Lost or Broken Glasses: Replacement Rules Under Medicaid

Children break glasses. Florida Medicaid's rules anticipate this for members under 21 — the key is knowing the sequence.

Step 1: Try repair first

Take the pieces to an optical office, even one that did not dispense them. Many repairs — screws, nose pads, temple arms, re-mounting a popped lens — are free and done while you wait. Do not throw broken glasses away before someone has looked at them.

Step 2: If repair is not possible

Ask the office about a replacement pair. Replacements for children are generally allowed when glasses are lost, stolen, or damaged beyond repair, and typically require:

• A statement from the parent or guardian explaining what happened

• Documentation from the provider that the glasses cannot be repaired

• Confirmation that the prescription on file is still current, or a new exam if it is not

Step 3: If the prescription is out of date

If the last exam was more than a year ago, schedule the exam first. It is covered, and the replacement cannot be ordered against an expired prescription anyway.

What not to do

• Do not let a child go weeks without glasses "until the next appointment." For a child in treatment for amblyopia or myopia control, lost wearing time is lost treatment.

• Do not buy readers from a pharmacy as a substitute for a prescription. They are the wrong correction and will not help.

• Do not assume a replacement is denied because you heard once-a-year. Ask.

Preventing the next round

• Record the frame model, size, and color so an identical replacement is easy to order

• Keep the previous pair as an emergency spare rather than discarding it

• Use a strap or cable temples for younger children

• Get sports goggles for contact sports rather than wearing regular frames on the field

Timeline

Expect one to three weeks for a replacement to be fabricated. Ask at the time of the order whether the lab has an expedite option.

Schedule an appointment

Advanced Vision Care serves families across Florida and accepts Florida Medicaid plans including Sunshine Health. Call our office to verify your benefits and schedule a comprehensive eye exam.

This article is general information, not medical advice, and coverage details can change by plan year. Confirm your specific benefits with your plan and discuss your child's care with your eye doctor.