Is Your Eye Exam Covered by OHIP? A Burlington Optometrist Explains

Let’s be honest: figuring out what OHIP covers for eye care can feel harder than reading the bottom line of a blurry eye chart.

So here it is, plain language, no jargon.

The Short Version 

 A lot of people think OHIP doesn’t cover any eye exams anymore. That’s not quite true.

Ontario still funds eye exams for:

• Kids (19 and under)
• Seniors (65+), with some limits
• Adults with specific medical conditions (like diabetes, glaucoma, or cataracts with a certain level of reduced vision)

If you’re a healthy adult between 20 and 64 with no eye disease than eye exams are out-of-pocket or covered by your workplace benefits.

Let’s break it down.

Kids (Ages 0-19) – OHIP covered eye exam

If your kids are aged 19 and under, their eye exams are covered by OHIP..

What you get: One comprehensive eye exam every 12 months.

Why it matters: Kids’ eyes can change fast. A small prescription shift or focusing issue can look like “laziness” in class or trouble reading. Regular exams catch that early before it affects their grades or love of learning.

Seniors (65+)

Once you hit 65, OHIP coverage splits into two paths.

If you have an active eye condition (glaucoma, macular degeneration, cataracts that affect your vision):
→ OHIP covers one full exam every 12 months, plus up to two follow-ups to monitor things.

If your eyes are otherwise healthy (no active disease):
→ OHIP covers one routine exam every 18 months.

So yes you are covered. Just know the timing changes based on your eye health.

Adults (20-64) with medical Conditions

For most adults, routine eye exams are not covered by OHIP, BUT if you have certain medical conditions, you are covered for an eye exam by OHIP once a year. 

OHIP covers annual exams for adults with:

• Diabetes (Type 1 or Type 2) — because diabetes can quietly damage the blood vessels in your retina
• Glaucoma (confirmed diagnosis)
• Cataracts that are progressing
• Active retinal disease or corneal disease
• Medications with eye risks such as Hydroxychloroquine, Chloroquine, Tamoxifen and Ethambutol

If your eye exam is not covered by OHIP, some adults in Burlington, Oakville, Hamilton etc can pay for routine eye exams using one of these three things:

1. Workplace benefits — Plans like Sun Life, Canada Life, and Manulife usually cover an eye exam every 24 months, plus glasses or contacts.
2. Health Spending Account (HSA) — If your employer offers one, eye exams, contact lens fittings, and even dry eye treatments are eligible expenses.
3. Tax write-off — Self-employed or paying out-of-pocket? Keep your receipt. Speak to your accountant to see if you can use this expense as a medical write off. 

Eye Emergenics – Skip the Joseph Brant waiting Room

Let’s say you’re gardening in your backyard in Tyandaga and a stray branch scratches your eye. Or you wake up Tuesday morning with a red, painful, weeping eye.

Most Burlington residents instinctively head to Joseph Brant Hospital’s ER. But honestly? You will wait hours.

An optometrist’s office is actually better equipped for most eye emergencies. With specialized microscopes (slit lamps) and tools to remove foreign objects, diagnose infections, or check for retinal issues like sudden flashes or floaters.

So before you sit in a hospital waiting room for four hours, call a local optometry clinic first. You’ll likely be seen faster and by the right specialist.

What OHIP Doesn’t Cover

Even if you qualify for a covered exam, OHIP doesn’t pay for everything. These services are typically private-pay or covered by workplace insurance:

• Contact lens fittings- Measuring your corneal curvature for safe, comfortable contacts
• Imaging- Retinal photography and OCT scans are not covered by OHIP. Think of them like dental X-rays for your eyes.
• Dry eye therapy

If you have symptoms like gritty, burning, or sandy-feeling eyes that don’t improve with drops, you need these advanced eye exam assessments and they’re worth every penny.

The Bottom Line for Burlington Patients

 At Blink Better in Burlington, we don’t expect you to be an expert on OHIP billing. That’s our job.

Whether you’re:

• Booking your kid’s annual exam
• A senior wondering when you’re due
• Or a working professional with benefits you’ve never used

We can check your OHIP eligibility for you before your appointment. Just ask when you call. And if you have workplace benefits? We can submit directly!