What Does Alberta Health Care Cover for Eye Exams?

Navigating healthcare coverage can be a daunting task, especially when it comes to understanding what is and isn’t included. For residents of Alberta, eye care is a critical aspect of health that Alberta Health Care Insurance Plan (AHCIP) helps manage. Whether you’re a parent ensuring your child’s vision is developing correctly, or a senior keeping tabs on age-related changes, knowing what eye care services are covered can give you peace of mind. Here’s a look at what Alberta Health Care covers for eye exams.

Eye Care Coverage for Children and Seniors

Alberta Health Care provides comprehensive eye exam coverage for specific age groups. Children aged 18 and under, as well as seniors aged 65 and older, are eligible for one complete eye exam per year. This coverage includes vision testing to determine if a glasses prescription is necessary, and an eye health examination. At Sherwood Park Eye Centre our Optometrists offer wide-angle retina imaging to all of our patients as an optional addition to the standard testing. This retina imaging, or retina scan, provides a more thorough look into the back of the eye (the retina) so we may detective early signs of disease as soon as possible.

Medically Necessary Eye Exams

For all age groups, Alberta Health Care covers medically necessary eye exams. These are exams required due to medical conditions or symptoms that may affect the eyes. Coverage includes:

Diabetes Management: Regular dilated fundus exams for diabetic patients to monitor and manage diabetic retinopathy.
Eye Infections and Injuries: Examinations and treatments for eye infections, injuries, or other acute conditions.
Chronic Conditions: Monitoring and management of chronic eye conditions such as glaucoma or macular degeneration.
Post-Surgical Care: Follow-up exams after eye surgeries to ensure proper healing and recovery.

Conditions and Exclusions

While AHCIP provides substantial coverage, it’s important to note some exclusions and conditions:

Routine Exams for Adults (19-64): Routine eye exams for adults aged 19 to 64 are generally not covered. These exams are often covered through private insurance plans or paid out-of-pocket.
Corrective Lenses: The cost of glasses or contact lenses is not covered by Alberta Health Care. Some private insurance plans may offer partial or full reimbursement for these expenses.
Specialized Procedures: Certain specialized eye care procedures, such as refractive surgery (e.g., LASIK), are not covered under AHCIP and will need to be paid for privately.
Contact Lens Fittings & Exams: Contact lens exams and fittings are not covered by Alberta Health Care.

Making the Most of Your Coverage

To make the most of your Alberta Health Care coverage for eye exams:

Schedule Regular Check-Ups: Ensure that children and seniors in your family have their annual eye exams scheduled.
Monitor Eye Health: Pay attention to any changes in vision or eye health and seek medical advice promptly to ensure conditions are treated early. We know sudden changes in your vision and eye health can be stressful, and our staff are equipped to triage your appointment to ensure you receive the care you need, when you need it! Simply bring in your Alberta Health Care card when you arrive for your appointment and we will handle the rest.
Check Insurance Details: If you fall within the 19-64 age range, review your private insurance options for additional coverage that can help with routine exams and corrective lenses. Our team at Sherwood Park Eye Centre can bill the majority of insurance providers.

By understanding what Alberta Health Care covers for eye exams, you can better manage your eye health and ensure that you and your family receive the necessary care. Regular eye exams are crucial for maintaining good vision and overall health, so take advantage of the coverage provided and keep your eyes in check!

Simply bring in your Alberta Health Care card when you arrive for your appointment and let the team at Sherwood Park Eye Centre handle the rest for you! Our staff will expertly handle billing Alberta Health Care for your eye exam. If you don’t have AHC coverage, we are equipped to bill over thirty different private insurance companies to make the process as easy as possible for you!