PreviousEyeglasses are covered under the Maine Care program only when they are purchased through the Department of Human Services’ Vision Care Volume Purchase Contactor. This requirement to purchase through the contractor applies to lenses, frames, frame parts. For Members 21 and over Maine Care will pay for one pair of eyeglasses per lifetime when the power is equal to or greater than 10.00 diopters. For Members under 21, Maine Care will pay for eyeglasses when the refractive error in at least one eye meets at least one of the following
Repair is also allowed. For the specific procedure to follow for replacement and/or repair, the reader should refer to Section 75-03-5 in the Maine Care Benefits Manual. If the refractive error is below the criteria established by the Department of Human Services (see below for criteria), then PA is required.
Tinted Lenses, Transition Lenses or Photochromic Lenses always require PA. A statement from an ophthalmologist or optometrist indicates the member has a valid complaint of photophobia.
For member 21 years of age and over, Maine Care will authorize tinted lenses, transitional lenses or photochromic lenses only if the prescription is equal to or greater than 10.00 diopters. For members under 21 years of age, Maine Care will authorize tinted lenses, transitional lenses or photochromic lenses as long as the prescription meets the criteria set forth in Section 75.03-2(B)(2) and medical justification is documented.
For members under the age of 21, Maine Care will reimburse for the initial contact lens(es) and one replacement lens per eye per year. Maine Care will only cover contact lenses for therapy of ocular pathology or for cases where visual acuity is not correctable to 20/70 with ophthalmic lenses, but can be improved to 20/70 or better with contact lenses. Maine Care does not cover contact lenses for members over the age of 21.
If the cost of the frames and/or lenses exceeds the maximum allowance, PA is required.
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