Eye exams are an essential part of maintaining overall health. Your first thought when it comes to eye exams might be reading off charts and looking through lenses, but that’s only the beginning!
Comprehensive eye exams do more than just determine your need for vision correction. They can also serve as a preventive measure, looking for early signs of eye diseases, such as glaucoma and macular degeneration.
But no matter how much you care about your eye health, we understand cost is always a concern. Fortunately, the Alberta Health Care Insurance Plan (AHCIP) covers certain optometry services. Eye exams are free for patients under 18 and over 65 in Alberta, as well coverage is available for some medically necessary eye exams, such as diabetic health check, eye infections, eye injuries, sudden changes to vision and more.
What Do We Mean By “Free” Eye Exams?
By “free,” we’re referring to cases where the cost of an eye exam is covered by AHCIP rather than you paying out of pocket or through private insurance. Alberta Health has guidelines for eye exam coverage. It’s essential to familiarize yourself with these to help you access the benefits you can use for long-term eye health support.
The Importance of Eye Exams
One of the most important reasons to have regular eye exams is to prevent or detect vision problems during their early stages. Optometrists can identify issues like near-sightedness, far-sightedness, astigmatism, and presbyopia during an exam, as well as other medical conditions.
An optometrist can examine the parts of your eye to diagnose eye diseases such as:
- Macular degeneration
- Diabetic retinopathy
- Dry eye disease
By identifying these conditions early, you and your optometrist may have the opportunity to address them before they cause long-term permanent damage. In some cases, prompt treatment could even prevent blindness.
Who Qualifies for Eye Care Coverage in Alberta?
The good news is that many groups are covered, including children, seniors, and adults with an eye disease or concern. It’s important to note that this is partial coverage, meaning there’s a maximum benefit per year.
If the charge for services exceeds the limit between the benefit year of July 1 to June 30, you’ll need to cover the difference out of pocket or with a secondary insurer.
AHCIP can cover these optometry services:
- One comprehensive eye exam, one partial exam, and one diagnostic procedure per benefit year for children under 18 and seniors over 65.
- Full coverage of some medical treatments provided by optometrists. While optometrists typically won’t charge you for services covered by AHCIP, you could be responsible for additional treatment costs.
- Full coverage of eye exams your optometrist deems medically necessary. This could be due to trauma, infection, medical conditions, or illness.
What Eye Conditions Could Be Covered?
It’s important to speak with your eye doctor about any medical conditions you have. You may be surprised to discover which situations could result in your eye exam being covered by AHCIP.
Some conditions that could cause AHCIP to cover your eye exam include:
- Foreign bodies in the eye
- Eye injuries
- Eye infections
- Secondary testing/exams for abnormalities or being on certain medications
- Eye diseases, such as glaucoma, cataracts, macular degeneration
How Often Should You Get an Eye Exam?
The Canadian Association of Optometrists recommends the following schedule for children and adults at different age ranges:
- 6–9 months: 1 exam
- 2–5 years: 1 exam
- 6–19 years: 1 exam annually
- 20–64 years: 1 exam at least every 2 years
- 65+ years: 1 exam annually
Remember, these are only guidelines. A few factors can increase your risk of developing serious eye issues, including your age, health status, family history of eye disease, and specific visual needs.
Your optometrist may recommend more frequent eye exams if you have a specific eye condition or are at risk of developing one.
Booking Your Next Eye Exam
Taking care of your family’s eye health is an integral part of maintaining overall wellness—and thankfully, in many cases, eye exams are covered by the Alberta Government.
Even if your exam isn’t covered by AHCIP, it’s still essential to keep up with proactive care. It’s important to remember that preemptive treatment can help prevent more costly, serious complications in the future.
Our experienced team wants to help you have access to professional eye care. So whether you are using AHCIP or another insurer, we can submit on your behalf (depending on whether your chosen insurer will allow non-policy holders to submit the claim).Eye care is for everyone, so book your next eye exam today!