Are eye doctors included in MassHealth’s network?
Yes, MassHealth has a wide network of eye doctors nationwide providing various vision care services. (MassHealth, 2025)
What vision care services are covered under MassHealth?
Vision care services include eye exams, screening, new eyeglasses, repair or replacement of broken eyeglasses, and contact lenses. Coverage may vary by age, plan type, and medical necessity. (MassHealth, 2025)
Do you need prior authorization by MassHealth for vision care services?
No, prior authorization is not required for most routine MassHealth vision services, such as eye exams, initial eyeglasses, and frames. However, depending on the type of vision service you need, your eye doctor may need to send a prior authorization directly to MassHealth or your MassHealth health plan. (MassHealth, 2025)
Do you need a referral to visit an eye doctor with MassHealth plans?
No, MassHealth does not require a referral for routine eye exams under most plans. Referrals may be required in some instances, such as when you have frequent exams beyond standard limits. If you are enrolled in a Primary Care ACO or the Primary Care Clinician (PCC) Plan, you will need a referral from your primary care provider for vision care services. (MassHealth, 2025)
