Understanding Ontario eye-exam coverage can be confusing because eligibility depends on age, medical circumstances and the date of the previous insured examination. Here is a clear guide for Markham families.
Coverage at a glance
- Children and youth 19 or younger: generally one major eye examination every 12 months.
- Patients with diabetes: one health-card-covered major eye examination every 12 months, regardless of age.
- Seniors 65 or older without an eligible medical condition: generally one major eye examination every 18 months.
- Adults aged 20–64: may be covered annually when they have an eligible medical condition affecting their eyes.
Who qualifies for an OHIP-covered eye exam?
Children and youth aged 19 or younger
OHIP generally covers one major eye examination every 12 months, along with eligible minor assessments when medically required.
A comprehensive children’s examination evaluates more than distance vision. It can assess focusing, eye coordination, prescription, alignment and eye health. Children do not always recognize or report blurry vision, so routine examinations remain important even when they have no obvious symptoms.
Patients with diabetes
Patients with diabetes are covered for one major eye examination every 12 months through OHIP with a valid Ontario health card, regardless of age. Regular examinations allow the optometrist to assess the retina and look for diabetes-related changes that may not cause noticeable symptoms at first.
Please tell the clinic about your diabetes when booking and bring your health card so eligibility can be confirmed.
Adults aged 65 and older
Seniors without an eligible medical condition are generally covered for one major eye examination every 18 months, plus two eligible minor assessments. Coverage may differ when diabetes or another eligible condition requires closer monitoring. The clinic can confirm the appropriate interval.
Adults aged 20–64
Routine examinations are not normally covered for adults aged 20–64 unless they have an eligible medical condition affecting their eyes. Eligible circumstances can include diabetes and certain diagnosed eye conditions. Because coverage depends on the specific condition and billing requirements, patients should confirm eligibility with the clinic rather than assuming an examination is insured.
What should I bring?
- A valid Ontario health card
- Your current glasses and contact lenses
- A medication list, if applicable
- Relevant insurance information
- Details of recent eye examinations or specialist care
RevitalEyes can confirm whether the planned examination appears eligible, although final coverage remains subject to OHIP requirements.
Does OHIP cover retinal imaging?
Digital retinal imaging is not normally covered by OHIP. It provides a detailed photograph of the retina that can establish a baseline and help document changes over time.
At RevitalEyes, digital retinal imaging is $60. A private-pay comprehensive examination with retinal imaging is $150.
What if my examination is not covered?
A comprehensive adult eye examination for patients aged 20–64 is $100. RevitalEyes also offers direct billing to many major insurance providers when supported by the patient’s plan. Patients should confirm their available vision benefits with their insurer.
Book an eye exam in Boxgrove, Markham
RevitalEyes Eye Care provides family eye care in English and Tamil at 72 Copper Creek Drive, Unit 104. Optometrist appointments are available Wednesday, Thursday and Saturday.
Email RevitalEyes to request an appointment and mention whether coverage is based on age, diabetes or another eligible condition.
Frequently asked questions
Are patients with diabetes covered every year?
Yes. Patients with diabetes are eligible for a health-card-covered major eye examination once every 12 months. Bring a valid Ontario health card.
Are children covered annually?
Children and youth aged 19 or younger are generally eligible for one major eye examination every 12 months.
Are senior eye exams covered every year?
Seniors without an eligible medical condition are generally covered every 18 months. Different coverage may apply when an eligible condition requires closer monitoring.
Is retinal imaging included with an OHIP examination?
No. Digital retinal imaging is normally an additional, uninsured service.
Source and medical review: Coverage intervals are based on guidance from the College of Optometrists of Ontario. This article was reviewed by Dr. Mathuraa Sasitharan. Eligibility and provincial rules can change; contact the clinic to confirm current coverage.