Routine eye exams depend on age
MSP pays for routine eye exams for residents aged 18 and under and 65 and over. It does not pay for routine exams at ages 19 to 64. For children, MSP pays for a routine exam once every 11 months.[1][2]
| Age | Routine eye exam |
|---|---|
| 18 and under | Paid by MSP, once every 11 months |
| 19–64 | Not paid by MSP unless there is a medical need |
| 65 and over | Paid by MSP |
With a medical need, any age is covered
MSP pays for exams that are medically required, at any age. Examples are an existing eye disease, an eye injury, a systemic condition such as diabetes that affects the eyes, or taking a medication that carries a risk to the eyes. Simply wanting new glasses or contact lenses is not a medical need.[2]
Optometrists may charge extra
An optometrist enrolled with MSP cannot charge extra for MSP-insured services. One who is not enrolled may charge more than MSP pays, but must tell you in advance how much you will pay and how much MSP will refund. For that reason many clinics charge more than MSP's payment, so ask when you book.[3]
Eyeglasses and contact lenses
Eyeglasses are not covered by MSP.[1] Two exceptions provide help:[4][5]
- Children under 19 in a household that qualifies for MSP supplementary benefits can get one pair of prescription glasses a year through Healthy Kids, covering lenses and a basic frame but not contact lenses.[4]
- Adults receiving income or disability assistance can get an eye exam and glasses once every 2 years.[5]
Employer plans
For people with employer benefits, a common arrangement is one pair of glasses reimbursed every 24 months; the amount and interval depend on the policy. Many limits reset each year, so it is worth confirming before year end.