Does ohip cover eye exams

Does ohip cover eye exams

In Ontario, OHIP provides coverage for eye exams under specific circumstances. Here’s a comprehensive breakdown of OHIP coverage for eye exams:

 

1. Eye Exam Coverage for Different Age Groups

**1.1. Children and Youth (Under 19):

 

OHIP covers eye exams for children and youth under 19 years old, including regular exams and assessments by optometrists or ophthalmologists. These exams are typically covered once a year.

**1.2. Adults (19-64 Years Old):

 

For adults aged 19 to 64, routine eye exams are not covered by OHIP. Adults in this age group will need to pay out-of-pocket or use private insurance for eye exams, unless they have specific medical conditions like diabetes or eye diseases.

**1.3. Seniors (65 and Older):

 

Seniors aged 65 and older are covered for eye exams under OHIP, including regular exams and those related to vision-affecting medical conditions. Seniors can have an eye exam once a year under OHIP coverage.

2. Additional Coverage Information

**2.1. Private Insurance:

 

Many individuals have private insurance that can cover eye exams, glasses, or contact lenses not covered by OHIP.

**2.2. Vision Care Services:

 

The cost of prescription glasses or contact lenses is not covered by OHIP and is typically covered by private insurance or paid out-of-pocket.

**2.3. Optometrist and Ophthalmologist Visits:

 

Optometrists perform routine eye exams and can prescribe glasses and contact lenses, while ophthalmologists specialize in eye diseases and surgeries.

How to Access OHIP-Covered Eye Exams

1. Find a Provider:
   • Optometrists: Locate an optometrist who accepts OHIP coverage.
   • Ophthalmologists: Consult with an ophthalmologist if you have a medical condition affecting your eyes.
2. Schedule an Appointment:
   • Contact the Provider: Book an appointment with an OHIP-covered provider, specifying your need for an eye exam.
3. Provide OHIP Information:
   • Health Card: Bring your OHIP health card to the appointment for coverage verification.

Summary

• Children and Youth (Under 19): Eye exams are covered by OHIP.
• Adults (19-64 Years Old): Routine eye exams are not covered, except for specific medical conditions.
• Seniors (65 and Older): Eye exams are covered by OHIP.

For more details or to verify specific coverage, you can contact OHIP or consult with your eye care provider.