Eye exams are crucial for maintaining overall health, yet many individuals need clarification about their healthcare coverage regarding these essential appointments. In British Columbia, understanding what the BC Health Care system covers regarding eye exams is necessary for adults and parents. 

We will explore coverage for both adult and children’s eye exams, what services are included and excluded, and available payment options. With this information, you can make informed decisions about your eye health.

Adults 19–64 do not receive eye exam coverage unless they have certain conditions such as diabetes. However, children 0–18 have coverage for annual exams. Adults 65+ are also covered, as aging can affect eyesight. If you are on assistance, the Medical Services Plan (MSP) can cover part of your eye exams and if you need a new pair of prescription glasses.

Why Are Eye Exams Vital?

Vision can affect education, employment, and daily tasks such as driving. Regular eye exams are vital as they not only assess your vision—they can also detect severe health conditions before other symptoms appear.

BC Health Care Coverage for Adults

BC Health Care coverage for adult eye exams generally includes tests necessary for medical reasons, such as eye disease, trauma, or systemic health conditions that have ocular implications, like diabetes. 

However, routine eye exams for adults aged 19–64 are not covered under MSP. Eligibility for an insured exam may depend on your health condition, with exceptions made for certain chronic systemic diseases that have potential eye health impacts.

BC Health Care Coverage for Children

Early eye care is paramount for children’s developmental reasons. In BC, infants, toddlers, children, and teenagers aged 0–18 are entitled to an annual eye exam covered by BC Health Care. This comprehensive coverage helps to correct vision issues early, supporting children’s educational and social development.

What’s Covered?

BC Health Care typically covers:

• Eye exams that are related to specific eye issues like infections or injuries.
• Prescriptions for eye diseases or treatments.
• Tests for individuals with conditions affecting eyesight, like diabetes.

This coverage focuses on providing medically necessary services. Preventive care and early detection of potential vision problems can prevent more serious complications later in life.

What’s Not Covered by BC Health Care?

Routine eye exams for most adults and additional services such as contact lens fittings are not covered by BC Health Care. Cosmetic or elective procedures are also excluded. If additional vision care or elective treatments are required, you may need to rely on private insurance or pay out of pocket.

In addition, BC Health Care does not cover the cost of glasses or contact lenses. However, in some cases where an individual has a medically necessary eye condition and cannot wear glasses or contacts, coverage may be provided for alternative vision correction methods such as laser eye surgery. 

Supplemental Insurance & Financing

While BC Health Care provides coverage for medically necessary eye care services, it helps to understand the limitations and exclusions of this coverage. Regular eye exams and preventive care play a crucial role in maintaining overall health and well-being, so it may be beneficial to explore supplemental insurance options or budget accordingly for out-of-pocket expenses for routine vision care. 

Payment Options

Patients have several options for payment when BC Health Care does not cover an eye exam. 

Private health insurance plans can provide supplemental coverage for routine eye exams and additional optical services. If you don’t have private insurance, you may need to pay out-of-pocket. Community programs and assistance may be available if you are in financial need, so it’s worth researching what is available in your area.

The Eye Exam Process

During a typical eye exam an optometrist:

• Tests your visual acuity to see how clearly each eye is seeing
• Checks for binocularity issues to see if your eyes work together correctly
• May perform a dilated fundus examinations to inspect the back of the eye
• Conducts tests for eye diseases like glaucoma and cataracts

These evaluations can identify eye health issues at an early, more treatable stage.

Get Your Eyes Checked for Your Health

Regular eye exams are necessary parts of health care for detecting vision issues and as a preventative measure for overall well-being. 

BC Health Care provides excellent coverage for children and essential eye care services for people of all ages. For routine adult eye exams, it’s necessary to know the limitations of the BC Health Care system and plan accordingly, whether that means investing in private insurance or setting aside savings to cover these health needs.

Eye health should not be taken for granted. Schedule your family’s eye exams today with Annik Eye Care in Surrey, BC, or contact us if you have questions about your eye health coverage.