Ontario Health Insurance Plan (OHIP)

The Ontario Health Insurance Plan (OHIP) covers standard ward room accommodations and medically necessary services during hospital stays. Private and semi-private rooms are not included in the coverage and will require an additional fee.

The Ontario Drug Benefit (ODB) program provides coverage for residents aged 65 and older, individuals receiving social assistance, and people in long-term care or receiving home care. Through OHIP+, people aged 24 and younger who aren’t covered by a private plan get eligible prescription drugs at no cost, and the Trillium Drug Program helps households with high drug costs. The ODB program covers drugs listed on the Ontario drug formulary, and participants pay a co-payment depending on their income level. The Biosimilars Initiative in Ontario ensures that only biosimilar versions of eligible drugs are covered under the provincial plan.

The Ontario Health Insurance Plan (OHIP) covers one major eye exam every 12 months for residents aged 19 and younger, 65 and older, and for those aged 20 to 64 with medical conditions requiring regular eye exams. Prescription glasses and contact lenses are not included.

In-hospital dental surgeries are covered when medically necessary, but routine dental services, such as cleanings, fillings, extractions, crowns, and dentures, are not covered under the Ontario Health Insurance Plan (OHIP). The plan also does not cover dental treatment for accidental injuries to teeth, leaving residents responsible for most dental care costs.

Ontario Health Insurance Plan (OHIP) provides limited coverage for podiatrist services, up to an annual maximum of $135, with additional fees for x-rays. Chiropractor, psychologist, massage therapy, and naturopath services are not covered under OHIP.

Ontario’s Assistive Devices Program (ADP) covers up to 75% of the cost of hearing aids and other customized equipment and medical supplies for residents with long-term physical disabilities. Residents pay the remaining 25%. ADP does not cover maintenance, repairs or replacement of hearing devices, or repairs and maintenance of other equipment and supplies. Eligibility is based on the individual’s condition, their long-term need for the equipment and the type of device required.

Ambulance services in Ontario are covered when medically necessary, both for land and air ambulance transportation within the province. However, residents are required to pay a copayment for these services, unless they meet specific exemptions. Some exceptions apply, such as for seniors, those with social assistance, or hospital-to-hospital transfers.

Ontario’s home care services are based on need and offer support such as personal care, nursing, rehabilitation, and home support services. The provincial government provides coverage if you qualify, ensuring care can be administered in the home or community for those with assessed medical requirements.

Ontario’s Out-of-Country Travellers Program provides coverage for emergencies only, reimbursing services at Ontario rates. The province also offers coverage for out-of-country dialysis services for Ontarians living with kidney failure. All other non-emergency or non-hospital services are not covered, and residents are responsible for any costs beyond provincial rates.

The Ontario Health Insurance Plan (OHIP) does not provide coverage for accidental death and dismemberment. Private insurance options are available for residents who require this type of protection.