Many of our patients wonder about the cost of getting an eye exam in Alberta and where coverage comes into play.
Government Funded Programs
The Alberta Health Care Insurance Plan (AHCIP) includes coverage for annual eye exams for eligible groups. You must be registered with AHCIP and have a personal health card to be able to take advantage of this coverage for vision care.
This program covers a range of services, including a comprehensive eye exam, which includes testing for visual acuity, eye health, and eye diseases. Coverage may also be provided for specific medically necessary procedures and treatments, as determined by your eye doctor.
Accessing the program is typically easy and straightforward. All you need to do is book an appointment with a participating eye care provider, such as our team, who will bill the vision care coverage directly for the cost of the exam. You can find a list of participating providers on the Alberta Health Services website.
So, who is eligible for a free annual eye exam through this program?
For children under 18 and seniors aged 65 and older, Alberta Health covers one eye exam per year, but an additional routine exam may be covered if the optometrist deems it necessary. This coverage includes routine eye exams, partial exams, and diagnostic procedures. Routine eye exams involve multiple vision tests, while partial exams focus on key tests. Diagnostic procedures are aimed at identifying specific eye conditions.
Unfortunately, Alberta Health does not cover eye exams for adults aged 19-64, except for medically necessary exams and eye health emergencies. This means that individuals in this age group are responsible for the cost of their eye exams. However, there are alternative options for obtaining coverage.
Kids’ Eye Exams Under 18
Are you wondering whether your child’s eye exam is covered under Alberta’s health care system? The good news is that children under the age of 18 are eligible for eye exam coverage in Alberta.
Early detection and treatment of vision problems are crucial for every child’s health and academic success. Eye exams can help detect a range of eye conditions, including myopia, amblyopia, and other childhood eye conditions.
Albertans under 18 are eligible for one routine eye exam, one partial exam, and one diagnostic procedure per year. These comprehensive exams help detect any visual issues or potential diseases early on. Additional exams and treatments may be covered based on medical needs or as deemed necessary by the optometrist.
It’s important to note that while the exam itself is covered, additional services such as glasses or contact lenses may not be covered under AHCIP. However, there are other private insurance plans and government programs, such as the Alberta Child Health Benefit (ACHB), that can provide financial assistance for these services.
Eye Exams for Seniors (Age 65 and older)
Similar to children, seniors aged 65 and older in Alberta are eligible for one complete eye exam, one partial exam, and one diagnostic procedure per year. Medically necessary exams and eye health emergencies are also covered by Alberta Health.
Additional Benefits for Low to Moderate-Income Seniors
Seniors with low to moderate incomes may qualify for additional benefits through the Dental and Optical Assistance for Seniors Program. This program provides financial assistance of up to $230 every 3 years for corrective eyeglasses (frames and lenses) or contact lenses.
All Albertans with AHCIP, regardless of age, are eligible for emergency or urgent eye care for ocular infections, injuries or sudden changes to their vision.
Understanding Emergency or Urgent Eye Care
Alberta Health Care covers exams and services related to eye diseases, medical conditions, or trauma. This includes coverage for eye or eyelid infections, retinal examinations for diabetic patients, and treatment for chronic eye diseases like glaucoma. It is advisable to check with your optometrist regarding any additional fees associated with these appointments.
In terms of urgent eye care, Alberta Health Care covers conditions such as eye infections, injuries, inflammations, foreign objects in the eyes, and sudden changes in vision. Monitoring for diabetes issues, glaucoma, and retinal diseases, as well as post-operative care for cataract patients, are also included. Doctors of optometry are equipped to diagnose, treat, or refer to specialists if needed. Referrals are not required, and most optometrists reserve daily appointments for urgent care. Alberta Health Care covers these appointments.
Non-Government Options for Eye Care Savings
While the government offers free eye exams to certain groups, such as children under 18 and seniors over 65, there are also other ways to access eye care and eyewear with the potential for reduced costs.
Private Insurance Coverage
Purchasing an insurance package from a private insurer can provide coverage for eye exams. Many private insurers offer packages that include optometry services along with other medical services. It is important to review the benefits included in the insurance package to ensure eye exam coverage.
Employer Benefits Package
Another option for eye exam coverage is through your employer’s benefits package. Check with your employer or review your benefits package to determine if eye exams are included. Some employers offer coverage for eye exams as part of their employee benefits.
Post-Secondary Student Health Insurance Plans
If you’re a student enrolled in a post-secondary institution, such as the University of Calgary or the University of Alberta, check with your school’s health insurance plan to see if they cover eye exams. Many plans do, and some even cover a portion of the cost of glasses or contacts. This can be one way to save money on your eye care if you’re a student.
Support for Eye Exams in Alberta
Whether you are eligible for a specific program or service or you simply need assistance covering the cost of an eye exam, there are resources available to help.
We encourage you to explore your options for obtaining an eye exam. Even if you believe you may not qualify for a free exam, it’s always worth taking the time to inquire and see what programs may be available.
If you’re interested in scheduling an eye exam with Bonavista Eye Care, we encourage you to take advantage of our services. We provide comprehensive eye exams that include a thorough review of your vision and an ocular health assessment.Don’t wait to schedule your appointment with us! Maintaining your eye health should always be a top priority, and our team of skilled eye care professionals is here to support you and your family.