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Learn About CHIP Vision Insurance

The Children’s Health Insurance Program (CHIP) is required to provide some level of CHIP vision insurance to kids enrolled in the program. However, the extent of that coverage can vary significantly from state to state. Some states may include basic surgical procedures in their coverage, while the majority limit coverage to a vision test and lenses. Only basic vision care for children is required by CHIP, Medicare and the Health Insurance Marketplace plans.

If you want vision insurance from CHIP for your child but do not meet the qualifications for Medicare, you may be able to obtain it through CHIP. This is because CHIP was created for families who make too much for Medicaid but still require financial assistance with insurance. Therefore, the program has higher income eligibility requirements for those who wish to qualify for coverage than Medicare does. The sections below describe what CHIP vision coverage options are available, how to use your benefits and the significance of ocular health.

What Vision Treatments CHIP Covers

All states have basic CHIP vision coverage, which includes an eye exam and access to glasses or frames. Some states subsidize both lenses and frames, while others pay only for the lenses and ask parents to pay for the frames. Still others may pay for frames as long as the frames are under a certain price. The cost sharing that parents can expect to take on will vary from state to state, and a handful of states offer additional vision insurance benefits. For example, Texas offers only the bare minimum coverage required by the federal government. On the other hand, Pennsylvania’s CHIP vision coverage includes not only an eye exam and glasses but also contacts, a vision evaluation, an aid allowance and follow-up examinations when necessary. Therefore, Pennsylvania’s CHIP vision insurance plan offers more than is required.

Parents interested in obtaining vision insurance for their children should consider whether CHIP offers adequate benefits in their state. A majority of states like Alabama, Connecticut and Utah may only have the bare minimum vision insurance for children in CHIP. Only a small handful of states offer more than that. In general, vision insurance plans available through CHIP tend to offer minimal vision benefits. This is because unlike other medical services, such as dental services, vision health is not considered critical to a person’s overall health.

To learn more about your vision insurance options through CHIP, download our comprehensive guide.

Vision Treatments CHIP Does Not Cover

Although vision insurance through CHIP typically covers the most basic services, it rarely covers more serious or intensive vision-related treatment. While eye screenings and corrective lenses are covered, surgery and correction is typically not. Additionally, treatments like vision rehabilitation or laser surgery are not covered by CHIP. The vast majority of states will only provide enough vision insurance for children to provide CHIP beneficiaries with glasses. Patients seeking more thorough coverage for additional treatment may have to purchase additional health insurance.

In some cases, treatment for an eye-related illness is not covered by vision insurance, but it is included in some other type of health coverage. For example, pediatric glaucoma treatment may still be covered by CHIP funding even if eye surgery is not listed as a covered benefit under vision insurance. Therefore, some treatments that appear not to be covered by your insurance plan may in fact be covered.

How to Use CHIP Vision Coverage

CHIP vision coverage comes as part of your standard CHIP coverage. Therefore, if you have applied for CHIP benefits for your children, they should be covered by at least a basic vision insurance plan. In order to use the plan to obtain corrective lenses for your child, you only have to find the correct contact. Typically when you sign up for CHIP, you receive a manual, handbook or enrollment card explaining your benefits and how to utilize them. The card or book will also include contact information for various benefits. The customer service representative can help you find a local optometrist and book an appointment for an eye exam.

Typically, your child’s CHIP vision coverage will include one annual eye exam and a pair of glasses per year. After you set up an appointment with your doctor, you can bring your child in to complete the eye exam and determine if he or she needs glasses. Your plan will have limits to how expensive glasses or frames can be, if they are covered. Review the requirements before selecting a pair of frames to ensure that the frames are covered by CHIP. If they exceed the cost covered, you may have to pay for the difference out of pocket.

After using your CHIP vision coverage benefits, you may or may not have a copay. Some states require copays for services outside of wellness and dental exams. If a copay is required, the amount required will typically depend on your income and the CHIP plan your child is enrolled in. Your copay could be anywhere between $3 to more than $50 depending on what state you live in.

To learn more about vision coverage, download our comprehensive CHIP guide.

Why Vision Coverage Matters

It is important for children to have access to vision insurance as they grow up. This is because unaddressed visual impairments can have a significant impact on a child’s ability to succeed in school. Children may struggle to see the board, read books or understand their teacher’s instructions if their vision is affected. Additionally, some eye diseases like amblyopia that cause vision loss in children can be treated with early intervention. However, according to the Center for Disease Control (CDC), fewer than 15 percent of preschoolers receive eye exams.

Therefore, if your children are enrolled in CHIP, it is important to take advantage of the vision coverage included in the plan. Taking your children to receive annual eye exams can identify causes of vision loss early so they do not get worse. Additionally, by getting glasses if your children need them, you can reduce the chance that their grades will suffer due to vision problems.