Does OHIP Cover Eye Exams in Ontario?
OHIP covers routine eye exams for Ontarians under 20 and over 64, and for any patient with a qualifying medical condition. Everyone else pays out of pocket — and OHIP coverage doesn't always cover the full standard of care.
Updated · Dr. David Wilkinson
Whether your eye exam is covered by OHIP depends on your age and whether you have a qualifying medical condition — not simply on who you are. Some patients are covered; others pay out of pocket, regardless of age.
It's also worth understanding that OHIP coverage and the full standard of care are not the same thing. OHIP reimburses a defined set of services. A thorough eye exam may include additional testing and imaging that falls outside that definition — and is billed separately.
Who OHIP covers
| Group | Frequency |
|---|---|
| Children under 20 | Once every 12 months |
| Adults 65 and older | Once every 18 months |
| Any patient with a qualifying medical condition | As medically necessary |
OHIP covers one complete eye exam per eligible period. If you visit more frequently than your covered interval allows, you pay for the additional visits yourself.
For the official list of covered services, see Ontario's OHIP coverage page.
If you're not covered: what to expect
If you're an adult aged 20–64 without a qualifying condition — or any patient visiting outside their covered interval — you pay for the exam yourself.
Fees across Ontario clinics generally range from $150–$250 depending on the practice and location. Many employer benefit plans include a vision care allowance — typically $150–$300 every 24 months — that reimburses the exam fee and part of the cost of glasses or contact lenses. Check your benefits booklet.
OHIP covers the basics — not necessarily the standard of care
OHIP's fee schedule was designed around a baseline examination. It does not account for the diagnostic tools that modern optometry relies on to detect eye disease early and meet a practitioner's duty of care to patients.
Full-scope optometry practices routinely perform imaging that OHIP does not cover, including:
- OCT (optical coherence tomography) — a cross-sectional scan of the retina or optic nerve that can detect glaucoma, macular degeneration, and other structural changes before symptoms appear
- Retinal photography — a wide-field image of the retina used to document and track changes over time
These are not covered by OHIP even for patients whose exam is otherwise billed to OHIP. They are charged separately by most full-scope practices as part of their standard of care. Ask your clinic what additional fees apply when you book.
Qualifying medical conditions
Patients of any age can have exams billed to OHIP if an optometrist is monitoring or treating:
- Diabetes — annual diabetic eye exams are OHIP-insured
- Glaucoma (diagnosed or suspected)
- Cataracts
- Amblyopia (lazy eye) or strabismus
- Age-related macular degeneration (AMD)
- Retinal disease
- Corneal disease
- Uveitis
- Optic pathway disease
- Acquired cranial nerve palsy
- Drug toxicity monitoring (e.g., hydroxychloroquine/Plaquenil)
Your optometrist determines whether your condition qualifies. You do not need a GP referral to see an optometrist in Ontario.
What OHIP never covers
OHIP does not cover:
- Prescription glasses or frames
- Contact lenses or contact lens fittings
- Laser eye surgery (LASIK, PRK)
- Cosmetic procedures
- Diagnostic imaging (OCT, retinal photography) — even for otherwise covered patients
Low-income support
The Ontario Works and Ontario Disability Support Program (ODSP) programs provide limited vision care benefits, including coverage for eye exams and basic eyeglasses for eligible recipients. Contact your caseworker for details.
Key takeaway
OHIP coverage is a starting point, not a complete picture. Being covered for your exam doesn't mean your visit will be free — and the additional testing your optometrist performs is there for good clinical reasons. Before your appointment, ask what's included in the exam fee and what, if anything, is billed separately.
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Book an appointment →Frequently Asked Questions
- Does OHIP cover eye exams for adults in Ontario?
- OHIP covers routine eye exams for children under 20 (once every 12 months) and seniors 65 and older (once every 18 months). Adults aged 20–64 are not covered for routine eye exams unless they have a qualifying medical condition.
- What conditions qualify a patient for OHIP-covered eye exams in Ontario?
- Patients of any age may qualify for OHIP coverage if an optometrist is monitoring or treating diabetes, glaucoma, cataracts, amblyopia (lazy eye), strabismus, retinal disease, corneal disease, uveitis, or certain other medically diagnosed eye conditions. Your optometrist bills OHIP directly in these cases.
- How much does an uncovered eye exam cost in Ontario?
- Fees vary by clinic, but most full-scope practices in Ontario charge between $150 and $250 for an uncovered exam. Additional fees may apply for diagnostic imaging, which is not covered by OHIP regardless of patient eligibility.
- If my exam is covered by OHIP, does that mean there's no charge?
- Not necessarily. OHIP covers the examination itself, but many clinics charge separately for diagnostic imaging — such as OCT retinal scans or retinal photography — that falls outside the OHIP fee schedule. These are part of the standard of care at most full-scope optometry practices and are billed directly to the patient.
- Does OHIP cover glasses or contact lenses?
- No. OHIP does not cover the cost of prescription glasses, contact lenses, or contact lens fittings regardless of age or condition. Some provincial programs provide limited assistance for low-income recipients.
- How often should I get an eye exam if I'm not covered by OHIP?
- The Ontario Association of Optometrists recommends a comprehensive eye exam every two years for healthy adults aged 20–64, and annually for those with risk factors such as diabetes, a family history of glaucoma, or a high refractive error.
Author
Dr. David Wilkinson, OD, FAAO — Pending clinical review
Optometrist, Spadina Optometry
A Toronto native and Fellow of the American Academy of Optometry, Dr. David Wilkinson has been part of our optometric practice since earning his OD from the Illinois College of Optometry in 2007. A certified clinical investigator with a special interest in contact lenses and myopia management, he serves as a part-time Clinical Instructor at the University of Waterloo's Waterloo Eye Institute and previously spent nearly a decade as Practice Advisor at the College of Optometrists of Ontario.