The cost of an eye exam in the greater Vancouver area can vary considerably with some clinics charging as low as $75 and others setting fees at over $200 for a comprehensive eye exam. There are many factors that affect the price of an eye exam including the experience of the attending optometrist and the level of technology that’s being used to conduct the exam. In this article we shed some light on what patients can expect to pay for an eye exam in metro Vancouver and what coverage options are available through provincial and private health insurance plans.
Technology Plays A Large Part In The Cost Of An Eye Exam
Eye examination instruments have evolved over the years to allow for incredibly sensitive imaging and analysis of key ocular structures. This has resulted in earlier and better detection of ocular pathology and allowed for more accurate assessment of many progressive eye diseases. For example, Optomap imaging which can capture high definition widefield images of the retina and Ocular Coherence Tomography which can visualize all retinal layers and analyze optic nerves, are two technologies that have revolutionized the delivery of eye care in the past decade. Clinics that include these technologies as part of their patient care generally have a slightly higher exam fee to help offset the additional costs of implementing and maintaining these high tech devices. In our opinion the additional cost is well worth it to help safeguard your eyesight!
Are Eye Exams in BC Covered By Your Care Card?
MSP Coverage For Kids and Seniors Eye Exams
The quick answer is: sometimes. In British Columbia, MSP provides some coverage for routine eye exams for children below 19 and seniors over 65. As most optometrists in the province have opted out of MSP, they balance-bill the eye exam fee. In other words, patients are required to pay the difference between what the particular clinic charges and what MSP covers for the particular visit. The vast majority of eye clinics – particularly those using more advanced diagnostic equipment during their patient examinations – charge a fee on top of what is covered by MSP for kids and seniors. The outstanding amount can range from 30 to 70 dollars for children and 50 to 100 dollars for seniors.
MSP Coverage For Adult Eye Exams
In British Columbia, adults between the age of 19-65 have not been covered for routine eye exams since the early 2000s. However, adults with specific medical conditions including diabetes, glaucoma, and macular degeneration receive at least partial coverage for medically required eye exams with their care cards. For a full list of medical conditions follow this link. It’s important to note that while MSP may cover part of the total eye exam exams, the majority of clinics charge a balance bill for adult eye exams ranging from $50-$150.
Other Provincial Eye Exam Coverage in BC
In addition to MSP, some BC residents have access to partial eye exam coverage through the Ministry of Social Development and Poverty Reduction. This coverage applies to patients on disability and on income assistance. There is partial coverage available for eye exams with $48.90 covered every two years in addition to partial coverage for glasses of approximately $130 every three years. For further details please follow this link.
Healthy Kids Program Eyeglasses Coverage
For low income families who have applied for Supplementary Benefits, some coverage for prescription eyeglasses is available for children under the age of 19. The amount of the coverage is approximately $130 and can vary depending on your child’s eyeglass prescription. To be eligible for the Healthy Kids Program annual family income must be $42,000 or below. For more details about the Healthy Kids Program please visit this link.
Private Insurance Coverage For Eye Exams and Eyeglasses
Eye exam coverage is also available under most private health insurance plans. The amount of coverage ranges from $0 to full coverage depending on the specific plan you are registered for through your employer. Oftentimes the balance bill owing after your MSP coverage is depleted is either partially or fully covered by your private health insurance. For details about specifics of eye exam coverage for your particular plan it’s best to contact your health insurance provider.
Direct Billing for Eye Exams and Eyeglasses
At Optiview Eye Clinic we offer our patients direct billing for both eye exams, glasses, prescription sunglasses, and contact lenses whenever possible. For many insurance plans we can collect payment directly from the insurance company and provide our patients with products and services with no out of pocket cost to the patient. Whether or not direct billing is available depends on your specific insurance plan. There are some plans that require the plan member to pay up front and then submit receipts to their insurance company for reimbursement. For these cases, we are able to provide our patients with a complete computerized invoice for submission. If you have misplaced your invoice please contact our front desk and we can send you a copy.
Free Eye Exams in BC
Interestingly enough, most of our patients receive their eye exam at no charge or for a very small charge once we combine their private insurance and MSP coverage. While this isn’t technically free, there is little to no out of pocket expense to the patient for their eye exam in these situations. For those with private insurance plans that don’t cover the full amount of the eye exam or with no insurance there is a proportional out of pocket cost.
