At Clare Senior Care AFC|GAFC, we know that maintaining your independence starts with being able to see the world clearly. Whether it’s reading a favorite book, navigating your home safely, or recognizing the faces of loved ones, good vision is vital for a high quality of life.
Many seniors in our Adult Foster Care (AFC) and Group Adult Foster Care (GAFC) programs rely on MassHealth for their healthcare. Understanding exactly what is covered can be confusing, so we’ve broken down the 2026 MassHealth Vision Benefits to help you make the most of your coverage.
1. Routine Eye Exams: Staying Proactive
Regular check-ups are the best way to catch conditions like glaucoma or cataracts early.
- Standard Coverage: For adults 21 and older, MassHealth covers one routine eye exam every 24 months.
- Need to see the doctor sooner? You can get more frequent exams if you have a referral from your doctor or if you experience symptoms like:
- Blurred vision or double vision.
- Frequent headaches or eye pain.
- Existing medical conditions like diabetes, hyperthyroidism, or HIV.
- New eye infections or redness.
2. New Eyeglasses and Frames
If your prescription changes, MassHealth helps you get the hardware you need to see clearly.
- Frequency: Adults are eligible for one new pair of eyeglasses (frames and lenses) every 24 months.
- The MassCor Catalog: Members choose their frames from the MassCor Vision Catalog. Your eye doctor can show you the latest options during your appointment.
- Bifocal Options: If you have trouble adjusting to bifocals due to age or a medical condition (like severe arthritis), MassHealth may pay for two separate pairs of glasses instead—one for distance and one for reading.
3. Repairs and Replacements
Accidents happen! If your glasses break or get lost, you aren’t necessarily stuck waiting two years for a new pair.
| Service | Covered? | Note for Adults (21+) |
| Repairs | Yes | Requires “Prior Authorization” if the repair is needed within 24 months of getting them. |
| Lost Glasses | Yes | One replacement pair every 24 months. If you lose them again within that time, your doctor must ask for special approval. |
| Lens Updates | Yes | If your prescription changes significantly, you can get new lenses with a valid provider’s request. |
4. Specialized Vision Needs
MassHealth goes beyond just “basic” glasses for members with specific medical needs:
- Tinted Lenses: Covered if you have a medical condition (like aphakia) that makes your eyes sensitive to light.
- Contact Lenses: These are covered if they are medically necessary (for example, for conditions like keratoconus or following cataract surgery).
- Extra “Spare” Pair: If you have a very high prescription (over 7.00D), you may be eligible for a backup pair.
How to Access Your Vision Benefits
The way you access these services depends on your specific plan:
- Senior Care Options (SCO) or PACE: If you are enrolled in a SCO (like Commonwealth Care Alliance or UnitedHealthcare) or a PACE program, you should call your plan directly. These plans often offer even more flexible vision benefits, such as annual exams or higher allowances for frames.
- MassHealth Standard / CarePlus: You will likely need a referral from your primary care doctor. Once you have that, you can visit any vision provider who accepts MassHealth.
- Dual Coverage (Medicare & MassHealth): If you have both, Medicare is usually billed first. Make sure your eye doctor accepts both types of insurance to avoid out-of-pocket costs.
We Are Here to Help
At Clare Senior Care, our care coordinators are dedicated to helping you manage your health and navigate your benefits. If you are a member of our AFC or GAFC programs and need help finding a local eye doctor or understanding your plan, don’t hesitate to reach out to your Case Manager.
Legal Disclaimer & Official Resources
Important Disclaimer
Please note: This information is provided as a general guide for our community members at Clare Senior Care and is based on the most recent 2026 MassHealth guidelines. Clare Senior Care is not a representative of MassHealth. Insurance policies, eligibility requirements, and coverage limits are subject to change by the Commonwealth of Massachusetts. Always verify your specific benefits with your MassHealth caseworker, your health plan provider (such as your SCO or PACE organization), or your eye care professional before scheduling services or purchasing materials.
Official MassHealth Vision Resource
For the most comprehensive and up-to-date details regarding your vision benefits, we encourage you to visit the official state resource page:
🔗 Learn about MassHealth Vision Care Services
Who to Call for Help
If you have specific questions about a bill, a denied claim, or finding a local doctor, use the following contact information:
- MassHealth Customer Service Center: (800) 841-2900 (TDD/TTY: 711)
- Hours: Monday – Friday, 8:00 a.m. – 5:00 p.m.
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