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Understanding the 2023 Updates to
OHIP Coverage for Eye Exams
Starting from September 1, 2023, the Ontario Ministry of Health (MOH) is enacting changes to the OHIP coverage for eye exams. This modification is done with an aim to ensure those individuals who are at risk or currently living with certain eye conditions receive the necessary, publicly funded care, thereby preventing vision loss.
For Children Aged 0-19 Years
No modifications have been made to the current coverage.
As has been the case, one comprehensive eye examination every 12 months will still be covered by OHIP for patients in this age group. In addition, OHIP will continue to cover "partial" visits for specific problems such as red eye or any follow-up visits recommended by a physician.
For Adults Aged 20-64 Years
Patients within this age group are not covered by OHIP unless the patient has one or more of the following potentially sight-threatening conditions. These patients are eligible for one comprehensive eye examination every 12 months under OHIP:
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Diabetes (confirmed cases only)
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Glaucoma (confirmed cases only)
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Retinal Disease
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Corneal Disease
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Optic Nerve Disease
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Cataracts (only if visual acuity is worse than 20/40 or surgery is needed)
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Uveitis
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Sudden-onset Strabismus (like those related to a tumor or nerve palsy)
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Certain medication usage: Chloroquine, Hydroxychloroquine, Ethambutol, Tamoxifen
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Starting from September 1, 2023, patients with Amblyopia or longstanding Strabismus will no longer be covered by OHIP. Moreover, OHIP will cover two "partial" visits related to the eye condition. Additional visits or partial visits unrelated to the specific eye condition would not be covered by OHIP.
Seniors (65+ years) OHIP Coverage
Seniors aged 65 and above need to have at least one of the potentially sight-threatening conditions listed below to be eligible for ONE comprehensive eye exam every 12 month under OHIP:
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Diabetes (confirmed)
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Glaucoma (confirmed)
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Retinal Disease
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Corneal Disease
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Optic Nerve Disease
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Cataracts (only if visual acuity is worse than 20/40 or surgery is needed)
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Uveitis
-
Sudden-onset Strabismus (like those related to a tumor or nerve palsy)
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Certain medication usage: Chloroquine, Hydroxychloroquine, Ethambutol, Tamoxifen
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If a senior patient doesn't have one of these conditions, the coverage changes from every 12 months to every 18 months. We still recommend a comprehensive eye exam every 12 months to detect eye diseases early. The fee for an eye exam is $129 which we can charge to private insurance plans if you have one. Alternatively, patients can choose to wait until 18 months to access an OHIP-insured exam.
Up to two “partial” exams will be covered between each comprehensive exam for all seniors aged 65 and over.
Maintain Your Eye Health with Regular Exams
At Red House Vision Centre, Dr. Jane Yang still recommends an annual eye exam for all patients regardless of age or OHIP eligibility. Early detection of eye diseases is the key to preserving vision and maintaining a healthy lifestyle.
If you have any questions about these changes or wish to book an appointment, please do not hesitate to contact us at (905) 434-8539.
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We look forward to seeing you soon!