There are several things to consider when booking an eye examination in Ontario. First, it is important to make sure you are booking an exam with a registered optometrist. You can use our public register to find a registered optometrist near you. Second, it is important to understand the costs associated with an eye examination, as well as any additional testing. Other costs to consider include vision aids such as glasses, prescription sunglasses, or contact lenses.
When paying for an eye exam, citizens of Ontario have several different options to consider. Along with any personal insurance you have, you may be eligible for one of the payment assistance programs listed below.
Ontario Health Insurance Plan (OHIP)
Ontario offers the Ontario Health Insurance Plan (OHIP) as the provincial health care plan for those who live in the province. Through this plan, the province can assist certain people with eyecare, as well as many other aspects of health care.
OHIP covers eye examinations for the following patients:
- children and youth aged 19-years-old or younger
- adults aged 65-years-old or older
- adults aged 20-64 years who have an eligible medical condition
Children and youth aged 19-years-old and younger are covered for:
– one major eye exam every 12 months, and any required minor assessments.
Adults aged 65-years-old or older who do not have an eligible medical condition affecting their eyes are covered for:
– one major eye exam every 18 months, and 2 additional minor assessments.
Adults aged 20-64 years who have an eligible medical condition affecting their eyes are covered for:
– one major eye examination every 12 months, and 2 additional minor assessments.
Please note, adults aged 20-64 who do not have an eligible medical condition affecting their eyes are not covered under OHIP for eye exams. These patients will be required to pay for their examinations and vision aid out of pocket, through their personal insurance, a combination thereof, or using one of the payment assistance programs below.
To learn more about OHIP, visit their website: https://www.ontario.ca/page/what-ohip-covers.
Ontario Disability Support Program (ODSP)
If you are not covered for vision care under the Ontario Health Insurance Plan (OHIP), you may be able to get help with the costs of eyecare through the Ontario Disability Support Program (ODSP).
ODSP may:
- cover a routine eye examination
- provide financial assistance with the cost of prescription eyeglasses
- provide financial assistance with the cost of eyeglass repairs
To learn more about ODSP, what it covers, and if you are eligible, visit https://www.ontario.ca/page/ontario-disability-support-program-health-and-disability-benefits#section-3.
Ontario Works
If you are not covered under OHIP or ODSP, you may be eligible to participate in the Ontario Works program. Through this program you may be able to get help to pay for vision care expenses such as:
- prescription eyeglasses
- eyeglass repairs
The Ontario Works program will cover the costs for routine eye exams once every 24 months (2 years). Ontario Works may help cover the cost of eyeglasses and eyeglass repairs for you and your family members.
Learn more about the Ontario Works program by visiting their website: https://www.ontario.ca/page/eligibility-ontario-works-financial-assistance.
Non-Insured Health Benefits (NIHB)
The Non-Insured Health Benefits (NIHB) program provides eligible First Nations and Inuit patients with coverage for certain health care services that may not be covered by provincial health insurance.
The NIHB program covers certain vision care expenses, including:
- eye examinations when they are not insured by the province of Ontario
- vision aid, such as glasses or contact lenses, when prescribed by a vision care professional
- eyeglasses repairs
Eligible First Nations and Inuit patients have two ways of utilizing the NIHB benefits to cover the eligible costs of an eye examination:
- If your optometrist is registered with the NIHB program, they can process the claims on your behalf. Patients are asked to contact the NIHB regional office to confirm the eyecare provider is registered with the program, and will bill NIHB directly for the exam and any vision aid.
- If your optometrist is not registered with the NIHB program, you may choose to pay for your eye examination out-of-pocket and apply for reimbursem*nt from NIHB for the eligible amounts.
The coverage for eyecare follows the guidelines set out by NIHB. Visit their website to read more about the Guide to vision care benefits with NIHB: https://www.sac-isc.gc.ca/eng/1579545788749/1579545817396.
Interim Federal Health Program (IFHP)
The Interim Federal Health Program (IFHP) provides limited, temporary coverage for certain healthcare services, including eye examinations. This program is intended for the people who do not have provincial or private healthcare coverage, and who identify as one of the following:
- refugee claimant
- victim of human trafficking
- victim of domestic violence
- immigration detainee held under the Immigration and Refugee Protection Act (IRPA)
The IFHP may cover costs for an eye examination, and/or vision aid. To learn more about coverage, visit their website: https://ifhp.medaviebc.ca/en/benefit-grids.
Assistive Devices Program (ADP)
The Assistive Devices Program (ADP) is a provincial funding program that helps people with long-term physical disabilities cover the costs of visual aids, such as magnifiers, optical aids, white canes, Perkins Braillers, and more.
To qualify for this program, you must:
- be a resident of Ontario
- have a valid Ontario health card
- have long-term low vision or blindness in at least one eye that can’t be corrected with surgery or regular vision aid (such as glasses or contact lenses)
To learn more about ADP, what it covers, and if you are eligible, please visit their website: https://www.ontario.ca/page/assistive-devices-program.
