Figuring out what the Ontario Health Insurance Plan (OHIP) covers for your eye health can feel complicated. But simply put, OHIP coverage for your comprehensive eye exam depends on your age group and certain medical conditions.
Cost shouldn’t prevent you or your family from maintaining good eye health with regular eye exams. Our team can help you understand your options, whether that’s exploring your provincial health insurance, extended health benefits, or other payment options. You shouldn’t have to choose between caring for your long-term vision health and other necessities.
OHIP Eye Exam Coverage for Children and Youth
For children and teenagers, OHIP provides specific coverage to support their developing vision and catch potential issues early.
OHIP covers 1 major eye exam every 12 months for anyone 19 years old or younger. The plan also includes coverage for any necessary minor assessments that your child may need between these comprehensive eye exams.
Consistent eye exams help detect vision problems that could affect a child’s development. For example, myopia management is typically most effective the earlier it begins. Early detection through regular children’s eye exams supports your child’s ability to learn in school and engage in daily activities without difficulty.
Eye Exam Coverage for Adults Ages 20–64
For most adults in this age group, routine eye exams aren’t typically covered by OHIP. But there are important exceptions for those with certain diagnosed, active, or progressive eye or health conditions that affect eye health.
Eligible Medical Conditions
You may be covered for an annual eye exam if you have certain health conditions that require eye disease management. These can include:
- Diabetes
- Glaucoma
- Cataracts
- Retinal disease
- Corneal disease
- Optic nerve disease
- Uveitis
- Cranial nerve palsy
- If you take medications such as hydroxychloroquine, chloroquine, ethambutol, or tamoxifen (for ocular drug toxicity screening)
If you have one of these conditions, OHIP covers one major eye exam every 12 months and up to 2 follow-up minor assessments. To be eligible, the condition must be active or progressive—not stable or resolved.
OHIP Eye Exam Coverage for Seniors
OHIP provides coverage for seniors to help maintain their eye health as they age, when the risk for certain conditions, such as glaucoma, cataracts, or age-related macular degeneration, increases.
If you are 65 years of age or older and don’t have an eligible medical condition, OHIP covers 1 major eye exam every 18 months. If you have a qualifying medical condition—such as glaucoma, diabetes, macular degeneration, retinal disease, or optic nerve disease—OHIP covers one major eye exam every 12 months.
OHIP also covers up to 2 follow-up minor assessments between your major exams, regardless of whether you are on the 12-month or 18-month schedule.
Regular check-ups are critical for catching age-related eye conditions before they progress. Our professional eye care team can monitor your vision and check for signs of common eye diseases that require diagnosis and management.
What to Do if OHIP Doesn’t Cover Your Eye Exam
If you don’t qualify for OHIP coverage for a routine eye exam, you still have options for managing the cost of your eye care.
Check Your Private Insurance Plan
Many workplace or private health insurance plans include benefits for vision care. It helps to understand the difference between a basic sight test and a comprehensive eye exam when you check. These plans may cover all or part of the cost, so it’s a good idea to review your policy.
Why Regular Eye Exams Are Important for Everyone
An eye exam is much more than a simple check for glasses. It’s a key part of your overall health care and a way to protect your sight.
A comprehensive eye exam assesses the health of your entire eye. It can detect signs of eye diseases long before you notice any symptoms, which is key to effective treatment. This process may include a dilated eye exam to give the doctor a better view of the inside of your eyes. If you’re ever unsure about your coverage, check with your optometrist before your appointment.
Book an Exam with Us Today
Whether covered by OHIP or a private plan, regular eye exams are a key part of your ongoing health care. Our team at Upper Appleby Eyecare is committed to supporting your vision at every stage of life. Book your comprehensive eye exam today to get a clear view of your eye health.
