Optical Services are Non-Covered for Medicare Qualified Beneficiary (MQB), Family Planning Waiver (MAFD), and Program of All-inclusive Care for the Elderly (PACE)

Under the MQB Medicare Eligibility Codes, Medicaid pays only for Medicare Part B premiums or premiums, deductibles, and coinsurance for charges covered by Medicare. Routine eye exams, refraction only and visual aids are not covered by Medicare for MQB beneficiaries.  Therefore, MQB beneficiaries are not eligible for Medicaid optical services.   

Under MAFD and PACE, program specific services are covered.  However, optical services are non-covered.  Therefore, MAFD and PACE beneficiaries are not eligible for Medicaid optical services.

For more information, please refer to Clinical Coverage Policy 6B, Routine Eye Examination and Visual Aids for Beneficiaries 21 Years of Age and Older, at: https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies.