OHIP Coverage for Eye Care Services
Eye Care Services Not Covered
Routine eye examinations provided by either an optometrist or physician, for patients aged 20 to 64, are not covered by OHIP. These individuals are responsible for payment for these examinations or have the cost covered by private insurance.
However, under the Ministry of Community and Social Services (MCSS), persons receiving assistance through the Ontario Disability Support Program, Ontario Works, or the Family Benefits Program will receive coverage for routine eye examinations once every two years. If you have any questions about the coverage provided under these programs, please call Client Services at MCSS at 1 888 789-4199 (toll free) or 416 325-5666 (Toronto) or 1 800 387-5559 (TTY).
Eye Care Services Covered
- People 65 years and older and those younger than 20, are covered by OHIP for a routine eye examination provided by either an optometrist or physician once every 12 months plus any follow-up assessments that may be required.
- Specified ophthalmology services for patients of any age with specified medical conditions or diseases affecting the eyes are insured.
- Insured persons aged 20 to 64 years with specified medical conditions affecting the eye can receive an OHIP insured regular eye examination once every 12 months.
- Insured persons aged 20 to 64 with any of the following conditions can go directly to their optometrist or physician to receive an OHIP insured eye examination: diabetes mellitus, glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal disease, strabismus, recurrent uveitis or optic pathway disease.
- Insured persons aged 20 to 64 who have certain medical conditions not listed above may also be covered for regular eye examinations. They should discuss this with their primary health care provider.
Frequently Asked Questions
Are insured persons between 20 and 64 exempt from paying for eye examinations if they have certain specific medical conditions?
Patients aged 20 to 64 years who have any of the following medical conditions can go to their optometrist or physician and receive an OHIP insured eye examination once every 12 months : diabetes mellitus, glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal disease, strabismus, recurrent uveitis or optic pathway disease.
I am 71 and have glaucoma. Does OHIP still cover my eye examinations?
Yes. OHIP covers one eye examination every 12 months for insured persons 65 years and older, provided by either an optometrist or physician. Any follow-up assessments that may be required are also covered.
Do persons aged 20 to 64 with other medical conditions that may affect their eyes need to get a physician referral in order to see their optometrist now?
Insured persons aged 20 to 64 who have conditions not listed above may also be covered by OHIP for a regular eye examination.
They should discuss this with their primary health care provider (e.g. family doctor or nurse practitioner). If their primary care provider determines they have a medical condition that requires regular monitoring, a requisition will be provided where appropriate for an OHIP covered eye examination. A requisition is valid for up to five years.
I am 52 and have diabetes. How often will OHIP pay for me to see my eye care physician or optometrist?
OHIP pays for you to have one regular eye examination every 12 months. OHIP also covers any related follow-up assessments you require before you have your next major eye examination.
How much will routine optometry eye examinations cost for people who are not covered by OHIP? Will the cost be regulated?
The optometrist determines patient fees. The ministry does not regulate these fees.
If you have any questions regarding eye care services that you have been charged for please contact: Ministry of Health and Long-Term Care at 613 536-3103 (collect calls are accepted) or toll-free at 1 888 662-6613.
April 2013, Reference Number 018198