Changes to Eye Care Services Covered by the Alberta Health Care Insurance Plan February 1, 2025

We want to inform you of important changes to the Alberta Health Care Insurance Plan (AHCIP) that will take effect on February 1, 2025. The Government of Alberta has made adjustments to coverage guidelines, which means certain optometry and eye care services that were previously covered, such as partial vision examinations, retinal imaging, and retinal photography, may no longer be covered under the plan. As a result, some visits may require patient payment and that particular services, previously fully covered, may now require a copay.

We understand that these policy changes by the Government of Alberta may be both unexpected and concerning to some. Please know that our Edmonton eye care clinic remains committed to providing exceptional eye care to all our patients. We recognize this decision by the government to delist particular eye care services may come as a surprise and place an unexpected burden on some individuals, and we share your disappointment over any inconvenience the policy change may cause.

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Changes to Eye Care Service Included in the Alberta Health Care Insurance Plan (AHCIP)

Alberta Health is implementing the following changes to optometry coverage, effective February 1, 2025:

  • Partial vision examinations for children and seniors will be delisted.
  • Fees for Computer Assisted Visual Fields and optometrist interpretation will be reduced.
  • Fees for retinal imaging (e.g., OCT) and interpretation and retinal photography and retinal interpretation will be reduced.
  • Retinal imaging and retinal photography along with their interpretation may be claimed up to twice per patient per benefit year regardless of the practitioner providing the service. Only one interpretation is payable per technical service. 2 technical services and interpretations may be claimed per benefit year.
  • Basic eye services will not be allowed to be billed on the same day as medically necessary eye care (e.g., dilations) for the same patient by any provider in the children and seniors' category.

All Albertans will be impacted by the changes announced by Alberta Health. The following populations will be most notably impacted:

  • Children and seniors
  • Patients with special needs
  • Low vision patients
  • Patients with chronic eye conditions including glaucoma, macular degeneration, diabetes, retinal or neurological conditions
  • Those with difficulties accessing transportation for multiple appointments
  • People in rural Alberta who must travel distances for eye care services

Delisting of Partial Eye Exams

The delisting of partial eye exams means that if during a full eye exam there is a reason the exam cannot be completed or there is a reason for a follow-up, there is no AHCIP-covered option available for the patient.

Potential Impact(s):

  • Service Fees

Reduced Coverage for Retinal Imaging & Photography

Reductions to diagnostic services covered by the AHCIP ill become difficult to follow up with patients as often as needed. In turn, this increases the potential for eye disease to needlessly advance.

Potential Impact(s):

  • Delayed Diagnosis
  • Increased Risk of Developing Eye Disease
  • Copay to Obtain Diagnostic Services

Same Day Basic & Medically Needed Eye Care Not Covered

These changes mean optometrists are no longer able to complete all of the needed care in one appointment. As a result, Albertans will need to schedule a follow-up examination on a different day to get the balance of care needed.

Potential Impact(s):

  • Delayed Diagnosis
  • Inconvenience
  • Service Fees if same day care is desired

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