Eye care is critical for maintaining not only your vision but also detecting early signs of potential health issues. But does the provincial health plan OHIP (Ontario Health Insurance Plan) help with the costs? Let’s break it down.
In Ontario, OHIP covers eye exams for certain groups, like those under 20 or over 65, and for people with specific health conditions. However, routine eye exams aren’t fully covered for most adults, and you may need private insurance or pay out of pocket.
It’s always a good idea to check your eligibility and confirm what’s covered before booking an eye appointment.
Who Is Eligible for OHIP-Covered Eye Exams?
Great news for some Ontario residents! OHIP provides coverage for specific eye exams, but eligibility depends on your age or, in some cases, your medical condition.
- Children and teens aged 19 and under: Eligible for an annual OHIP-covered eye exam. Regular check-ups ensure their vision is developing correctly and school-aged kids are seeing clearly.
- Seniors aged 65 and older: Also eligible for an annual OHIP-covered eye exam. Your golden years come with plenty of perks, and your vision care is one of them.
- People with specific medical conditions: If you have a condition like diabetes, glaucoma, or cataracts, you may qualify for routine OHIP-covered eye care, even if you’re between 20—64. Certain medications may also qualify you for coverage, be sure to confirm with your eye care provider.
If you’re outside these age groups or don’t have a covered medical condition, unfortunately, OHIP doesn’t cover routine eye exams.
What Types of Eye Exams Does OHIP Cover?
OHIP isn’t just limited to general eye tests. Depending on your eligibility, it may cover additional services related to specific concerns.
- Routine eye exams: These annual check-ups assess your vision and diagnose refractive errors such as nearsightedness, farsightedness, and astigmatism.
- Eye-related conditions: OHIP may cover certain tests for people with medical conditions like diabetes or glaucoma, as these can impact eye health.
- Follow-up appointments: Concerned about symptoms like blurry vision or eye pain? Eligible patients can receive OHIP-covered follow-ups to monitor or treat particular issues.
However, specialized tests like visual field testing or retinal imaging are often not included in OHIP coverage.
How Often Can You Get an OHIP-Covered Eye Exam?
The frequency of OHIP-covered exams depends on your age and health:
- Under 20 and over 65: Once per calendar year. If you require additional visits for complications or symptoms, those might also be covered.
- Eligible medical condition (any age): The number of covered visits varies. Some conditions, like diabetes or glaucoma, might necessitate multiple visits within a year. It’s best to confirm specifics with your eye care professional.
Remember, OHIP won’t cover additional routine tests if you’ve already attended your annual exam within that year.
Does OHIP Cover Specialized Eye Care Services?

Specialized eye care often involves advanced diagnostic technologies or treatments. Unfortunately, services like these aren’t typically covered by OHIP:
- Retinal imaging: Often used to screen for eye diseases like macular degeneration, this usually falls under out-of-pocket expenses.
- Prescription eyewear consultations: Glasses and contact lenses themselves aren’t covered.
If you feel the need for specialized care, some private insurance policies may partly or completely cover these services. Check with your provider for details.
Are There Costs for Eye Exams Not Covered by OHIP?
Yes. If your visit or test doesn’t fall under the OHIP-covered criteria, you’ll need to pay out of pocket. Additional examinations, like contact lens fittings or imaging tests, may have added costs.
What to Expect During an OHIP-Covered Eye Exam
For eligible patients, the process is simple. You’ll need your Ontario health card when visiting the optometrist. Here’s what typically happens during your appointment:
- Vision check: The optometrist will assess your ability to see clearly at different distances.
- Health assessment: They’ll check for warning signs of conditions like cataracts, macular degeneration, or glaucoma.
- Discussion: Your optometrist might inquire about your lifestyle or family history to create a more individualized care plan.
OHIP Coverage for Eye Emergencies
Experiencing a sudden change in vision, eye injury, or swelling? OHIP often covers emergency eye care visits. Whether it’s an unexpected eye infection or retinal issue, urgent care at your optometrist or an ophthalmologist should be covered, no matter your age.
If it feels like an emergency, don’t delay. Reach out to White Oaks Optometry and ask if OHIP covers your concern.
How to Check If Your Eye Exam Is Covered by OHIP
Before you book, double-check that your exam qualifies for OHIP coverage. Here’s how:
- Ask your optometrist: Optometrists in Ontario are well-versed in what OHIP covers and will confirm before scheduling your appointment.
- Contact OHIP directly: You can contact ServiceOntario for clarification on your coverage.
- Check your health card: Make sure your OHIP coverage is active, typically, this means ensuring your health card is valid and up to date.
Why Regular Eye Exams Are Important, With or Without OHIP
Even if you’re not covered by OHIP, regular eye exams are an investment in your well-being. Did you know that many eye diseases show no symptoms in their early stages? Routine check-ups ensure that any potential issues are caught early, giving you the best chance to maintain healthy vision.
Besides protecting your eyesight, visits to an optometrist can reveal other health concerns. For example, high blood pressure and diabetes can often be detected through eye exams.If OHIP doesn’t cover your exam, consider private insurance, workplace benefits, or saving up for an annual visit. It’s a small price to pay for healthy vision. If you have any more questions about OHIP or your eye health, book an appointment with White Oaks Optometry.