Taking care of your eyes is vital to your overall health, but understanding what’s actually covered by Alberta Health can be confusing.
The good news is that the Alberta Health Care Insurance Plan (AHCIP) covers certain eye exams, including those for children under 18 and adults over 65. However, routine check-ups aren’t always included for everyone.
On February 1, 2025, Alberta Health made changes to optometry coverage. These changes, included delisting certain services and reducing billing frequency for some services, having a significant impact on patients across the province.
Whether you’re booking your kid’s first eye exam or checking in on your own vision, it’s helpful to know what’s included, who qualifies, and how to make regular eye care more accessible.
What’s Changed in Alberta’s Optometry Coverage?
The new changes affect both the services covered by Alberta Health and the frequency some services can be claimed, including:
- Delisting of partial eye exams for children and seniors: Previously, partial eye exams for children and seniors were covered. Under the new policy, children under 19 and seniors over 65 are still eligible for 1 comprehensive eye exam each year, but the partial eye exam service will no longer be covered.
- Reduction in retinal imaging and photography: The frequency of retinal imaging and retinal photography is now reduced by 50%. This means these services can only be claimed twice per patient per benefit year, which may impact patients requiring frequent monitoring for conditions like diabetes or glaucoma.
- Increased restrictions on billing: Eye doctors can no longer bill for basic eye services and medically necessary care on the same day, potentially making it harder for some patients to receive all necessary care during a single appointment.
- Fee reduction for visual field testing: The fees associated with computer-assisted visual field (CAVF) testing will be reduced, which could affect the cost and availability of this diagnostic tool for some patients.
What Does Alberta Health Cover for Eye Exams Now?
Alberta Health provides partial coverage for eye exams depending on your age and medical needs. These services are primarily designed for kids, older adults, and people who need medically necessary interventions. Here’s an overview of how coverage is structured.
Eye Exams for Kids & Seniors
As mentioned, kids under 19 and seniors over 65 can currently receive 1 annual comprehensive eye exam, but partial exams are no longer covered. If additional testing or follow-up care is needed, you may incur an out-of-pocket cost.
Patients with Chronic Eye Conditions
People with conditions like glaucoma, macular degeneration, diabetes, or retinal diseases will likely need more frequent monitoring. Reducing retinal imaging and photography coverage may pose challenges for those who rely on these diagnostic tools for regular care.
However, we encourage regular check-ups to monitor and manage concerns early, which can help reduce potential complications. As we age, even small vision changes can increase the risk of falls, driving accidents, and reduced independence.
Medically Necessary Exams
Alberta Health continues to cover medically necessary eye exams for individuals with chronic conditions such as:
- Diabetes
- Glaucoma
- Multiple sclerosis
These exams are essential for monitoring and managing eye health complications associated with these conditions.
However, recent changes to Alberta Health’s optometry coverage have introduced some modifications:
- Many clinics now require co-payments for medically necessary exams
- Optometrists can no longer bill for routine eye care & medically necessary care on the same day, potentially requiring patients to schedule separate appointments for different services
Despite these changes, Alberta Health still covers medically necessary eye exams related to chronic conditions. You are encouraged to consult with your optometrist to understand how these changes may affect your care and associated costs.
If you’re experiencing any symptoms, it’s critical to promptly book an appointment with a licensed optometrist. Ignoring these issues could lead to more severe health consequences.
Trinity Hills Eyecare accepts AHCIP coverage for eye emergencies and medically necessary visits. Please contact us if you are unsure whether your symptoms qualify.
Coverage Limits During Emergencies
If you require new glasses or contact lenses as a result of an emergency eye exam, the cost of the prescription and eyewear is not included and must be paid separately.
What Is Not Covered by Alberta Health?
Routine eye exams for adults aged 19–64 are not covered by Alberta Health and are typically paid out-of-pocket or through private insurance plans.
Essential services such as updating your glasses or contact lens prescriptions, or getting checked for early signs of eye disease, are classified as routine and are typically paid for out-of-pocket—unless you have private or employer-provided insurance.
While these exams remain vital for maintaining eye health and detecting silent conditions early, they are not covered by Alberta Health unless they are linked to a medical concern.
Tip: Many health benefit plans do cover partial or full costs of these routine eye exams, so be sure to check with your insurance provider.
Why Are Routine Eye Exams Still Important
Even with the provincial coverage changes, routine eye exams remain a crucial part of maintaining long-term vision and health. Eye conditions often develop gradually and without symptoms, making proactive care essential.
Early Detection of ‘Silent’ Conditions
Some of the most serious eye diseases, including glaucoma, macular degeneration, and diabetic retinopathy, can develop quietly and painlessly in the early stages.
By making regular exams, optometrists can detect subtle changes in your vision using diagnostic tools like retinal imaging and visual field tests, allowing for early intervention and better outcomes.
Tracking & Managing Existing Conditions
If your vision keeps changing, you may need more than just a stronger prescription. Conditions like myopia, astigmatism, and presbyopia require ongoing monitoring.
- Adults in their 20s and 30s can still experience progressive nearsightedness.
- Cataracts and macular degeneration often start developing in your 40s or 50s—well before Alberta Health’s coverage resumes at age 65.
- Routine exams help you get the right lens prescription and identify any potential health issues.
Detecting Overall Health Conditions
Your eyes can reveal signs of systemic health conditions like high blood pressure, heart disease, or diabetes. Routine eye exams can act as an early warning system, helping you address potential health concerns promptly.
The Importance of Eye Exams for Kids
Routine eye exams are essential for children’s development and academic performance. Poor vision can impact reading, concentration, and even confidence.
Conditions like amblyopia (lazy eye), strabismus (crossed or misaligned eyes), or myopia (nearsightedness) can be caught early and treated more effectively.
Trained optometrists can also detect subtle signs of vision issues such as:
- Head tilting
- Excessive blinking
- Difficulty with spelling or reading
Annual check-ups ensure your child has the visual tools they need to thrive.
Alberta Health & Advanced Eye Care Services
Despite the recent delistings, Alberta Health continues to cover medically necessary eye care. This includes:
- Visual field testing for glaucoma
- Monitoring ocular diseases such as macular degeneration or uveitis
- Post-surgical follow-up, like after cataract surgery
These services are still accessible when medically indicated and prescribed by your optometrist or ophthalmologist.
Take Care of Your Vision Today
Understanding Alberta Health’s current coverage helps you plan for essential vision care. Whether your needs are fully insured or require an out-of-pocket investment, your eye health is worth protecting.
Regular vision exams can support long-term eye health, improve daily quality of life, and contribute to the early detection of broader health issues. Book your next eye exam with Trinity Hills Eyecare today.
