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Are Eye Exams Covered by Alberta Health?

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As much as we care about our physical health, our eyes also require special attention. Regular eye exams are essential to keep our vision clear, but they do so much more than that—they can also help identify potential sight-threatening eye diseases and other health issues. 

As an Albertan, you may wonder whether your provincial health plan covers eye exams. Alberta Health covers 1 eye exam per year for children 18 years and under and seniors 65 years and older. It does not cover eye exams for ages 19 to 64. Despite this, it is still essential to continue a regular eye exam schedule throughout your adult life.

Eye Exams: The Foundation of Eye Health

Your eyes are intricate and delicate organs that require more than simply vision correction. Eye health goes beyond prescriptions for glasses or contact lenses

Regular eye exams are proactive measures to help identify potential vision problems early on. From refractive errors like nearsightedness and farsightedness to eye conditions and diseases like glaucoma and macular degeneration, eye exams can detect problems that might otherwise go unnoticed. 

How Often Should You Have an Eye Exam?

According to the Alberta Association of Optometrists, babies should have their first eye exam between 6 and 9 months. Toddlers and preschoolers should have 1 eye exam between 2 and 5 years. Once in school, children should have an annual eye exam until 19 years old. Adults 19 to 64 may need an eye exam every 1–2 years, and seniors 65 and over should have a comprehensive eye exam annually. 

A curly-haired girl undergoing a slit lamp test.

Alberta Health Coverage & Eligibility

The Alberta Health Care Insurance Plan (AHCIP) provides eligible Alberta residents with covered and partially covered services. Partially covered services or services that exceed the benefit limit means you or your secondary insurance must pay the cost difference. Within Alberta, AHCIP covers the following per benefit year (July 1 to June 30):

  • 1 eye exam for children 18 and under and seniors 65 and older
  • 1 additional partial exam
  • 1 diagnostic procedure
  • Eye exams deemed medically necessary by your optometrist, including for those 19 to 64

Alberta Health also covers urgent care and medically necessary care, such as the following:

  • Eye infections
  • Eye injuries
  • Eye and eyelid inflammation
  • Foreign objects in the eye
  • Dry eye
  • Styes
  • Sudden changes in vision
  • Monitoring for diabetes-related eye issues, glaucoma, and retinal disease
  • Post-operative care for cataract patients

What Does Alberta Health Not Cover?

Adults aged 19 to 64 do not have coverage for eye exams under Alberta Health. However, many employers offer insurance benefit packages that encompass vision care. 

Privatized insurance plans, customized to meet the needs of families, can include coverage for eye exams, corrective eyewear such as glasses or contact lenses, and specialized treatments, if necessary. 

You can check with your employer or insurer for specific information about your health coverage before visiting your eye doctor. 

Optical Assistance for Seniors

Low-income seniors can qualify for the Dental and Optical Assistance for Seniors program. To be eligible, you must be:

  • 65 years or older
  • A resident of Alberta and have resided in Alberta for at least 3 months before applying
  • A Canadian citizen or admitted to Canada for permanent residence
  • Approved to Seniors Financial Assistance within the limits allowed by the program for annual income 

Eligible seniors for optical assistance will receive up to a maximum of $230 every 3 years to use toward:

  • Prescription eyeglasses
  • Prescription sunglasses
  • Prescription contact lenses
  • Frames
  • Eyeglasses repairs

Optical services not covered include the following:

  • Eye surgery
  • Lenses for cataract surgery
  • Accessories
  • Magnifying devices
  • Eye medication
  • Non-prescription sunglasses

The funding renews every 3 years, however, unused funds do not carry over to the next funding period. If you had cataract surgery within the same 3-year period you received funding and have a change in your prescription, you may be eligible for additional funding, depending on the date of your cataract surgery.

If you are enrolled in the Dental and Optical Assistance for Seniors program, mention this to your eye doctor during your appointment. Your eye doctor may be able to direct bill to save you the hassle. 

The Importance of Prevention & Early Intervention

Though Alberta Health’s coverage might not include routine adult eye exams for adults 19 to 64 years, it is essential to consider the long-term benefits of regular eye check-ups. Prevention is a cornerstone of healthcare, and because eye exams help identify potential eye issues before they escalate, they can go a long way in preserving your vision. 

Comprehensive Eye Exams at Chestermere Optometry

While routine eye exams might not be universally covered by Alberta Health, understanding the exceptions, exploring workplace benefits, and considering private insurance plans can significantly ease the burden of eye care expenses. Moreover, fostering a proactive approach to eye health can yield lifelong dividends, enhancing your vision and overall well-being. 

Book your next eye exam with Chestermere Optometry today. We can discuss the cost of services and plans before you receive any treatment and directly bill most insurance companies. 

Written by Jennifer Sanchez

Dr. Jennifer Sanchez was born and raised in Calgary, Alberta. She completed her Bachelor of Science Degree in Biological Sciences at the University of Calgary and Doctor of Optometry Degree, with honours, at Southern California College of Optometry. Dr. Sanchez worked alongside optometrists at American Veteran Affairs Hospitals and Indian Health Services and practiced co-management with ophthalmologists specializing in refractive and cataract surgery through a clinical externship.

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