Children under 19
AHCIP insures one routine (oculo-visual) exam plus one diagnostic procedure each benefit year. Since February 1, 2025 these exams are only partially covered, so a co-pay applies, which our team confirms before the visit.
Coverage & direct billing
Alberta Eye Exam Coverage & Direct Billing
Know what is covered before you book, and let us handle the billing.
Alberta Health Care partially covers routine eye exams for children and seniors and covers medically necessary eye care for everyone. Following changes that took effect on February 1, 2025, a co-pay now applies to these exams. Capital Vision Care helps you understand your coverage and direct bills most major insurers, so there are no surprises at checkout.
- Children and seniors: partially covered, co-pay applies
- Medically necessary care for all ages
- Changes took effect February 1, 2025
- Direct billing to most insurers
In short
Are Eye Exams Covered in Alberta?
Alberta Health Care (AHCIP) still insures one routine eye exam per benefit year for children under 19 and for seniors 65 and older. As of February 1, 2025, the province reduced what it pays toward these exams, so they are now only partially covered and a co-pay applies. Routine exams for adults 19 to 64 are not covered, though many people have these covered through private or employer insurance.
Medically necessary eye care is covered for Albertans of all ages, and patients with diabetes are generally eligible for an insured eye exam each year. The benefit year runs from July 1 to June 30, and your clinic will confirm any co-pay or fees before your exam.
Who is covered
What Alberta Health Care Covers
Coverage depends on your age and your eye health needs.
Seniors 65 and older
Seniors are insured for one routine exam plus one diagnostic procedure each benefit year. Since February 1, 2025 the province reduced what it pays, so the exam is only partially covered and a co-pay applies.
Patients with diabetes
Because diabetes affects the eyes, an annual diabetic eye exam is generally covered as medically necessary care, at any age.
Medically necessary care
Eye care for injury, infection, sudden vision changes and certain conditions is covered for all ages, including adults 19 to 64.
Direct billing
We Direct Bill Most Major Insurers
If you have vision benefits through work or a private plan, we can usually bill your insurer directly, so you only pay any remaining balance.
Bring your benefits information to your appointment and our team will check your coverage for you.
- Alberta Blue Cross
- Alberta School Employee Benefit Plan (ASEBP)
- Sun Life
- Manulife
- Canada Life
- Green Shield Canada
- Many other private and employer plans
Good to know
What Alberta Health Care Does Not Cover
These are usually paid out of pocket or through private or employer benefits.
- The co-pay portion of children and senior exams, in effect since February 1, 2025
- Partial or interim eye exams, which Alberta delisted on February 1, 2025
- Routine eye exams for adults aged 19 to 64
- Prescription glasses, lenses, contact lenses and fittings
- Refractive laser eye surgery
- Some advanced diagnostic imaging and testing
The rules above reflect the changes Alberta Health made on February 1, 2025. Coverage can change again, and your clinic team will confirm what applies to you and any co-pay before your exam.
Ready to book?
Not sure what you are covered for? Book and we will check it for you.
Book an Eye Exam
How it works
How Billing Works at Your Visit
- 1 Bring your cardsBring your Alberta Health card and any vision benefits or insurance information.
- 2 We check your coverageOur team reviews what Alberta Health Care and your private plan cover for your visit.
- 3 We direct bill where we canWe submit the claim to Alberta Health Care and your insurer directly whenever possible.
- 4 You pay only the differenceIf anything is not covered, we explain it up front so there are no surprises.
Living with diabetes?
Diabetic Eye Exams
Your Annual Diabetic Eye Exam May Be Covered
Diabetes is one of the leading causes of vision loss, and Alberta Health Care generally covers an eye exam each year for Albertans with diabetes. Early detection helps protect your sight.
Quick questions
Coverage Questions, Answered
Are kids eye exams free in Alberta?
Children under 19 are insured for one routine eye exam each benefit year, but since February 1, 2025 these exams are only partially covered, so a co-pay applies, which our team confirms before the visit.
Do seniors pay for eye exams?
Seniors 65 and older are still insured for one routine eye exam each benefit year, but as of February 1, 2025 it is only partially covered, so a co-pay applies. Our team will confirm the amount before your exam.
Do you direct bill insurance?
Yes. We direct bill most major insurers, including Alberta Blue Cross, ASEBP, Sun Life, Manulife, Canada Life and Green Shield.
Where to go
Book at a Clinic Near You
Capital Vision Care has six Edmonton-area clinics, all set up to check your coverage and direct bill most insurers.
Good to know
Frequently Asked Questions
Are eye exams free in Alberta?
Children under 19 and seniors 65 and older are insured for one routine eye exam per benefit year, but since February 1, 2025 these exams are only partially covered and a co-pay applies. Adults aged 19 to 64 are not covered for routine exams, though many have them covered through private or employer insurance.
What changed for Alberta eye exam coverage in 2025?
On February 1, 2025, Alberta Health reduced its optometry funding. Routine exams for children and seniors are now only partially covered, so a co-pay applies. Partial (interim) exams are no longer covered, retinal imaging is limited to twice per benefit year, and a routine exam and medically necessary care can no longer be billed on the same day, so some follow-up care may need a separate visit.
Do seniors pay for eye exams in Alberta now?
Seniors 65 and older are still insured for one routine eye exam each benefit year, but since February 1, 2025 it is only partially covered. A co-pay applies, and our team will confirm the current amount before your exam.
Does Alberta Health Care cover eye exams for adults 19 to 64?
Routine exams are not covered for this age group. However, medically necessary eye care, such as for injury, infection or certain conditions, is covered at any age, and private or employer benefits often cover routine exams.
Is a diabetic eye exam covered in Alberta?
Patients with diabetes are generally eligible for an insured eye exam each year because diabetes affects eye health. Your optometrist can confirm your eligibility.
How often does Alberta Health Care cover an eye exam?
For those who are eligible, one routine eye exam is partially covered per benefit year, which runs from July 1 to June 30. Since February 1, 2025 a co-pay applies for children and seniors.
Does Alberta Health Care cover glasses or contact lenses?
No. Prescription glasses, contact lenses and contact lens fittings are not covered by Alberta Health Care. They may be covered by private or employer vision benefits.
What should I bring to use my coverage?
Bring your Alberta Health card and any vision benefits or insurance information. Our team will check what is covered before your exam.
Which insurers do you direct bill?
We direct bill most major insurers, including Alberta Blue Cross, ASEBP, Sun Life, Manulife, Canada Life, Green Shield and many other private and employer plans.
Are there fees for additional testing?
Some advanced diagnostic tests or imaging are not covered by Alberta Health Care and may involve a fee. Your clinic team will explain any costs before proceeding.
Explore more
Related Services
Book With Confidence
We will check your Alberta Health Care and private coverage and direct bill where possible, so you know your costs before your exam.
Sources
Sources and Further Reading
Coverage details on this page are based on current Alberta optometry guidance. Your clinic team will confirm what applies before your visit.