Beginning September 1, 2023, changes to OHIP’s coverage of eye exams will be felt by many Ontarians due to the recent four-year funding agreement between The Ontario Association of Optometrists (OAO) and the Government of Ontario.
Changes for Seniors
Ontarians aged 65 and over will receive an OHIP insured eye exam every 18 months instead of annually. Additionally, seniors will no longer be able to receive unlimited minor follow-up assessments after an annual eye exam. Instead, they will receive two assessments every 18 months.
However, seniors with eligible medical conditions affecting their eyes such as macular degeneration, glaucoma or diabetes will continue to receive one exam every 12 months.
The cost can be anywhere from $55 to $260 for those who are able to pay out-of- pocket for more frequent exams.
“The way eye care is delivered has changed over the past decade,” said Sylvia Jones, Deputy Premier and Minister of Health. “Together, we were able to come to a long-term and sustainable agreement. Through their OHIP card, people of all ages will continue to be connected to high-quality and publicly funded eye care that better reflects the latest best practices and expert advice.”
“I am pleased to announce that we were able to work through a new historic four-year funding agreement,” said Dr. Josephine Pepe, President of the Ontario Association of Optometrists. “We will be working together to ensure optometrists can continue providing the high-quality access to care that Ontarians deserve, both now and for future generations.”
Eye Exams for Ontarians with Eye Conditions
Adults aged 20 to 64 amblyopia (lazy eye) and strabismus (misaligned eyes) will no longer be eligible for OHIP insured eye exams. Instead, adults 20 to 64 with either of these conditions will continue to be able to seek medical care from a primary care provider in response to any complications or acute concerns. However, those who have sudden onset of strabismus will continue to be insured. Monitoring children with these conditions will continue to be insured.
For people with diabetes, optometrists will be empowered to clinically assess and verify whether a patient has diabetes to receive an insured eye exam.
Eye exams were previously insured by OHIP for people with cataracts, even when they do not experience decreased vision that impacts their daily life. Eye exams will now only continue to be insured for adults with cataracts that have clinically significant decreased vision that impacts their daily life, or when a surgery referral is made.
People with an eligible medical condition will be able to receive an insured eye exam from an optometrist without a referral letter from their primary care provider.
There are no changes under this agreement to eligibility coverage for children or Ontarians receiving social assistance.
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