Regular comprehensive eye exams are important to maintaining good eye health. They help your optometrist monitor your vision health and potentially detect many eye diseases in their early stages before they can cause too much damage.
But the cost of these exams can be a concern for many people. The Ontario Health Insurance Plan (OHIP) covers a range of medical services, including eye exams for seniors, children, and people with eligible medical conditions.
The Importance of Regular Eye Exams
Our eyesight is one of the most precious things we have, yet it’s often taken for granted. We use and strain our eyes daily, whether for work or leisure, and we must take care of them. Regular eye exams are one of the most effective ways to maintain good eye health.
Many eye diseases, such as glaucoma and age-related macular degeneration, don’t have any noticeable symptoms until they have already progressed to the point where vision loss may be permanent. An eye exam can catch early signs of these diseases, allowing for early intervention. Typically, the earlier a problem is detected, the better the chance for successful treatment.
Our eyesight can also change over time, and an eye exam is an effective tool for detecting these changes. Regularly checking your vision allows your optometrist to update your prescription lenses if necessary.
Children’s eyes are still developing, and it’s crucial to identify any vision problems early on. Vision problems can lead to learning difficulties and other developmental issues if left untreated. Children should have their first eye exam around 6 months, then another between 2–5 before starting school. After that, bring your child in for an eye exam annually.
What Does OHIP Cover?
The Ontario Government has recently changed its coverage for eye conditions, increasing access to care for vulnerable seniors and people with chronic medical conditions. Children’s eye exam coverage hasn’t changed, but it’s still a good idea to familiarize yourself with what OHIP offers.
Children & Youth
If you have a child who is 19 years old or younger, they’re eligible for 1 full eye exam every 12 months. This includes vision and general eye health check-ups.
OHIP also covers any minor assessments that your child may need. This can include a check-up assessing a single ocular condition present during a previous eye exam or advice offered to your child.
Adults with Eligible Medical Conditions
If you are between the ages of 20 and 64 and have an eligible medical condition that affects your eyes, OHIP will cover 1 full eye exam every 12 months and 2 additional follow-up minor assessments.
Some medical conditions need to be acute or chronically progressive for OHIP to cover your eye exams. If you’re ever in doubt, talk to your optometrist. They can help you understand your condition’s severity and how it relates to OHIP coverage. The eligible medical conditions include:
- Diabetes mellitus
- Glaucoma that requires treatment
- Cataracts that significantly impact vision which can include cataract surgery
- Retinal disease
- Optic pathway disease
- Acquired cranial nerve palsy resulting in strabismus
- Ocular drug toxicity screening for patients taking hydroxychloroquine, chloroquine, ethambutol, or tamoxifen
OHIP can also cover medically necessary surgeries for some of these eligible conditions. However, if the surgery is considered elective, you’ll likely have to pay out of pocket.
If you are 65 years or older and do not have an eligible medical condition that affects your eyes, OHIP will cover the following services:
- 1 full eye exam every 18 months
- 2 additional follow-up minor assessments
However, seniors with an eligible medical condition, as mentioned above, can instead receive 1 full eye exam every 12 months in addition to their 2 minor assessments.
Who is Covered Under OHIP?
You’ll need to apply for OHIP coverage. If approved, you’ll get an Ontario health card, proving you’re covered under this plan. To be eligible for OHIP, you must meet the minimum qualifications and at least 1 of the additional requirements.
First off, to meet the minimum requirements for OHIP, you need to:
- Spend at least 153 days in Ontario during any 12-month period
- Be physically in Ontario for a minimum of 153 days within the first 183 days after you move to the province
- Make Ontario your primary place of residence
Once you’ve covered those, you must meet at least 1 of these additional criteria. You could:
- Be a Canadian citizen
- Be an Indigenous person registered under the federal Indian Act
- Hold the status of a permanent resident or be currently applying for it
- Hold a valid work permit
- Be a refugee
- Have a Temporary Resident Permit
- Be a clergy member
Book Your Next Eye Exam
Eye exams are an important part of maintaining good eye health; in many cases, OHIP can cover these exams. We cannot overstate the benefits of early detection and treatment of eye problems. Even if OHIP doesn’t cover your exam, Toronto Centre Eye Care accepts many different types of coverage and can help you understand what your benefits can do for you.Whether you’re due for an annual check-up or haven’t had an eye exam in a while, book your appointment today. Your eye health is too important to neglect!