Our vision and eye health are incredibly important in every stage of life, but seniors in particular often require support from an optometrist or ophthalmologist as they deal with age-related eye issues. It’s important to stay on top of all medical appointments, but unlike your family physician, eye care isn’t always covered by OHIP—and soon, even less coverage will be available through the provincial insurance plan.
As CBC reported earlier this year, “As of Sept. 1, people aged 65 and older will be covered for one eye exam every 18 months, instead of one a year, unless they have a condition affecting their eyes such as macular degeneration, glaucoma or diabetes.”
What’s currently covered?
This document from the Government of Ontario details the current eye care coverage rules, though as noted above, these guidelines will change on September 1st, 2023. Here’s a brief summary:
- Routine eye examinations are not covered by OHIP unless you are under the age of 20 or over the age of 64.
- Children and seniors (defined above) have OHIP coverage for one eye exam every 12 months.
- Individuals with qualifying medical conditions (cataracts or retinal disease, for example) typically qualify for additional eye care coverage.
The provincial government has made significant changes that will come into play later this year. Here’s how the changes taking effect on September 1, 2023 will impact eye care cover for seniors and other Ontario residents.
- Children and seniors (defined above) will have OHIP coverage for one eye exam every 18 months. All other eye exams will require payment to your optometrist.
- However, if you have a qualifying medical condition (for example, diabetes, macular degeneration or glaucoma) you will still qualify for a fully covered routine eye exam every 12 months. Ask your eye doctor if your conditions qualify.
- Individuals with cataracts will not qualify unless they are deemed as having "clinically significant decreased vision that impacts their daily life" or if a surgery referral has been made.
- Individuals with retinal disease, corneal disease and optic pathway disease will only qualify for additional coverage if their cases are considered active.
- Having strabismus, also known as a “lazy eye” no longer qualifies you for additional coverage.
We recommend speaking to your optometrist directly if you have more specific questions about your eye health, how often you should see an eye care professional or what’s covered (now and in future) by OHIP.
Contact us to learn more about in-home care
We hope this information has been helpful to you and perhaps inspires you to book an eye care appointment for yourself or an aging loved one. If you’d like to learn more about in-home caregivers services in the greater Toronto area, please contact us. We’d be pleased to answer your questions, provide a personalized consultation and offer a quote for caregiver services. Thanks for reading and take care!