Medically Necessary Eye Health Examinations

What Alberta Health Care Covers for Optometric Eye Exam

Ages 0-19 and 65+

Alberta Health Care provides routine eye exam coverage for patients 0-18 years of age and 65 and older.  For these age groups, most services are insured, but coverage is limited to one complete eye exam per year.  (Alberta Health Care calendar billing year is from July 1 to June 30. That means if you were seen in June of this year, you would be eligible for a full exam again in July of the same year. Likewise, if you were seen in August of one year, you would be covered for a full exam again in July of the following year). There are some exceptions based on clinical need.  For example, patients with glaucoma, diabetes, or cataracts may need additional "follow up" procedures.  Ask your optometrist for more information about coverage and potential costs for specific visual conditions.

Ages 19-64

For patients of the ages 19-64, Alberta Health covers only medically necessary optometric services.

What is considered medically-necessary?

  • Monitoring for diabetes issues, glaucoma and retinal disease
  • Pre and Post-operative care for cataract patients
  • Eye infections or injuries
  • Foreign objects in the eye
  • Sudden appearance of floaters, spots, or flashes of light
  • Sudden changes in vision or acute pain in the eye
  • Other visual disturbances may be covered... ask your optometrist!

The bottom line is, if you are unsure whether or not a service is covered, ASK BEFORE entering the exam room.

Coverage only applies to the procedures or services necessary to treat the immediate medical condition.  A routine eye exam (testing involved in attaining a prescription for glasses or contact lenses) is not covered for adults (19-64). Other optometric services such as contact lens assessments and vision therapy are not insured by Alberta Health Care.

Optometrists treat specific eye disease

All of Eye Gallery's Calgary optometrists are educated in the use of diagnostic and therapeutic agents which allow them to treat conditions ranging from bacterial conjunctivitis (pink eye) to co-management of glaucoma therapy. Individuals who suffer from conditions such as "pink eye", or who are suffering from an eye injury, eye infection, or other eye health problem should visit our optometrists as soon as possible. Alberta Health Services covers medically necessary (non-glasses or contact lens associated) eye health related visits for individuals 19 through 65. Please have your Alberta Health Care card handy when phoning or dropping in for an eye health related appointment. Eye Gallery's optometrists are available during the week, on evenings and on Saturdays.

If I visit an ophthalmologist, can I still visit Eye Gallery's optometrist?

There is a misconception that if an individual sees an optometrist, then they will no longer be covered to see an eye surgeon (ophthalmologist). This is not true. You can see our optometrists, have your visit covered through Alberta Health Care (see the criteria above) and, when required, you still can have an ophthalmologist visit covered through Alberta Health Care.