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Vision Insurance Coverage in Canada: Which Regions Offer Eye Care?

on 14 Apr, 2019

The Canada Health Act provides all essential and medically necessary care through its provincial arms. But it doesn’t mandate the provision of eye care outside of emergency circumstances.

Vision insurance coverage changes according to province and territory. In most cases, young people and seniors receive the best access to care. Most (but not all) provinces and territories cover one complete vision exam at least once every two years. 

The rest of the population receives care for emergency issues only.

Although Canada treats optometry and ophthalmology as somewhat as an afterthought, it is critical coverage for everyone. Vision loss will likely grow by 30 percent over the next decade, and 75 percent of all vision loss is preventable and treatable.

What coverage does your province or territory offer? Are there extra programs or benefits available to you? Keep reading for the comprehensive guide to vision care in Canada.

What Provinces and Territories Offer Vision Insurance Coverage?

Each province decides how it wants to provide coverage under the Canadian Health Act. While they must cover GP and hospital services as well as medically necessary procedures. However, each provincial and territorial government has the leeway to decide how it wants to cover vision care.

We broke down exactly what each government authority offers.

Keep in mind that each province updates its coverage on a regular basis. Those updates often appear when the government makes significant changes to the budget. Your coverage may change, so you should always get in touch with the government to make sure

Alberta

Like many provinces, Alberta only covers complete exams for children (19 and under) and seniors (65 and over).

If you fall into those categories, you can access a partial exam, a complete exam, and one diagnostic procedure annually. The calendar year for medical exams runs between July 1 and June 30.

If you aged 20 to 64, you still have access to care. Eye injuries and eye diseases receive care as part of the national and provincial health exam. 

British Columbia

Are you a resident of British Columbia who qualifies for the BC Medical Services Plan (MSP)?

If so, you receive free annual eye exams if you 18 or under and 65 or older.

As per the law, MSP covers all medically required services related to eye and vision care. Canadians of all ages may access treatment for eye injuries and eye diseases.

Manitoba

In Manitoba, children under 19 and seniors over 65 receive one free complete eye exam every two years.

People who fall outside those age ranges receive coverage only for eye injuries and other medically necessary procedures.

New Brunswick

New Brunswick offers no eye care services for any age group.

Instead, it offers exams to those who meet income qualifications. Anyone on social assistance receives coverage from the government.

Additionally, the province runs the “Health Smiles, Clear Vision” program. It provides eye exams, glasses, and lenses for three years to children under 18 years old who come from qualifying low-income families. It also covers emergency exams as well as minor exams.

However, Healthy Smiles, Clear Vision is not free. The government requires a 30 percent participation fee on frames, dispensing, and diagnostics. You pay the optician directly.

Newfoundland and Labrador

New Foundland and Labrador offer no eye exam coverage.

You can request assistance with payment for an eye examination if you receive Income Support. If you receive aid, your maximum contribution will be $55.

There are limits to assistance. Children under 18 can request assistance once a year. Adults can seek assistance once every three years.

Those using the Income Support Program may also apply for contributions towards the cost of eyeglasses.

Nova Scotia

Nova Scotia provides free eye exams every two years to children under 10 and seniors over 65.

If you have an eye injury or health condition, the province health care plan covers all your related care.

Nova Scotia also offers a unique service compared to other provinces. If you deal with allergies, eye inflammation, or eye infections, then you can get a maximum of six partial examinations per year to diagnose and treat the issues.

You also get coverage for other conditions including low vision assessments.

Prince Edward Island

Prince Edward Island offers no eye care coverage.

Ontario

Ontarians under 20 and over 65 get their free annual eye exam covered by showing their OHIP card.

If you are 19 and older or 65 and under can receive a referral for an eligible eye exam from a physician. They also receive coverage for eye injuries, diseases, and disorders.

Ontario provides a complete list of covered conditions:

  • amblyopia
  • cataracts
  • corneal disease
  • diabetes mellitus
  • glaucoma
  • optic pathway disease
  • recurrent uveitis
  • strabismus
  • visual field defects

If you have one of these eye diseases, you receive one covered exam every year as well as follow-up appointments.

People who qualify for the Ontario Disability Support Program (ODSP) and Ontario Works may receive further eye care benefits.

Quebec

If you live in Quebec and qualify for the provincial health care program, then you have limited access to vision care.

Children (up to 17) and seniors (over 65) receive one free annual eye exam under the program.

Quebec differs in the way it provides emergency care. An emergency diagnosis falls under the umbrella of provided patient care. However, you are responsible for the costs of your emergency treatment.

Saskatchewan

Saskatchewan’s health benefits primary focus is on children under 18 who receive a complete eye exam, repeat eye exam, and partial eye exam each year.

You also qualify for the free exams if you receive Family Health Benefits or a Saskatchewan Income Plan supplement (SIP). SIP goes to seniors 65 and over.

All residents of Saskatchewan receive coverage for the initial assessment and care for eye injuries and other eye health emergencies.

Care for First Nations and Indigenous Peoples

First Nations and Indigenous people qualify for provincial healthcare program in their province or territory of residence. However, you may also be eligible for additional eyecare benefits.

The Non-Insured Health Benefits program offers the following services:

  • Eye exams (when uncovered by the province or territory)
  • Eyeglasses (including repairs)
  • Eye prosthesis
  • Benefits based on individual medical requirements

You can access these benefits once every two years if you are over 18 and once a year when your under 18. You can also ask for coverage when your vision changes suddenly. Those with diabetes also receive full exams once a year.

Not all vision products are included. You won’t receive funding for:

  • Any service/product covered by government health plans
  • Vision exams for occupation or sports reasons
  • Implants
  • Laser surgery
  • Esthetic products

You can, however, access these services privately.

The Time for Vision Care is Now

Vision problems begin as early as your 40s, and there’s no reason to wait until you reach your 60s to start annual eye exams. An ophthalmologist will be able to predict the potential of vision loss and ideally prevent it before it begins to impact your light.

You have a particular need to focus on vision health if you:

  • Have a family history of disease like macular degeneration or glaucoma
  • Live with diabetes
  • Need medication to manage high blood pressure
  • Take medicines that have vision side effects (drugs for arthritis, anxiety, depression, high cholesterol, and thyroid)
  • Work in an eye-hazardous occupation

If you have needs that go unmet by your provincial health plan, then you might benefit from vision insurance through your health insurance plan.

Buy Health Insurance with a Vision Care Benefit

If you have a family history of poor eye health or a job that takes its toll on your vision, you should consider choosing a private insurance plan that offers vision care expenses coverage.

These plans vary and may pay for some or all of the following expenses:

  • Full eye exams
  • Prescription glasses (frames and lenses) and contacts
  • Laser surgery
  • Visual training aids

Each plan will come with its own maximum coverage amounts, and some may require you to complete a waiting period.

Having coverage encourages people to visit the optometrist and ophthalmologist when they begin to experience vision changes – not after those changes impact their lives.

Choosing Health Insurance in Canada

Vision insurance coverage in Canada is significantly lacking. Although it covers our most vulnerable citizens and residents, everyone else is left to pay for their own expenses. It’s problematic because vision issues can come up as early as your 40s, and as our population ages, vision loss will grow significantly.

One way to cover health expenses that your province or territory doesn’t provide is to invest in private health insurance. Private insurance may include a vision care plan that covers the costs of exams, glasses, contacts, and surgery so that you can protect your vision throughout your life.

Are you interested in finding new health coverage that works for you? Click here for your free health insurance quote.

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