Eye exams do more than check how well you see—they also help detect early signs of glaucoma, diabetic retinopathy, and cataracts, as well as other conditions that could threaten your vision. But without knowing what’s covered, the potential cost of a check-up can stop people from booking the care that they need.
In Alberta, the Alberta Health Care Insurance Plan (AHCIP) partially covers eye exams for:
Routine eye exams for healthy adults 19–64 are typically not covered, so you may need to pay out-of-pocket. Even for covered exams, clinics often require a co-pay, and additional services may incur extra costs. Understanding your coverage helps avoid surprises and ensures you get the care you need.
Understanding Alberta Health Care Coverage for Eye Exams
Alberta Health provides partial coverage for optometry services through the AHCIP, but this coverage comes with specific eligibility requirements and benefit limits. The plan only covers eye exams for certain age groups and medical conditions, though even these patients may sometimes need to pay additional costs beyond the covered amount.
Partial coverage means Alberta Health pays up to a specific dollar limit for covered services. When your optometrist’s fees exceed this benefit limit, you or your secondary insurance plan must cover the difference. To avoid surprises, always discuss potential costs with your eye care provider before proceeding with any services.
Who Qualifies for Alberta Health Care Coverage?
In Alberta, the Alberta Health Care Insurance Plan (AHCIP) provides coverage for certain eye exams, but eligibility and costs vary:
Children and Seniors
Children’s eye exams were once fully covered, but as of February 2025, most clinics now require a mandatory co-pay, often around $30 per exam. This co-pay is a fixed amount paid to the clinic to cover the costs of a full comprehensive assessment rather than just a basic vision check. This ensures that children receive a full ocular health assessment instead of just a quick vision screening.
Adults over 65 are also eligible for coverage of one annual comprehensive eye exam, up to the plan’s benefit limit. However, seniors may also be required to pay a co-pay for services that exceed this limit. This age group faces a higher risk of conditions such as glaucoma, macular degeneration, and cataracts, making regular monitoring crucial for maintaining good vision health.
Adults with Medical Conditions
Adults aged 19–64 may be eligible for AHCIP coverage if an eye exam is medically necessary. Common reasons include:
- Eye trauma or injury
- Diabetes or other systemic conditions affecting vision
- Sudden changes in vision or persistent eye discomfort
- Follow-up care for diagnosed eye conditions
- Vision side effects from medications
Even when exams are covered, clinics may request a co-pay, and additional services not fully covered by AHCIP may incur out-of-pocket costs. Most private clinics, including ours, can balance bill (paying the “extra” amount beyond what coverage allows) for services that exceed the covered benefit.
What’s Not Covered Under Alberta Health?
Routine eye exams for healthy adults aged 19–64 are not covered, so preventive care in this group is typically out-of-pocket. Other services usually not included under AHCIP coverage include:
- Eyeglasses or contact lenses
- Vision therapy
- Cosmetic procedures
- Advanced testing beyond standard evaluation
Changes to Alberta Eye Exam Coverage
As of February 1, 2025, several changes affect AHCIP-covered eye exams:
- Mandatory co-pays: Many clinics now charge co-pays for children’s exams and certain adult exams.
- Partial exams discontinued: Children and seniors no longer receive partial exams under AHCIP.
- Limits on retinal imaging: Restricted to two images per patient per benefit year.
- Same-day billing restrictions: Optometrists cannot bill for routine and medically necessary services on the same day.
- Reduced fees for advanced testing: Some specialized tests now receive lower AHCIP reimbursement.
Because of these changes, confirming both your eligibility and potential out-of-pocket costs with your optometrist’s office is more important than ever.
Why Regular Eye Exams Matter
Comprehensive eye exams protect your vision by detecting problems in their earliest stages. Many serious eye conditions develop without noticeable symptoms, progressing silently until they cause permanent vision damage.
Common conditions that can be identified during routine eye exams include:
- Glaucoma: Often called the “silent thief of sight,” glaucoma can cause irreversible vision loss without early symptoms. Regular pressure checks and optic nerve evaluations help detect this condition early.
- Diabetic retinopathy: Diabetes can damage blood vessels in the retina, leading to vision loss. Annual eye exams help monitor people with diabetes for these complications.
- Age-related macular degeneration: This condition affects central vision and is most common in older adults. Early detection allows for treatments that can slow progression.
- Cataracts: While cataracts are common with aging, monitoring their development helps determine the optimal timing for treatment.
Recommended Exam Frequency
According to the Canadian Association of Optometrists:
- Children and teens should have annual eye exams to monitor development
- Healthy adults aged 19–64 should schedule eye exams every year
- Adults over 65 should have annual comprehensive eye exams
- People with diabetes, a family history of eye disease, or other risk factors may need more frequent monitoring
Your optometrist may recommend more frequent visits based on your individual risk factors, medical history, or current eye conditions. Following these recommendations supports healthy vision over time.
Maximizing Your Alberta Health Benefit
To make the most of your AHCIP eye exam coverage:
- Schedule your exam within your benefit year
- Bring your Alberta Health card and secondary insurance details
- Discuss coverage and potential co-pays with your clinic
- Ask about payment options for services not fully covered
- Keep records of your exams for insurance or tax purposes
Protecting Your Vision and Your Budget
Regular eye exams are essential for long-term eye health. Even if you’re partially covered, early detection is often more cost-effective than treating advanced eye disease. Many clinics, including ours, offer flexible payment options to make care accessible.
Book your appointment today at Dr. Bishop and Associates to review your Alberta Health benefits and protect your vision.
