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Does OHIP Cover Eye Exams?

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A close-up image of a woman smiling during a comprehensive eye exam.

Comprehensive eye exams are a crucial part of maintaining your eye health. They give your optometrist the chance to thoroughly look at the different structures in your eye and check for all kinds of potential problems. However, for residents of Ontario, it’s important to remember that there’s often a financial side to eye care. So, does OHIP cover eye exams?

OHIP covers eye exams for some residents, but not all. The general guidelines are:

  • For residents under the age of 19, OHIP will cover 1 eye exam every 12 months
  • For residents over the age of 65, OHIP will cover 1 eye exam every 18 months
  • For residents between the age of 20-64, OHIP will cover 1 eye exam every 12 months, but only when deemed medically necessary for a diagnosed eye condition.

If you’re ever unsure about whether or not your eye exam will be covered by OHIP, contact your optometrist. They’ll be able to help!

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.

What Is OHIP?

OHIP is the Ontario Health Insurance Plan, available to most permanent residents of the province. It’s a government-run health insurance system designed to provide easy access to a wide range of healthcare services to residents with a valid OHIP card.

This plan covers services that are deemed medically necessary, allowing residents a way to gain medical care where it otherwise may be inaccessible. The standard services covered by OHIP include:

  • General visits to your primary physician
  • Emergency medical care
  • Hospital stays
  • Lab testing and diagnostics
  • Ambulance services
  • Some medications
  • Some dental surgeries

While OHIP does cover a wide range of services, it doesn’t cover anything. This insurance plan does have some limitations, making it crucial to understand what is and isn’t covered.

A close-up image of paperwork for prescription eyewear during an eye exam.

So what about eye care?

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!

Written by Dr. Ronald Nicholas Strohan

Dr. Strohan has been an integrative optometrist in the Milton, Ontario area for over 40 years and has always stayed true to his philosophy of focusing on excellent patient eye care. He has studied behavioural optometry for more than 4 decades and is passionate about providing clear vision for patients of all ages. He takes pride in offering the latest eye care products and advancements in vision therapy.
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