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Vision Coverage

Optometrists

Optometrists are medical professionals for the eye. They can:

  • Examine, diagnose, treat and manage diseases, injuries, and disorders of the eye and associated structures.
  • Identify related conditions affecting the eye.
  • Prescribe medications.
  • Provide low vision rehabilitation and vision therapy.
  • Offer vision services such as eye exams.
  • Prescribe eyeglasses and contact lenses as needed.

Ophthalmologists

Ophthalmologists are medical and surgical physicians who treat eye problems. They can:

  • Provide complete eye care as listed above.
  • Do surgical procedures for cataracts, glaucoma, eye trauma, and other conditions.

UPMC Community HealthChoices participants can self-refer to participating optometrists for a routine eye exam. A referral from a primary care practitioner (PCP) is needed to see an ophthalmologist to treat a problem.

Participants who are dual eligible for Medicare and Medicaid must use their Medicare vision benefits before using UPMC Community HealthChoices benefits. When using Medicare benefits, vision providers must be in the participant’s Medicare network. When using UPMC Community HealthChoices benefits, vision providers must be in the UPMC Community HealthChoices network.

UPMC Community HealthChoices vision benefits are administered through Envolve Vision. Find participating UPMC Community HealthChoices vision providers.

Vision Services

  • Routine vision exams twice a year
  • $100 allowance toward eyeglasses (one frame and two lenses) or toward one pair of contact lenses and fitting per year*
  • Glasses or contact lenses to treat aphakia (medical condition)
  • Specialist eye exam with referral from PCP

*If you choose standard eyeglasses or contact lenses that are within the allowance, there is no cost to you. If you exceed the allowance, you will be responsible for any cost over the $100.

Participants who need help finding an eye care provider, or have questions about their vision benefit, can call the UPMC Community HealthChoices HealthCare Concierge team at 1-844-833-0523 (TTY: 711).

For more information on vision services, view the UPMC Community HealthChoices handbook.

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