Key Takeaways
- Routine eye exams are generally covered for patients 19 and under and many seniors aged 65 and older.
- Adults aged 20–64 are typically only eligible for coverage if they are managing ongoing specific medical conditions.
- Vision correction options, such as prescription glasses and contact lenses, may require private payment or insurance.
Provincial Vision Coverage Details
When you or someone you love is experiencing vision changes, the last thing you want to factor into your appointment is the cost. At Durham Vision Care, our team knows you want to take care of your family’s vision, which is why we want to help you understand what OHIP may cover for you and your family.
Children, seniors, and adults with certain medical conditions may qualify for OHIP-covered eye exams, while routine exams for healthy adults aged 20–64 typically require out-of-pocket payment or insurance.
OHIP for Children and Youth
Children are growing quickly, and so are their eyes. During their growing years, their eyesight can shift rapidly, sometimes without them even noticing, which can impact their confidence and learning in school. That’s why eye exams are so important for kids: They can help detect signs of things like myopia so that they can get back to thriving in the classroom.
OHIP covers 1 routine eye exam for children 19 and under once a year, so you can support their sight in and out of school.
Signs Your Child May Need an Eye Exam
Kids sometimes assume that everyone sees the world the way they do, so they won’t tell you they have blurry vision. You know your child better than anyone, so keep an eye out for these signs that they might benefit from an eye exam:
- Frequent squinting or sitting very close to the TV.
- Holding books very close to their face.
- Complaints about headaches or rubbing their eyes often.
Medical Conditions That Can Qualify Adults
If you’re a healthy adult between the ages of 20 and 64, you may need to pay out of pocket or through your work’s insurance plan for eye care.
OHIP may cover eye exams for eligible medical conditions, with frequency depending on the condition and the need. If you do have an ongoing medical condition, it’s important to go to your eye exams. Our team provides testing to help detect signs of damage before they progress, supporting your long-term vision health.
Common Eligible Health Conditions
Certain health conditions may qualify you for covered eye examinations. This could include:
- Diabetes, which can damage the tiny blood vessels inside your eyes, possibly causing complications.
- Glaucoma, which often has no signs in the early stages and can affect your side vision.
- Cataracts, when they affect vision and require monitoring or surgical planning.
Eye Exam Support for Seniors
If you’re over the age of 65, OHIP may cover routine eye exams. This is important because as you age, your risk of diseases such as age-related macular degeneration, glaucoma, and other eye conditions increases. Detecting these problems early is key because treatment is often more effective in the early stages.
Eye Exam Frequency for Seniors
Your eye doctor can tailor an eye exam schedule to your life and health to help provide the care you need. Otherwise, many eye care professionals recommend regular eye exams for those over 65 to help detect issues early.
Services and Items Excluded from OHIP
If you are covered under OHIP, that coverage does not extend to things like glasses or contact lenses. If you need vision correction, you may need to pay out of pocket or through private insurance.
Our team at Durham Vision Care can help you find the right glasses for your face shape and lifestyle, or get you fitted for contact lenses. If you’re looking for a long-term vision correction option, we can also provide laser eye surgery consultations, which can be a great option if you don’t want to rely as much on glasses or contacts.
Options to Manage Eye Exam Costs
Many of our patients use workplace benefits to cover the cost of eye exams. We also provide direct billing to many major insurance providers, so that you can focus on your eye health. We always recommend double-checking your insurance plan to see what you’re covered for.
Schedule Your Eye Exam
Our staff at Durham Vision Care is here to help you understand OHIP, your benefits, and your options before your appointment begins. Whether you’re looking for an eye exam or just wanting to update your frames, we’d love to see you. Book your next visit today.