Blog Hero

Is Optical Coherence Tomography Covered by Insurance?

Request Appointment
Close-up of a young patient undergoing an Optical Coherence Tomography (OCT) scan.

Optical coherence tomography, or OCT, is an innovative approach to modern eye care. These scans can take in-depth cross-sectional images of your eye to detect all kinds of eye conditions, all during a regular comprehensive eye exam. But as amazing as this technology is, how much does it cost to get an OCT scan? Does insurance cover optical coherence tomography?

OHIP, the publicly available insurance program for Ontario residents, doesn’t currently cover OCT. However, if you have private insurance, it may be covered under your plan. It’s essential to thoroughly read what is and isn’t covered by your private insurance to determine if your provider will cover OCT.

Close-up of Optical Coherence Tomographer.

What Is an OCT Scan?

Optical coherence tomography, more commonly referred to as OCT, is a non-invasive imaging technology that provides detailed cross-sectional images of the retina. It uses light waves to capture high-resolution images of the different layers of the retina, allowing eye care professionals to assess its health and detect any abnormalities.

Unlike more traditional methods of eye scans, an OCT scan provides an in-depth, comprehensive view of the retina. This makes it much easier for an eye care professional to detect a wide range of potential eye diseases and conditions earlier, allowing for more timely intervention and treatment if necessary.

Here at Stoney Creek Optometry, we incorporate OCT scanning into every standard comprehensive eye exam to understand your eye and its inner workings properly.

Image explaining macular degeneration.

What Conditions Can OCT Detect?

So, what exactly are we looking for during these exams? Since OCT lets us see inside your eye, we can detect several conditions that otherwise would be much harder to find.

Some conditions we may be able to detect with OCT include:

Close-up of Age-related macular degeneration.
  • Glaucoma: This is a group of eye diseases that cause high internal pressure in the eye. If left unaddressed or untreated, glaucoma can begin damaging the optic nerve and can cause permanent damage.
OCT screen of Glaucoma.
  • Diabetic retinopathy: This is a diabetes-related condition that can damage the blood vessels in the retina.
OCT screen of Diabetic retinopathy.
  • Early signs of retinal detachment: This is where the retina detaches from the back of the eye. 

What Eye Services Does OHIP Cover?

Ontario residents have access to a public insurance plan called the Ontario Health Insurance Plan, or OHIP. It covers many different medical services, from regular doctor visits to more complex lab testing. It does cover some eye services but to an extent.

OHIP will cover:

  • 1 eye exam per year for Ontario residents aged 19 and under
  • 1 eye exam every 18 months for Ontario residents aged 65 or older who do not currently have a diagnosed eye condition, with 2 minor follow-up appointments as well
  • 1 eye exam per year for Ontario residents aged 65 or older with a previously-diagnosed eligible eye condition 

OHIP doesn’t cover eye exams for Ontario residents between the age of 20-64 unless they have a previously diagnosed condition that can affect their eyes. 

When Does OHIP Cover Eye Exams?

OHIP may cover a comprehensive eye exam if you’ve been previously diagnosed with:

  • Diabetes
  • Glaucoma
  • Cataracts
  • Retinal disease
  • Uveitis
  • Corneal damage
  • Damage to the optic nerve
  • Cranial nerve palsy

If you have one or more of these conditions, OHIP may cover 1 eye exam a year, along with 2 follow-up appointments.

If you do not meet these qualifications, you must either pay for the scan out-of-pocket or purchase private insurance from a third-party provider.

How Much Does an OCT Scan Cost?

The cost of an OCT scan can vary depending on a few factors. Primarily, this cost is determined based on the specific clinic you’re going to. Location and the skill of the optometrist performing the scan may also affect the price.

Without OHIP coverage, an OCT scan and a comprehensive eye exam can cost roughly $100-200 CAD. However, depending on your optometrist, the scan may cost slightly more or less.

It can help to contact your optometrist before your appointment to ask about their fee structure! And remember: if you have private insurance, make sure you thoroughly learn what is and isn’t covered to avoid any financial surprises.

The optometrist displays an OCT screen to the patient.

Booking Your Next Eye Exam

Comprehensive eye exams are one of the most essential steps to taking care of your eyes. That’s why our team at Stoney Creek Optometry incorporates OCT scans into every comprehensive eye exam—we want to understand your eyes fully so we can treat them properly. So, request an appointment with our team today, and let’s work together to care for your eyes!

Written by Dr. Douglas Fernick

More Articles By Dr. Douglas Fernick

Extended Hours, Direct Billing, & Conveniently Located

Life can get busy, and we want to help simplify your eye care experience. We are conveniently located on all major bus routes, provide free parking, have extended evening and Saturday hours, and offer direct billing to most insurance companies. We implement our extensive experience and innovative technology into our eye exams to ensure your visit is a productive one.

Our Location

Our clinic is located on Queenston Road, right next to Fortinos Plaza in the prestigious Stoney Creek Professional Arts Building.

Our Address

  • Stoney Creek Professional Arts Building, 980 Queenston Rd. Suite 202
  • Stoney Creek, ON L8G 1B9

Contact Information

Hours of Operation

  • Monday: 8:00 AM 5:00 PM
  • Tuesday: 8:00 AM 7:00 PM
  • Wednesday: 8:00 AM 5:00 PM
  • Thursday: 8:00 AM 7:00 PM
  • Friday: 9:00 AM 5:00 PM
  • Saturday: 9:00 AM 1:00 PM
  • Sunday: Closed

Dr. Douglas Fernick

Dr. Edward Hadzocos

Dr. Adam Jeary

Dr. Julia Baltais

Dr. Robert Stodulka

instagram facebook facebook2 pinterest twitter google-plus google linkedin2 yelp youtube phone location calendar share2 link star-full star star-half chevron-right chevron-left chevron-down chevron-up envelope fax