As of February 1, 2025, changes to optometry coverage in Alberta are in effect. These changes, which include delisting certain services, reducing the frequency with which some services can be billed and cutting the amount that optometrists are paid, will significantly impact patients across the province.
Despite these changes, Alberta’s optometrists are committed to helping patients navigate this new landscape, providing advice, exploring alternative funding options, and delivering essential care.
What’s Changed in Optometry Coverage?
The new changes affect both the services covered by Alberta Health and the frequency with which some services can be claimed, including:
- Delisting of partial eye exams for children and seniors: Previously, partial eye exams for children and seniors were covered. Under the new policy, children under 19 and seniors over 65 are still eligible for 1 comprehensive eye exam annually (although a small co-pay has been instituted for seniors), but the partial eye exam service will no longer be covered.
- Reduction in retinal imaging and photography: The frequency of retinal imaging and retinal photography will now be reduced by 50%. This means these services can only be claimed twice per patient per benefit year, which may impact patients requiring frequent monitoring for conditions such as diabetes or glaucoma. The fees for imaging and photography have also been cut.
- Increased restrictions on billing: Optometrists will no longer be able to bill for basic eye services and medically necessary care on the same day, potentially making it harder for some patients to receive all necessary care during a single appointment.
- Fee reduction for visual field testing: The fees associated with computer-assisted visual fields (CAVF) testing have been significantly reduced, which could affect the cost and availability of this diagnostic tool for some patients.
Who Will Be Affected by These Changes?
While these changes will likely affect all Albertans, some will experience a greater impact due to their specific circumstances.
Children & Seniors
As mentioned, children under 19 and seniors over 65 can still receive 1 annual comprehensive eye exam (with a small co-pay for seniors), but partial exams are no longer covered. If additional testing or follow-up care is needed, there could be an out-of-pocket cost.
Patients with Chronic Eye Conditions
People with conditions such as glaucoma, macular degeneration, diabetes, or retinal diseases will likely need more frequent monitoring. Reducing retinal imaging and photography coverage may pose challenges for those who rely on these diagnostic tools for regular care.
Rural Albertans & People with Limited Mobility or Transportation
People living in rural or remote areas and those with limited mobility or transportation may face challenges in accessing eye care due to reduced coverage for multiple visits or tests. The increased cost of care could become a barrier for patients already struggling to travel to appointments, whether due to distance, lack of transportation options, or physical limitations.
If you fall into any of these categories or are unsure how these changes will affect you, contact your optometrist for advice on how best to proceed. Your optometrist will help assess your situation and may recommend alternatives or payment options for services that are no longer covered.
The Importance of Not Skipping Essential Eye Appointments
Even with the recent changes to optometric coverage in Alberta, one thing remains clear: maintaining your eye health is important. Many eye conditions, especially those that can lead to vision loss, progress slowly and often without noticeable symptoms in the early stages.
Continuing with your annual eye exams or more frequent visits as needed gives you the best chance of catching potential issues early when they’re more treatable. Optometrists are skilled at detecting not only refractive errors like nearsightedness or farsightedness but also more serious eye conditions, such as:
- Glaucoma: Often called the “silent thief of sight,” glaucoma can cause irreversible damage to the optic nerve without warning signs.
- Macular degeneration: This age-related condition can lead to central vision loss, which severely impacts the ability to perform everyday tasks.
- Diabetic retinopathy: For those with diabetes, annual eye exams are critical for monitoring any changes in the retina that could be caused by the disease.
- Cataracts: Though common with aging, cataracts develop gradually and may not affect vision significantly in the early stages.
Even though some services are now delisted or limited, urgent and medically necessary care, such as eye infections, injuries, and sudden vision changes, will still be partially covered by Alberta Health; small co-pays have been instituted at the majority of optometry offices for these services as a result of the government cuts. Patients should not delay seeking care for emergencies, as prompt attention can prevent vision loss.
Alternative Care Coverage Options
While Alberta Health coverage is now more limited in optometry services, other resources are available to help you manage the cost of eye care.
If you have work insurance, you may be able to use your employee benefits to cover some or all of the cost of optometric services. Many insurance plans offer vision care benefits, covering everything from routine eye exams to prescription glasses and specialty lenses.
Here are some other options to consider:
- Alberta Works: If you currently receive support from Alberta Works, you may be eligible for assistance with optometry services. Alberta Works provides financial support for basic healthcare needs; in some cases, vision care may be covered.
- No benefit coverage: Some optometrists offer payment plans or sliding scale fees based on income if you do not have coverage through Alberta Health or a work insurance plan.
- Private insurance plans: If you don’t have access to workplace insurance, consider looking into private insurance options that offer vision care coverage. There are a variety of plans available that can help reduce the out-of-pocket costs of regular eye exams, glasses, and specialty treatments.
What Can You Do?
While the changes to optometry coverage may feel frustrating, there are actions you can take to advocate for the preservation of essential eye care services. The Alberta Association of Optometrists (AAO) has been actively lobbying to ensure that patients’ needs are met, and Albertans need to make their voices heard.
One of the most impactful steps you can take is to contact your local Member of the Legislative Assembly (MLA) to express your concerns. By voicing your opinion, you can help advocate for the restoration of important services and ensure that the needs of vulnerable populations are considered. We have a form letter to assist in the process so please reach out to us if you would like a copy.
Book an Appointment & Stay Informed
Regular eye exams are essential, especially if you have a chronic condition or are at risk for vision loss. Our team at Red Deer Eye Care / The Eye Care Centre is dedicated to providing the best possible care despite these changes and will continue to prioritize your eye health.
Please contact us or book an appointment to discuss how these changes may impact your care.
As Albertans, we are here for you and will continue to support your vision health. Your well-being is our priority, and together, we’ll navigate these changes with care and dedication.
