Does OHIP Cover Eye Exams?

Why Are Regular Eye Exams So Important?

When you think about eye exams, you probably recall the eye chart on the wall, and flipping through different lenses to find out which one is clearer. Maybe your optometrist shines a light in your eye or checks your peripheral vision. These are all crucial parts of an eye exam, but they’re just one piece of the puzzle.

Eye exams aren’t just about finding your new prescription—though that is an extremely important part of it. These exams give a trained professional the chance to examine your eyes in depth, checking for all kinds of potential problems.

Your optometrist will be looking for signs of:

• Vision changes
• Glaucoma
• Cataracts
• Macular degeneration
• Diabetic retinopathy
• Retinal detachment
• Optic nerve damage
• General health conditions such as high blood pressure and diabetes

These problems can all develop gradually, and without early intervention, they can cause long-term damage to your vision. That’s why these exams are so important—your optometrist can look for these indications and help you make a plan to preserve your vision.

How Much Do Eye Exams Cost In Ontario?

You might find yourself wondering—how much does a standard eye exam cost? This can vary depending on a few factors, including:

• Your location
• The optometrist’s experience
• Whether additional tests are needed

In Ontario, a regular eye exam can cost anywhere between $80-250. However, this cost doesn’t include the fee for new glasses, additional testing, replacement contacts, or any other regular add-ons.

It’s always crucial to check with your optometrist to discuss specific pricing, and whether or not you’ll likely need additional testing. During this conversation, you’ll also be able to ask about OHIP.

When Does OHIP Cover Eye Exam?

When it comes to eye health, OHIP provides coverage for eye exams under specific conditions—mostly based on age and medical necessity. Typically, OHIP only covers eye exams for:

• Ontario residents under the age of 19: OHIP covers a full eye examination once every 12 months plus any minor follow-up assessments if necessary.
• Seniors over the age of 65: OHIP covers a full eye examination once every 18 months, alongside 2 follow-up assessments if necessary.
• For adults between the age of 20-64: It becomes a little more complicated.

OHIP & Eye Exams

For most adults in Ontario, OHIP does not cover eye exams; you’ll need to pay out-of-pocket when visiting your optometrist. However, there are some exceptions.

If you have an eligible health condition that requires the monitoring of your eye health, then OHIP will cover 1 eye exam every 12 months, alongside 2 follow-up assessments when necessary. The eligible conditions include, but are not limited to:

• Diabetes, due to how diabetes damages the blood vessels at the back of the eye.
• Glaucoma, and most related treatments.
• Cataracts, once they impair your visual acuity.
• Retinal disease or detachment.
• Uveitis, where the middle layer of your eye becomes inflamed.
• Damage to the optic nerve.
• Nerve damage that results in damage to the eyes or surrounding systems.

If you’re not sure whether your health condition qualifies for OHIP coverage, it helps to contact your optometrist. They can explain what conditions are covered and whether this exception would apply to you.

Take Care of Your Eye Health

At Milton Eye and Vision Care, we’re dedicated to helping you take care of your vision. That’s why we offer comprehensive eye exams to help catch potential problems early on. Our team of experienced eye care professionals is here for you, so book an appointment with us today!