You know that regular check-ups are part of a healthy lifestyle, and prioritizing your eye health is no exception. A common question for many families is about the cost of eye care. Let’s look at how eye exam coverage works under the Alberta Health Care Insurance Plan (AHCIP).
The answer depends on your age and your reason for the visit. While not all eye exams are free, AHCIP does cover the full cost of many medically necessary appointments and annual exams for specific age groups. Understanding these details can help you and your family plan for your vision care needs.
Alberta Health Care & Your Vision
The Alberta Health Care Insurance Plan, or AHCIP, helps cover a variety of medical services for residents. This includes some specific optometry services. Coverage often depends on your age or if the exam is for a specific medical reason.
What AHCIP Typically Covers
AHCIP helps pay for medically necessary visits to a healthcare professional. For eye care, this means exams related to specific health conditions or for certain age groups. However, vision-correcting aids like eyeglasses, contact lenses, or laser eye surgery are not part of this plan.
Coverage for Children & Seniors
For the youngest and oldest members of your family, AHCIP provides more comprehensive coverage for eye health. This focus helps support healthy development in children and manage age-related conditions in seniors.
Children (18 & Under)
Alberta Health covers one complete eye exam each year for children up to age 19. Since a child’s vision can change quickly as they grow, these annual check-ups help monitor their eye health and development. Early detection of vision problems is very important for a child’s success in school and other activities.
Seniors (65 & Older)
Seniors aged 65 and over are also eligible for one covered eye exam each year. AHCIP may also cover additional follow-up appointments if they’re needed for eye disease diagnosis and management of conditions like glaucoma or cataracts. Regular care is a key part of maintaining eye health as you age.
What About Eye Exams for Adults?
If you’re between 19 and 64 years old, routine adult eye exams are not covered by AHCIP. Many Albertans in this age group use workplace or private insurance plans to help with these costs. It’s a good idea to check your personal benefits to see what you’re eligible for.
The Cost of a Routine Exam
If you’re paying for an exam, the price can range from around $90 to over $160. The final cost depends on the specific tests you need, the technology used, and the fees of your local practice.
At Focus West Optometry, we believe in being transparent about any costs associated with your appointment.
Medically Necessary Exams Are Covered
Even for adults, AHCIP will cover an eye exam if it’s considered medically necessary. An appointment for a health concern that may require prompt emergency eye care, is treated differently than a routine vision test.
This coverage applies to situations such as:
- Eye infections or injuries
- Foreign objects in the eye
- Sudden changes in your vision
- Monitor for glaucoma or retinal disease
- Flashes or floaters in your vision
- Eye health checks related to diabetes
Fun Fact: Sea otters have the densest fur of any animal, but lack a layer of blubber to stay warm. To protect their eyes from salty ocean water, they produce tears that constantly wash over their corneas.
The Value of a Regular Eye Exam
A comprehensive eye exam does more than just test how well you see—it’s a key part of your overall health care. Regular visits allow a professional to spot potential issues early. Your eyes can offer a window into your general wellness.
What Your Optometrist Checks For
During an eye exam, your optometrist assesses many aspects of your eye health, including:
- Your visual acuity at different distances
- The pressure inside your eyes
- How well your eyes work together
- The health of your retina & optic nerve
- Your peripheral vision
Sometimes, an eye exam can reveal signs of other health issues (like diabetes or high blood pressure) before you notice other symptoms. This connection between eye health and overall health is why you need an eye exam even if your vision is 20/20.
Plan for Your Next Eye Exam
Knowing your coverage helps you plan for your family’s eye care. Whether you’re booking an annual check-up for your child or a routine appointment for yourself, it’s good to be prepared. This helps make the process smooth and predictable.
A Note on AHCIP Service Changes
As of February 1, 2025, some services that were previously fully covered may now require a co-payment. For more details, you can read our guide to understanding Alberta’s optometry coverage changes. It’s always a good idea to ask your local clinic about any potential costs before your appointment.
Services Not Covered by AHCIP
It’s helpful to remember that AHCIP does not pay for vision aids like eyeglasses or contact lenses. However, these items may be covered by a third-party insurance plan.
Understand Your Options
Understanding your coverage is an important part of your health care journey. If you have questions about your benefits, our team may be able to help.
At Focus West Optometry, we’re passionate about providing personalized care for every patient. If you have questions or want to book an appointment, don’t hesitate to contact our team today. We’re here to help you and your family see clearly.