If you live in Ontario, chances are you or someone you know has an Ontario Health Card and is enrolled in the Ontario Health Insurance Plan (OHIP) — Ontario’s government-run health plan that covers most basic and emergency health care services.

OHIP covers eye exams for specific age brackets. But what other optometrist services are or are not covered under the plan? Here, we will go over some of the basics.

Does OHIP Cover Eye Exams?

For some patients in certain age groups, it does, although there are some optometrist services that OHIP may not cover for everyone. According to the Ontario Association of Optometrists, these plans cover the following eye care services:

– Children 0 to 19 years old: An annual, full comprehensive eye examination plus any follow-up assessments that may be required.
– Seniors aged 65 +: An annual, full comprehensive eye examination plus any follow-up assessments that may be required.
– Adults aged 20 to 64 years: OHIP does not cover comprehensive eye examinations for this age group. These individuals have private insurance coverage or pay out-of-pocket.”

When Does OHIP Cover Eye Exams?

OHIP covers comprehensive eye exams for patients once a year. Any extra eye exams during the same year usually need the patient to pay out-of-pocket or through their private insurance. While comprehensive eye exams are covered once a year for seniors and those 19 years old and younger, a few optometrist services are not covered. Those services usually include:

– Contact lens fitting exams and progress checks are also typically not covered.
– Some eye tests like retinal imaging (retinal photography, ocular coherence tomography) are also not usually covered.
– Low vision aids
– Vision Therapy (Eye coordination exercises)
– Medications to manage diseases of the eye and surrounding tissues.

Does OHIP Cover Eyeglasses?

No, OHIP does not cover the cost of corrective vision, including eyeglasses. A few items also not covered under these plans include:

– Laser refractive surgery co-management (pre- and post-operative) visits
– Eyeglasses
– Contact lenses

While OHIP is limited in what it will and will not cover, there are some exceptions to OHIP coverage that may apply to individual patients depending on the medical condition. It is essential to speak to an optometrist if you qualify for exemptions within the OHIP plan. For more about OHIP, eye exams and coverage for optometrist services, contact our eye specialists today.