Does Medicaid Cover Vision in Utah? Adults, Children, and CHIP

Utah Medicaid does cover vision care, but what you get depends on your age. Every enrolled member can get a routine eye exam each year. Eyeglasses and contact lenses, however, are only covered for children under 21 and for pregnant members. Other adults pay out of pocket for corrective lenses even when the exam shows they need them.¹

What Adults Get: Exams, Not Glasses

Adults aged 21 and older on Utah Medicaid are entitled to one routine eye exam per rolling year with an optometrist or ophthalmologist. Additional exams are allowed when medically necessary or when glasses have been lost or broken.¹

As of May 1, 2025, Utah Medicaid also covers a refraction exam once per rolling year. That’s the standard test used to determine a glasses prescription, billed under CPT code 92015, and it’s covered in addition to other eye exam codes.²

Where the coverage stops is at the frames and lenses themselves. Eyeglasses and contact lenses are not a covered benefit for non-pregnant adults 21 and older.¹ You can walk out of a Medicaid-covered exam with a valid prescription and still need to pay for the glasses yourself. Pregnant members are the exception and remain eligible for eyewear.

If you’re subject to copays, expect $4 per visit with an optometrist and $4 per visit with an ophthalmologist. Children, pregnant members, American Indians and Alaska Natives, hospice patients, Cancer Medicaid members, Targeted Adults Medicaid members, and TANF/FEP members don’t pay copays at all.³

What Children Under 21 Get: Full Coverage, Including Glasses

Vision benefits for children and young adults under 21 are much broader because of a federal Medicaid requirement called Early and Periodic Screening, Diagnostic and Treatment, or EPSDT. States must provide vision screenings, diagnosis, and treatment of vision defects, including eyeglasses, for all Medicaid-enrolled children.⁴ If a provider decides a child needs a vision service that Medicaid wouldn’t normally cover for adults, it can still be covered under EPSDT as long as it’s medically necessary.⁵

For eligible children, Medicaid pays for one pair of eyeglasses every 12 months. Replacement glasses are also allowed once per 12-month period. Replacing frames inside that window requires prior authorization, but replacement lenses can be covered without prior authorization if the provider reuses the existing frames.⁶

A new pair can be approved before the 12-month mark in specific situations:

A prescription change of 0.5 diopters or more
A medically necessary change identified during an exam
A change in head size
An allergic reaction to the previous pair
Glasses that are lost, broken, or irreparably damaged

For lost or damaged glasses, the request has to be accompanied by a written statement explaining what happened. Glasses broken or lost through member abuse or neglect won’t be replaced. Extra pairs such as reading glasses, safety glasses, or spares are also not covered.⁶

Contact Lenses

Contact lenses are covered only when medically necessary.⁷ They aren’t offered as a routine alternative to glasses. In practice, Medicaid programs limit contact lens coverage to cases where glasses can’t adequately correct a patient’s vision, such as after cataract surgery or for conditions like aphakia, and prior authorization is almost always required.⁸

CHIP Covers Exams but Not Glasses

If a child is enrolled in Utah’s Children’s Health Insurance Program instead of full Medicaid, the vision benefits are narrower. CHIP covers eye exams and vision screenings, but it does not cover eyeglasses to correct refractive error, and it does not cover eye surgery to correct vision. Benefits are the same across the three CHIP plans (SelectHealth, Molina, and Healthy U). Vision screening copays run $5 under Plan B (one per year) and $25 under Plan C. Verified American Indian and Alaska Native children owe no copays, deductibles, or coinsurance.⁹

Families whose children need glasses but are on CHIP rather than Medicaid often turn to charitable programs. Friends for Sight, based in Utah, has provided free eye exams and glasses to people in need since 1955.¹⁰ National options include VSP Eyes of Hope, available to families at or below 200 percent of the federal poverty level, and New Eyes.¹¹

Adults Who Also Have Medicare

Adults who need glasses and are stuck without that benefit under standard Medicaid have one route worth checking. Members who qualify for both Medicare and Medicaid can enroll in a Medicare Advantage Dual Special Needs Plan, which often adds vision benefits beyond what Medicaid alone provides.¹² The UnitedHealthcare Dual Complete plan for Utah in 2026, for example, includes a $0 copay routine eye exam each year, a $200 annual allowance for frames or contact lenses, and full coverage of standard prescription lenses with scratch-resistant coating.¹³ The SelectHealth Medicare Dual plan likewise lists $0 copays for routine eye exams, contact lenses, and eyeglass frames and lenses, with certain limits.¹⁴

Finding a Vision Provider

Utah Medicaid delivers care through several managed care organizations: Healthy U, Molina Healthcare, Health Choice Utah, and SelectHealth. Covered vision services are the same across the comprehensive managed care plans, so the benefit itself doesn’t change with your plan choice.¹⁵ To find an in-network eye doctor, go through your plan:

Molina partners with Vision Service Plan. Search at VSP.com or call (844) 350-4089.¹⁶
Healthy U members can search at uhealthplan.utah.edu or call Member Services at (833) 981-0212.¹⁷
SelectHealth members can use the directory at selecthealth.org or call Member Advocates at (800) 515-2220.¹⁸
Fee for Service members can call a Health Program Representative at 1-866-608-9422.¹⁹

Bring your Medicaid card to the appointment, along with your managed care plan card if you have one. Providers may ask for a government-issued photo ID. If you carry other health insurance, bring those cards too.¹⁹

One last thing to watch at the office: if a service isn’t covered by Medicaid, you’re on the hook for the cost. In that case, the provider should have you sign a form that identifies the specific service, confirms Medicaid won’t pay, and states the amount you’ll owe before the service is performed.¹²

1
Utah Department of Health & Human Services. November 2024 Medicaid Information Bulletin
2
Utah Department of Health & Human Services. May 2025 Medicaid Information Bulletin
3
Utah Department of Health & Human Services. Medicaid Copay Chart
4
Medicaid.gov. Early and Periodic Screening, Diagnostic and Treatment
5
Utah Medicaid. Early and Periodic Screening, Diagnostic and Treatment
6
Utah Department of Health & Human Services. EPSDT Services Provider Manual
7
Molina Healthcare. Utah Medicaid Vision Services
8
National Academies. Medicaid Vision Coverage by State
9
Utah CHIP. CHIP Members Guide 2024
10
Friends for Sight. Friends for Sight
11
National Eye Institute. Get Free or Low-Cost Eye Care
12
Utah Department of Health & Human Services. Utah Medicaid Member Guide 2025
13
UnitedHealthcare. UHC Dual Complete UT Summary of Benefits 2026
14
Q1Medicare. SelectHealth Medicare Dual Plan Benefits
15
Medicaid.gov. Utah Managed Care Delivery Systems
16
Molina Healthcare. Utah Medicaid iCare Vision Services
17
University of Utah Health Plans. Healthy U Medicaid Member Handbook
18
SelectHealth. SelectHealth Medicaid Member Handbook
19
Utah Department of Health & Human Services. Utah Medicaid Member Guide 2024