As the season starts to change so too is OHIP coverage for eye exams. Beginning September 1, 2023, there are some new rules on what OHIP covers for eye exams in Ontario. These changes are the result of mutual discussions between the Ontario Ministry of Health and the Ontario Association of Optometrists.
What has not changed is coverage being grouped by age. These groups are individuals under age 19, those between 20-24 and those over 65. Each age group has their own rules for coverage.
Ages 0-19 OHIP Covereage
Great news! OHIP coverage for eye examinations remains the same for this age group after September 1, 2023.
Individuals 19 years and younger continue to be eligible for an OHIP-insured comprehensive eye examination once per year. And unlimited partial examinations.
Annual eye exams for this age group are critical to make sure kids have the vision skills and eyesight to be successful in school, sports and life! We love working with young people and helping them see their best.
Ages 20-64 OHIP Coverage
More great news! Beginning September 1, 2023, an individual aged 20 to 64 with a potentially sight-threatening condition is eligible for an OHIP-insured comprehensive eye examination once per year. And two OHIP-insured follow up visits to monitor their condition.
Examples of sight-threatening conditions include Diabetes, Glaucoma, Cataracts, Macular Degeneration and certain prescribed medications.
Most eye diseases are silent and painless. Regularly scheduled eye examinations with the latest imaging technology helps to detect problems at the earliest stage and potentially prevent permanent vision loss.
Ages 20-64 OHIP Non-Coverage
Research has shown that eye conditions such as strabismus (crossed-eyes) and amblyopia (lazy eye) remain stable after childhood. Routine monitoring does not change how these conditions affect vision. These individuals are no longer eligible for OHIP-insured eye examinations as of September 1, 2023.
Ages 65 and Older Coverage
Individuals over 65 are covered but eligibility is determined by their eye health. This age group is where things can get a little confusing.
If a person over 65 has a potentially sight-threatening condition (the same conditions that are covered for ages 20-64) they are eligible for an OHIP-insured comprehensive eye examination once per year. And two OHIP-insured follow up visits to monitor their condition.
As was mentioned earlier, examples of sight-threatening conditions include Diabetes, Glaucoma, Cataracts, Macular Degeneration and certain prescribed medications.
Beginning September 1, 2023, patients aged 65 and over with healthy eyes and no sight-threatening conditions are covered by OHIP every 18 months for comprehensive eye examinations.
It is important to remember for any patient there is the option to pay privately for services not funded by OHIP at any time.
Change often triggers confusion and can be uncomfortable, hopefully, with a little more information and explanation these OHIP changes will be smooth sailing for all of us.
When in doubt, ask questions. We love helping our local community with all their eye care needs. We look forward to many years of providing services and adapting to changes!