A comprehensive eye exam can reveal meaningful insights about your eye health and overall well-being. By prioritizing regular eye exams, you can maintain healthy vision for years to come.
As an Ontario resident, you may wonder if you are eligible for a free eye exam through the Ontario Health Insurance Plan (OHIP). OHIP does cover the cost of many health services, including some eye care services, for eligible Ontario residents.
While OHIP does not cover the cost of eye exams for everyone, it does cover the cost of an eye exam every 12–18 months for some Ontarians, including children, seniors, and those with certain medical conditions.
What Does OHIP Cover?
OHIP is a provincially funded healthcare plan for eligible residents of Ontario. While it does cover a variety of important medical services, including doctor visits, hospital stays, and some diagnostic tests, it’s important to note that OHIP coverage for eye care is limited. As of September 1, 2023, OHIP covers the following eye care services:
- An eye exam every 12 months, plus any minor appointments for children (19 years and younger)
- An eye exam every 12 months, plus 2 follow-up appointments for adults (20 to 64 years old) who have certain medical conditions
- An eye exam every 12 months, plus 2 follow-up appointments for seniors with certain potentially sight-threatening conditions (65 years and older)
- An eye exam every 18 months, plus 2 follow-up appointments for seniors without sight-threatening conditions (65 years and older)
- Exams that are requested by your doctor for a specific reason, with a referral
Children’s Eye Exams
Routine eye exams can play an important role in healthy childhood development. The Canadian Association of Optometrists recommends that infants have their first exam between the ages of 6 and 9 months, and at least 1 exam between the ages of 2 and 5 years. These initial exams can help monitor early eye development and coordination, and screen for conditions such as amblyopia or strabismus.
Once children enter school, it’s recommended that they have yearly eye exams, which OHIP does provide coverage for. The classroom can be a visually demanding environment, and an estimated 25% of school-age children live with an undetected vision problem that is impacting their learning. During these key developmental years, it’s also more common for us to experience frequent vision changes. Given all of these factors, you can begin to understand why children’s eye care is so important.
Senior Eye Exams
It’s normal to experience vision changes as we get older. In addition to regular vision changes, seniors are also at a higher risk of developing a range of potentially vision-threatening conditions, including cataracts, glaucoma, and age-related macular degeneration. In many cases, routine eye exams play a key role in diagnosing and monitoring these conditions. Fortunately, OHIP does cover the cost of a yearly eye exam and follow-up visits for eligible seniors.
What Conditions Are Covered by OHIP for Eye Exams?
In Ontario, adults aged 20 to 64 typically aren’t covered for routine eye exams under OHIP. However, there are nine specific medical conditions or circumstances where OHIP will cover a comprehensive eye exam:
- Diabetes: Due to the risk of diabetic retinopathy, which can cause permanent vision damage.
- Glaucoma: A group of eye diseases that increase intraocular pressure and can irreversibly damage the optic nerve.
- Visually significant cataracts: Clouding of the eye’s natural lens that noticeably impairs vision.
- Progressive retinal conditions: Including retinal detachment or degeneration.
- Progressive corneal conditions: Such as corneal ulcers, infections, or trauma.
- Optic nerve disease or damage: Including conditions like optic neuritis or a stroke affecting the optic nerve.
- Active uveitis: Inflammation inside the eye that can impact vision and eye health.
- Use of specific medications: Certain drugs are known to affect the eyes and may warrant ongoing monitoring.
- Sudden onset of serious vision changes: For example, the rapid appearance of crossed eyes or other dramatic vision disturbances.
If you fall into any of these categories, OHIP covers one full eye exam annually, along with up to two follow-up partial assessments to track changes. Regardless of coverage, these conditions should always be properly evaluated by an optometrist to avoid further complications or vision loss.
What Does OHIP Not Cover?
While OHIP does cover some eye care services, it’s important to keep in mind that this coverage is not comprehensive. Perhaps most notably, OHIP does not cover the cost of any eye exams for adults (19 to 64 years old) who do not have 1 of the aforementioned medical conditions.
Regular eye exams are vital for maintaining good eye health and preventing potential vision problems at any age. Even if you don’t fall within the age groups covered by OHIP for eye exams, it’s recommended that adults aged 20 to 64 have their eyes examined at least once every 2 years.
The Importance of Comprehensive Vision Care
In most cases, OHIP only covers the cost of a basic eye exam that does not include important health screening tests such as retinal imaging or OCT scans. These advanced tests can play an essential role in diagnosing and monitoring potentially serious conditions such as glaucoma, macular degeneration, and diabetic retinopathy.
OHIP also does not cover specialty eye care services, such as corneal topography for contact lens wearers or dry eye diagnosis and therapy. While these exams may not be covered by OHIP, they can still play an essential role in your vision care.
Alternatives to OHIP Coverage
For those not covered by OHIP, it may be worthwhile to explore alternative options for eye care coverage. This may include employer benefits, private insurance, or other government programs such as the Ontario Disability Support Program or Ontario Works.
Your Eye Care Partner in Ontario
At Eye Wellness, we believe in a holistic approach to eye care that prioritizes preventive care and health education. We’re proud to offer our patients comprehensive eye care services, including eye exams for the whole family. Contact our office today to schedule your appointment.
