Are Eye Exams Covered by OHIP? A Clear Guide for Oshawa Patients

One of the most common questions patients ask when booking an eye exam in Oshawa is: “Is it covered by OHIP?” The answer depends on your age, health, and the type of exam. Understanding what’s covered can save you from unexpected costs and ensure you and your family get the care you need.

At Durham Vision Care, we make it simple by offering direct billing and helping you navigate Ontario’s OHIP coverage alongside private insurance. Here’s a clear breakdown for patients in Oshawa and the Durham Region.

OHIP Coverage for Eye Exams in Ontario

The Ontario Health Insurance Plan (OHIP) provides coverage for certain groups:

• Children and teens (0–19 years old):
  • 1 full eye exam every 12 months, plus any follow-up appointments if needed.

  • Covered because children’s vision changes rapidly, and early detection prevents future problems.

  • Learn more about children’s eye exams.

• Seniors (65 years and older):
  • 1 full eye exam every 18 months, plus two follow-up visits. A senior with diabetes, glaucoma, or retinal disease will be covered every 12 months, plus two follow-up visits.

  • Additional non-OHIP tests, like OCT, are often needed to diagnose, monitor, and manage certain eye conditions.

• Adults (20–64 years old) with certain medical conditions:
  • OHIP covers annual exams if you have specific eye-related or systemic health conditions, including:
    • Diabetes

    • Glaucoma

    • Retinal disease

    • Use of Certain medications (e.g. Hydroxychloroquine, Tamoxifen)

    • Uveitis

  • If you’re an adult with one of these conditions, OHIP will cover your comprehensive exam and two follow-ups.

Who Pays Out of Pocket?

Adults 20–64 years old without qualifying medical conditions are not covered by OHIP for routine eye exams. This means you’ll pay privately for a standard annual exam.

The good news: Most extended health insurance plans and employee benefits include coverage for eye exams. At Durham Vision Care, we direct bill most insurance providers, so you don’t have to handle paperwork or pay out of pocket upfront.

Additional Eye Care Not Covered by OHIP

Even if your exam is covered, OHIP does not cover:

• Glasses or contact lenses

• Specialty testing

• Refractive surgery consults

Durham Vision Care provides transparent pricing for any services not covered and helps patients understand their benefits.

Why Annual Eye Exams Still Matter

Even if you’re not covered under OHIP, regular eye exams are vital for:

• Detecting early signs of conditions like glaucoma and diabetes

• Monitoring prescription changes

• Ensuring optimal eye health for learning, working, and daily life

Investing in your vision is an investment in your quality of life.

FAQs About OHIP and Eye Exams in Oshawa

Is my child’s eye exam free?
Yes. OHIP covers children 0–19 for one full exam each year, plus any necessary follow-ups.

Are seniors’ exams fully covered?
Yes. Seniors 65+ are entitled to a full exam every 18 months, including two follow-up visits if needed. Some seniors are eligible for an annual exam if they have an eligible condition, including two follow-up visits if needed.

Does OHIP cover glasses or contact lenses?
No. Glasses, contact lenses, and specialty lens options are not covered.

If I’m 30 and healthy, am I covered?
No. Adults 20–64 without eligible conditions must pay privately or use extended health insurance.

What if I’m diabetic?
Adults with diabetes (any age) are covered for an annual comprehensive eye exam through OHIP, including two follow-up visits if needed.

Conclusion: Clear Eyes, Clear Coverage

Understanding OHIP coverage helps you plan for routine and preventative eye care. Whether you’re scheduling your child’s first check-up, monitoring senior eye health, or managing a medical condition, Durham Vision Care is here to guide you.

👉 Book your eye exam in Oshawa today. Our team will confirm your OHIP eligibility and handle direct billing whenever possible.