With the new year here, it’s a perfect time to think about your eye health — and whether you’re due for an exam. But when it comes to paying for eye care in Ontario, the rules aren’t always straightforward. Below is a simple guide to help you understand who gets coverage under OHIP and when a private exam may be needed.
Who Is Covered by OHIP for Eye Exams
Children and youth (19 and under)
OHIP covers one comprehensive eye exam every 12 months, plus any follow-up or minor assessments that are medically necessary.
This means regular eye checks for kids and teens are fully covered, making the new year a good reminder to book their annual visit.
Adults (age 20–64) with certain eye-related or medical conditions
If you have a qualifying condition, such as diabetes, glaucoma, cataracts, retinal disease, corneal disease, etc., OHIP will cover a comprehensive eye exam every 12 months.
Seniors (65 and older)
OHIP provides coverage for major eye exams for those 65+, even without an existing eye disease or condition. Up to two follow-up assessments may also be covered.
Coverage renewal varies from 12- to 18-months, depending on certain health-related criteria. These include diabetes, glaucoma, macular degeneration, and some others.
When You Likely Need to Use a Private Insurance Plan
If you are between 20 and 64 years old and do not have a qualifying eye or medical condition, OHIP does not cover routine eye exams.
Also, even when your exam is covered under OHIP, eyeglasses or contact lenses are not covered — those remain out-of-pocket or through private vision insurance, regardless of age.
Many working adults fall into this group, which is why private insurance (for example, through employer benefit plans) plays an important role in helping cover regular vision care.
Why We Still Need Your Health Card Number, Even If You’re Not Eligible
Whether your eye exam is OHIP-insured or privately paid, we ask all patients for their Ontario health card number. This isn’t for billing, but rather because your health card is how we accurately communicate with other healthcare providers.
If we need to send a report to your family doctor, coordinate with a specialist, or share diagnostic findings, your health card number ensures your information is matched correctly within Ontario’s healthcare system.
It’s one of the simplest ways to keep your care coordinated and seamless.
Why Regular Exams Matter, Even If They Aren’t Covered
Eye health can change over time: issues like early glaucoma or retinal changes often show up before you notice symptoms. A regular exam helps catch them early, which is critical for preventing long-term damage.
For adults without coverage, a yearly or bi-yearly private exam helps ensure your vision correction stays up to date (glasses or contact lens prescription), and lets you address lifestyle-related eye strain or vision changes as you age.
Even if you feel your vision is fine, an eye exam can detect health issues — high blood pressure, diabetes-related retinal changes, or age-related eye conditions — before they become serious problems.
How Often Should You Get an Eye Exam — A Practical Recommendation
Based on what we know about eye health, risk factors, and OHIP coverage, here’s a simple guideline:
Kids & Teens (≤ 19): Every 12 months (covered)
Adults 20–64:
- If you have a diagnosed eye condition → Every 12 months (OHIP-covered)
- If you have no existing condition → Approximately every 1–2 years (private exam)
Seniors (65+): At least every 18–24 months (or more often if eye issues develop; OHIP-covered)
If you’re not sure whether you qualify for OHIP coverage — or when your last exam was — give us a call. We’ll check for you.
What You Should Know Before Booking an Exam
Bring your Ontario health card — required if you hope to claim OHIP coverage. Let us know your age and any known eye/health conditions — this helps us determine eligibility. Even if you’re covered, you may still want extra services (e.g., retinal scans, contact lens fitting, eyewear), and know that glasses/contacts are not covered by OHIP.
Final Thoughts for the New Year
Starting 2026 with a clear understanding of your coverage and eyecare needs can make a big difference, especially if vision changes sneak up slowly. If you’re unsure whether you’re due for an exam, or want to explore contact lens or glasses options under private coverage, please don’t hesitate to ask.
If you are in the Halton/Burlington area, contact us to book your eye exam at our clinic — together, we’ll make sure your vision stays healthy this year and beyond.
