. Prescription eye glass lenses without a scratch coating will most likely have scratch marks on them within a day or two of teenager usage. Scratch resistant coatings are not scratch proof, but they will certainly extend the usable life of the lenses. There is a way to have thinner, lighter lenses covered for your child. If you request polycarbonate lenses, they will be much thinner and attractive for higher eye glass lens prescriptions, and help your child’s self image. Polycarbonate lenses are usually recommended for children and teens needing eyeglasses due to their extreme impact resistance.
  6. Other services may be available with prior authorization. Vision devices for children that have significant sight loss from eye diseases, some lens treatments, therapy for lazy eye, and other services are sometimes approved. Don’t expect a fast approval, but it is worth the wait when the service ends up being covered.

Medicaid is constantly changing and this information is provided as educational, not as representative of current state policy. Different types of programs are available in some areas of Colorado. Eligibility for enrolling in Medicaid and understanding your vision benefits is your responsibility, and the State of Colorado has resources to help you. Visit the Colorado State website at: www.colorado.gov/hcpf [http://www.colorado.gov/hcpf]. Thousands of children are eligible for Medicaid coverage in Colorado but are currently not enrolled or covered by any insurance plan. You can help keep your kids healthy by taking the time to enroll them now, and keeping up with annual preventative eye doctor examinations.

Reduce Your Health Insurance Deductible to $100 for Accidents

Almost everyone can see the logic of carrying a high-deductible health insurance plan to protect against the major unexpected expenses. Yet a high deductible can make some people a little nervous. Even a short trip to the emergency room to get stitches can cost several hundred dollars. If you break your leg skiing, the cost could quickly run into thousands of dollars.

Fortunately for people with these concerns, inexpensive supplemental accident plans are available which can reduce your deductible to just $100.

Though any type of medical expense can sneak up on you, most chronic illnesses provide clues long before they get serious. If you’re overweight, if you have digestive issues, or if you have a difficult time climbing a flight of stairs, you’re aware that you have health concerns long before your doctor or insurance company knows. But nothing sneaks up on you faster than an accident.

How Accident Plans Work An accident plan won’t pay a penny if you get sick, but if you have an accident and go to the doctor, emergency medical clinic, hospital emergency room, or even if you’re admitted to the hospital, they’ll cover 100% up to the set limit after a $100 deductible.

Some insurance companies offer these as options with their plans, or you can purchase an accident plan separately. These stand-alone accident plans will pay up to $5,000 or $10,000. And they are very reasonably priced, ranging from $32/month for the $5,000 plan for an individual, to $42 for a $10,000 plan for a family.

How Accident Plans can Work with Your HSA Having an accident plan can be a great way to buffer the risk that comes with a high-deductible health insurance plan. Let’s say you have a $5,000 deductible on your HSA plan, and it then pays 100%. In that case, you may want to consider adding a $5,000 accident plan to your coverage. If you were to have an accident that led to an emergency room bill of $800, you would only be responsible for $100.

If you were to have a very major accident that required hospitalization, your accident plan would pay $5,000 after you paid the first $100. This would cover your deductible on your HSA plan, which would then pay 100%. Your exposure would only be $100.

Another money-saving strategy you may want to consider is raising the deductible on your HSA (which will lower your premium), and adding an accident plan.

How To Avoid Medicare Supplement Insurance Pricing Pitfalls

In general, your age, gender, whether you use tobacco and your zip code factor into what you’ll pay for a Medicare Supplement plan. That’s just the “tip of the iceberg” when it comes to pricing schemes for Medicare Supplements. In fact, some people have paid hundreds of dollars more than others for the very same coverage. Don’t depend on the integrity of a salesman. Instead, learn how the industry works so you can find to the best value available.

Medigap Insurance Can Have The Same Coverage For Vastly Different Prices

Since Medicare Supplemental insurance or Medigap plans are standardized to offer the same benefits, it’s logical to expect pricing would also be standardized. Nothing could be further from the truth.

Medigap insurance has been divided into ten different benefit packages designated by letters ranging from A through N. Medigap Plan A has the minimum coverage, but Plan N does not have the most comprehensive coverage. That would be Plan F and Plan C is next.

Standardization means that every Plan A includes the same benefits whether it’s available from a well-known insurer or a relatively unknown insurance company. Paying higher premiums won’t get you extra coverage. You’ll have to change to a plan with a different letter to change your benefits.

In spite of this, insurers do charge inexplicably different prices for Plan A, Plan B, etc. The only way to know you are getting the best rate for the plan you pick is to get estimates from lots of different companies. That’s where the Internet comes in handy. Several websites offer quotes on plans from different companies and frequently provide personal assistance to help you compare plans.

Medigap Plan Pricing Is Not All The Same

Plans can be priced based on three different models and the lowest price may not serve you as well as you’d like. That’s because you’ll have less opportunity to change plans if your health deteriorates over time. When you’re turning 65, an open enrollment period guarantees you can get the standard rate with no increases or exclusions for pre-existing health problems. Unfortunately, the cheapest plans when you’re 65 may not be best-priced plans a decade later.

The pricing model that increases premiums based on age is known as Attained Age Rated. It’s tempting because it really does offer low rates for 65-year-olds. It’s a risk because your premiums will increase not only based on inflation, but just because you inevitably grow older. By the time your premiums are higher than those of other plans based on different pricing models, your health may not allow you to move to less expensive plans. That means you either have to pay higher rates or give up supplementing Medicare and pay for a lot of health care out of your own pocket.

Another pricing model is known as Issue Age Rated, but it’s not very common. Pricing is based on your age when you apply for a plan and rates don’t increase just because you get older. Rates do rise with inflation, though. These plans typically cost less if you apply at a younger age.

A third pricing model may be the most popular because it’s not based on age. Rates are the same for everyone in a designated area independent of their age or gender or even whether they use tobacco. Rates typically start out higher that other pricing models, but that will be different in later years. These plans won’t be the most expensive because their rates won’t be raised to account for your advancing age.

It may not be readily apparent which pricing model has been applied to the plans available in your area. Finding an agent willing to do some research can help. Finding an agent who will compare a lot of plans or a website that allows you to comparison shop quickly and easily is your best bet.