Figuring out what is and isn’t covered by the Ontario Health Insurance Plan (OHIP) can feel a bit daunting. When it comes to your eyes, you might wonder if your next visit to the eye doctor is “on the province.”
OHIP provides coverage for eye exams based on your age and specific medical conditions you may have. But eye examinations are essential for maintaining good eye health, so people of all ages should have regular visits to see their eye doctor, which makes it helpful to know where you fit in to understand your coverage.
Whose Eye Examinations Does OHIP Cover?
OHIP eye examination coverage mostly depends on your age group. But there are also exceptions to the coverage for specific medical conditions that can affect your eligibility for more or less provincial coverage.
Children and Youth 19 Years and Younger
If you’re 19 years old or younger, OHIP covers 1 major eye examination every 12 months. It also covers minor follow-up assessments that may be needed. This frequency helps support healthy vision from a young age.
Adults Aged 20–64
OHIP typically doesn’t cover eye examinations in this age range. But there are exceptions, and coverage is available if you have a specific medical condition that affects your eye health. With eligible conditions, you should qualify for 1 major examination every 12 months with up to 2 follow-up assessments.
Seniors Aged 65 and Older
Once you turn 65, OHIP covers 1 major eye examination every 18 months with 2 additional follow-up assessments. But if a senior has an eligible condition, this coverage increases to an annual examination instead.
Specific Medical Conditions
If you’re in one of the grey areas of coverage that depend on having a medical condition, your eye doctor can help determine if you’re eligible for increased coverage. Some of these conditions include:
- Diabetes
- Glaucoma
- Cataracts
- Retinal disease
- Corneal disease
- Acute or chronic uveitis
- Optic pathway disease
- Cranial nerve palsy
- Drug toxicity screening (hydroxychloroquine, chloroquine, ethambutol, tamoxifen)
What OHIP Doesn’t Cover
It’s just as important to know what isn’t covered so you can plan for your visit. OHIP doesn’t pay for everything related to your eye health. Being prepared for these costs can help you manage your eye care budget. While OHIP may cover eye emergencies assessed by a family doctor, urgent care clinic, or emergency department, these services are not always insured when provided by an optometrist.
Routine Eye Examinations for Most Adults
If you are 20–64 and do not have an eligible medical condition, OHIP won’t cover your regular eye check-up. But many private insurance plans or extended health benefits through work can help with these costs. Check your plan to see what it includes.
Eyeglasses and Contact Lenses
OHIP doesn’t cover the cost of prescription glasses or contact lenses; this applies regardless of your age or medical condition. This limitation also applies to services such as contact lens fittings and adjustments. These are considered out-of-pocket expenses.
Eye Health Scans and Additional Testing
Your eye doctor may recommend additional tests to get a more detailed look at your eye health. These types of scans often use innovative imaging technology, such as optical coherence tomography (OCT), to get a closer look at the structures inside your eye. These particular tests are typically not covered by OHIP. OHIP also has limits on how often certain insured services can be performed within a benefit period.
The Value of a Full Eye Examination
A comprehensive eye examination does more than just check your vision; it’s a key part of your overall health care. Your eye doctor checks for eye diseases that often have no early symptoms. They can even spot signs of other health issues in your body.
Book Your Next Eye Examination Today
Even if your examination isn’t covered by OHIP, investing in regular eye care is a way to protect your vision and overall health. An experienced eye doctor in London can provide a thorough check-up to give you peace of mind.
Our team at Westmount Optometrists is here to help you with your eye health questions. Contact our team today and book an appointment for your next eye examination.
