Sunshine Health Vision Benefits: Frequently Asked Questions

These are the questions our front desk answers every day.

Is my child's eye exam really free?

For members under 21 at an in-network provider, a covered comprehensive exam typically has no copay. Optional cosmetic lens upgrades are the only thing you would ever be asked to pay for, and those are always your choice.

How often can my child get an exam?

Generally once every 12 months, plus additional visits whenever there is a documented medical reason.

Can adults get glasses?

Adult glasses coverage under Florida Medicaid is limited. Lenses after cataract surgery are covered. Beyond that, check whether your plan currently offers a vision allowance as an expanded benefit — those change by plan year.

My child broke their glasses. Now what?

Bring them in. Many repairs are free and same-day. If they cannot be repaired, ask about a replacement — replacements for children are allowed under defined circumstances.

Do I need a referral?

Usually not for a routine eye exam with an in-network provider. Specialty and surgical care may require prior authorization.

Are contact lenses covered?

Contacts are covered when they are medically necessary — for example keratoconus, high anisometropia, or aphakia — not simply as a preference over glasses. Your doctor documents the reason.

Is myopia control covered?

The exam is covered. Specialty myopia control lenses and treatments are frequently not covered as a plan benefit. Ask the office about self-pay pricing and whether it is worth it in your child's case — sometimes it clearly is, sometimes standard glasses and more outdoor time are the right call.

What if my coverage just ended?

Eligibility can lapse after a redetermination without much warning. Check your portal, respond to state mail promptly, and ask the office about self-pay rates while you sort it out. Do not let a lapse turn into two years without an exam.

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.