Alberta Health Care

Understanding Alberta Health Care Coverage

Alberta Health Care provides comprehensive coverage for various medical needs, including a wide range of eye care services. 

Understanding what is covered, especially routine eye exams, emergency care, and special tests, can help Albertans access the care they need and make informed healthcare decisions. This page will review what is covered and isn't covered by Alberta Health Care in 2024. 

Routine Eye Exams for Kids Age 0-18

Children's eyes are constantly developing, making regular eye exams crucial for detecting any vision problems affecting their learning and development. Alberta Health Care understands this need and covers the cost of routine eye exams for all children and teenagers from birth until they turn 19. These exams are vital for catching issues early when they are most treatable.

Only 1 in 3 children are seen by an optometrist every year. Children should have an eye exam every year, even if you don't think they have any problems. 

Routine Eye Exams for Adults Age 19-64

While Alberta Health Care provides comprehensive coverage for various age groups and medical conditions, it's important to note that routine eye exams for adults aged 19-64 are not covered. This means that for many working-age adults, the cost of regular check-ups and vision tests must be managed out-of-pocket or through private insurance.

Routine Eye Exams for Seniors Aged 65 and Older

As we age, the risk of eye diseases and conditions increases. Recognizing the importance of early detection and ongoing monitoring, Alberta Health Care provides coverage for routine eye exams for seniors aged 65 and older. Regular check-ups can help catch age-related issues such as cataracts, glaucoma, and macular degeneration early on.

Emergency Eye Care for All Albertans

Eye emergencies can happen to anyone, regardless of age. Whether it's sudden vision loss, eye trauma, or severe pain, Alberta Health Care covers emergency eye care for all residents. This includes visits for eye infections, red eyes, and other urgent issues. Immediate access to care can prevent more severe complications and ensure quick and effective treatment.

Some of the most reasons people might need to book an emergency eye exam include:

• Conjunctivitis (Pink Eye): Characterized by redness, itching, and discharge, this infection can be viral, bacterial, or allergic.

• Corneal Abrasion: Scratches on the cornea often caused by foreign objects, contact lenses, or rubbing the eye too hard.

• Foreign Object in the Eye: Anything from dust to metal shards that gets lodged in the eye, causing discomfort or potential injury.

• Stye (Hordeolum): A painful, red bump near the edge of the eyelid, indicating an infected gland.

• Chemical Burn: Exposure to harmful chemicals, requiring immediate flushing and medical attention.

• Subconjunctival Hemorrhage: A burst blood vessel in the eye, leading to a bright red patch on the white of the eye.

• Uveitis: Inflammation of the middle layer of the eye, causing redness, pain, and blurred vision. It’s heavily linked to autoimmune conditions like Crohn’s, Irritable Bowel Syndrome, and Arthritis.

• Retinal Tears & Detachment: An urgent condition where the retina pulls away from its normal position, leading to potential vision loss.

• Acute Glaucoma: A sudden increase in eye pressure causing intense pain, redness, and blurred vision.

• Orbital Cellulitis: A severe infection involving the tissues around the eye, leading to pain, swelling, and redness.

When in doubt, give our office a call. Optometrist are the best health care practitioners for diagnosing and treating the majority of eye infections.

Annual Diabetes and High Blood Pressure Eye Health Exams

Individuals with diabetes and hypertension are at a higher risk for eye diseases. Alberta Health Care provides annual eye health exams for all Albertans with these medical conditions, regardless of age. These exams are crucial for monitoring the health of your eyes and preventing diseases like diabetic retinopathy and hypertensive retinopathy, which can lead to severe vision loss if left unchecked. No referral from your family doctor or nurse practitioner is required for these exams. These exams involve a dilated retinal examination as well as special imaging tests.

Special Tests Covered When Medically Necessary

When specific eye conditions are suspected, Alberta Health Care covers the cost of special tests that provide a more in-depth look at your eye health. This includes:

• Optomap Ultra-Widefield Imaging: Captures a detailed image of your retina, helping detect signs of disease.

• OCT Eye Health Scans: Provides cross-sectional images of the retina, essential for diagnosing and monitoring conditions like macular degeneration and glaucoma.

• Computerized Visual Field Testing: Assesses your peripheral vision, which is crucial for detecting glaucoma and other neurological conditions.

These tests are covered when deemed medically necessary by your eye care professional. To fall within the rules, your optometrist may need to bring you back on a separate day to perform these tests.

What’s Not Covered by Alberta Health Care

• Upgraded Services: If you opt for services that are not covered under the standard eye exam, such as certain advanced imaging tests or treatments, the optometrist might charge extra for these additional services.

• Missed Appointment Fees: Alberta Health Care does not cover no-show or missed appointment fees. These fees must be paid personally. Please review our cancellation policy.

• Forms: There may be a small charge for filling in forms, sick notes, or providing letters. Alberta Health Care also does not cover the cost of drivers forms or workplace medicals.

Accessing Your Alberta Health Care Benefits

Accessing your Alberta Health Care benefits is straightforward. Simply present your Alberta Health Care Card and a piece of government-issued photo ID at your eye care provider's office. They will handle the rest, ensuring you receive the covered services without hassle.

____________

New Rules for 2024 - Albert Health Care

When Alberta Health Care covers an eye exam or special test, optometrists are typically reimbursed directly by the government for the cost of the procedure. However, the government has allowed the contract to expire. Because of this, optometrists have not had these fees adjusted in several years, which is not allowing them to keep up with the cost of doing business and with general inflation. Under the old contract, optometrists can 'Balance Bill' for the difference between their standard fees and the fee paid by the government. This Balance Bill system is similar to the one currently in British Columbia. 

Currently, Helio Optometry does not balance bill for Alberta Health Care covered services. This may need to be reviewed in the future, however, we are optimistic that a new contract will be signed soon, highlighting the fiscal realities we need to operate in.