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Are Eye Exams Covered by Alberta Health?

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Cheerful family at the eyes doctor ready to have their eye exams.

Routine eye examinations are a crucial part of sustaining your eye health and catching any potential eyesight issues. Whether you are an adult, senior, or child, keeping up to date with your regularly scheduled eye exams is important. Under the Alberta Health Care Insurance Plan, or the AHCIP, you may be eligible for coverage of your routine eye examinations.

What is the Alberta Health Care Insurance Plan (AHCIP)?

The AHCIP provides eligible Alberta residents with full coverage for medically necessary physician services and some dental and oral surgical health services. Services that are deemed necessary will be determined by your doctor; if you are unsure if a service is considered necessary, ask your doctor or contact the AHCIP office.

Who Is Eligible for the AHCIP?

To be eligible for the AHCIP, you must be an Albertan resident and be registered with the AHCIP through Alberta Health. A list of services that are covered by the AHCIP can be found through Alberta Health’s Schedule of Medical Benefits and the Allied Health Services Benefits Schedules.

Eye Exam Coverage in Alberta

Children aged 18 and under, and seniors aged 65 and older are covered for one eye exam per year under Alberta Health

This also includes one partial exam and one diagnostic procedure if necessary. For example, if your optometrist recommends you have a dilated eye exam, in addition to your standard eye exam, this is covered by Alberta Health.

Albertan residents aged 19-64 are not covered under the AHCIP for routine eye exams. However, an eye exam can be covered for those aged 19-64 if your optometrist deems it medically necessary. A medically necessary eye exam includes situations where you have:

  • An eye injury or trauma
  • An illness or medical condition that affects the eyes (ex: eye infection, diabetes)

Seniors with low to moderate incomes may also be eligible for some benefits through the Dental and Optical Assistance for Seniors Program.

Daughter accompanied by her mother as she gets her eye exam from an optometrist.

Options for Those Not Covered by the AHCIP

For those who are age 19-64, there are two ways to receive coverage for your routine eye exams: personal health care insurance and employee benefits. 

Buying an insurance package from a private insurer will enable anybody to receive coverage for their eye examinations as long as they are included in the benefits of said package. Along with optometry services, many private insurers offer insurance packages that include a range of coverage for multiple medical services. 

You may also be able to receive coverage for eye examinations through your employer. Check your benefits package or get in touch with your employer to see if your employee benefits include coverage for eye examinations. 

Regular Eye Exams Are Crucial

Having a regular eye exam is crucial to your eye health. Even if you don’t have vision issues, you should still be having an eye exam regularly. Depending on your age, your eye exam schedule should be:

  • Once per year for children aged 6-19 and seniors 65 or older
  • Once every 2 years for adults aged 20-64

However, the best person to recommend your eye exam schedule is your optometrist. Your optometrist knows you and your eyes, and might recommend you come in more or less frequently, depending on your needs.

If it’s been over 2 years since your last eye exam, contact your optometrist to schedule your next appointment.

Written by Shazeen Manji

Dr. Shazeen Manji was born and raised in Edmonton, Alberta, and attended the University of Alberta, where she completed her Bachelor of Science degree. She then went on to earn her optometry degree at the Pennsylvania College of Optometry at Salus University, where she graduated with honours. Dr. Manji received her training in a vast array of clinical settings, including private practices and Veterans Affairs hospitals, where she focused on pediatrics and contact lenses. Though she enjoys all aspects of private practice, Dr. Manji has a particular interest in ocular disease and contact lenses. She completed her ocular disease externship at the Wilmington V.A. Hospital and has completed an advanced studies course in contact lenses, giving her unique insight into fitting specialty contact lenses. In 2019, Dr. Manji purchased River Heights Eye Care where she is now practicing.
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