Key Takeaways
- OHIP covers 1 major eye exam every 12 months for children and youth 19 and under.
- Adults 65+ can get 1 major eye exam every 18 months, plus 2 follow-up minor assessments.
- Adults 20 to 64 may qualify for coverage if they have an eligible medical condition, such as diabetes or glaucoma.
- Glasses, contact lenses, and routine exams for adults 20 to 64 without an eligible condition fall outside OHIP.
- You should always check your individual plan or ask your optometry team about what you may be eligible for.
You booked a checkup for your child, and now you’re wondering if your own eye exam comes with a bill. It’s a fair question, and the team at Woodstock Vision Care hears it often from families across the area, because OHIP rules change with your age and health.
OHIP covers eye exams for children and youth 19 and under, adults 65+, and adults 20 to 64 with eligible medical conditions, while generally healthy adults usually pay out of pocket or with insurance. Knowing where you fit can help you plan for your visit.
Who Qualifies for OHIP-Covered Eye Exams?
Children and Youth 19 and Under
If your child is 19 or younger, OHIP covers 1 major eye exam every 12 months.
Any minor assessments your child needs are covered too, so a quick follow-up visit for a new concern may not add to your costs. Bring your child’s health card when you visit your Woodstock optometrist.
Adults 65+
Once you turn 65, OHIP covers 1 major eye exam every 18 months. You also get 2 follow-up minor assessments between those exams.
If you have an eligible condition, you can have an exam every 12 months instead.
Adults 20 to 64 with Eligible Conditions
Adults in this age group usually pay for their own exams. However, if you have an eligible medical condition, OHIP covers 1 major eye exam every 12 months and 2 follow-up minor assessments.
If you receive support through the Ontario Disability Support Program or Ontario Works, you may have access to extra coverage.
Which Medical Conditions Qualify for Coverage?
Common Eligible Conditions
Several medical conditions can qualify you for an OHIP-covered eye exam, including the following:
- Diabetes, glaucoma, and certain levels of cataracts often qualify for coverage.
- Retinal disease, corneal disease, and optic pathway disease may qualify as well.
- Recurrent uveitis, amblyopia, and strabismus are usually included.
What Does OHIP Not Cover for Eye Care?
Common Costs Outside OHIP
Even with OHIP, a few eye care costs come out of your own pocket:
- Routine eye exams for adults 20 to 64 without an eligible condition aren’t covered.
- Glasses and contact lenses are paid for separately.
- Purchases from the optical boutique and in-house lab are paid for separately.
- Additional testing your optometrist may recommend to properly assess, monitor, or manage your eye condition.
What About Cataract Surgery?
OHIP covers medically necessary cataract surgery. However, if you choose an upgraded lens to reduce how often you reach for your glasses, you may pay for that lens yourself.
Related testing for upgraded lenses usually also falls outside OHIP.
How Much Does an Eye Exam Cost in Ontario?
Typical Out-of-Pocket Costs
The average eye exam cost in Canada varies by clinic. If you’re an adult without OHIP coverage, talking to your eye care provider about what costs to expect can be a good starting point.
Other Ways to Help with Costs
You may have more support than you expect, so check these options before your visit:
- Workplace benefits sometimes include vision coverage.
- Private health plans may cover part of your exam.
- Some plans also help with glasses and contact lenses.
Why Regular Eye Exams Matter for Your Family
Eye Exams for Kids
A child who squints at the whiteboard or misses a passed ball at recess may have a vision problem. An eye exam can spot these issues before they affect school and play.
If your child is nearsighted, myopia control may be a good option and tends to work well when started early.
Eye Exams for Adults
An eye exam does more than update your prescription, and it can help you in several ways:
- The eye doctor can detect signs of eye diseases like glaucoma early and recommend management options to preserve your remaining sight.
- Your eyes can reveal signs of health conditions like high blood pressure or diabetes.
- The eye doctor can flag concerns and help guide you through next steps.
Local Eye Care in Woodstock
If you’re looking for eye care in Woodstock, we’re excited to welcome you. Woodstock Vision Care offers exams for all ages, so you can book your child’s checkup and your own in one place. Whether OHIP, your workplace plan, or your own budget covers your visit, our team at Woodstock Vision Care can walk you through your options. Book your appointment online today and let us support your family’s vision.
