Health Insurance Ontario - Plans, Costs & Vision Coverage

Health Insurance in Ontario: Public and Private Coverage Options

December 4, 2024

Scroll down for full content ↓

Life in Ontario is full of possibilities. Whether you’re climbing the corporate ladder in Toronto or finding inspiration in the tranquility of cottage country—there’s no shortage of opportunities here.

To make the most of it all, staying healthy is essential—and that’s where the Ontario Health Insurance Plan (OHIP) comes in. OHIP Provides coverage for essential medical care, but services like dental and vision care are not included.

Pairing private insurance with OHIP helps you access the care you need to embrace every opportunity Ontario has to offer. This guide covers everything you need to know about health insurance in Ontario—including public and private options—so you can get the coverage you need to stay healthy and active.

Key Takeaways

Ontario’s Public Health Insurance (OHIP): Provides essential health services like hospital visits and diagnostic tests, but it doesn’t cover dental or vision care.
Private and Supplemental Insurance Many Ontarians use private health insurance to fill gaps left by OHIP—covering dental, vision, and medication costs.
Choosing the Right Plan:Picking the best health insurance in Ontario depends on your needs, budget, and priorities—whether it’s comprehensive family coverage or an affordable basic plan.

Understanding Health Insurance in Ontario: Public vs Private Options

Whether you’re exploring private health insurance for the first time or looking to supplement existing coverage, it’s important to understand how public and private options can work together to meet your needs.

OHIP covers a wide range of essential healthcare services, including:

Doctor Visits: Both in-person and virtual appointments.
Hospital Visits and Stays: This includes diagnostic tests like blood work and X-rays, as well as doctor and nursing services, medications (for in-patients), and standard room accommodations.
Laboratory Testing: Medically necessary lab tests performed in hospitals and approved community labs.
Podiatry: Partial annual coverage for foot-health services.
Ambulance Services: Partial or full costs, depending on the situation.
Travel for Nothern Ontario Residents: OHIP assists with travel and accommodation costs when seeking specialized treatment far from home.
Eligible Dental Surgeries: Such as reconstructive surgery or tumor removal.

Despite OHIP’s extensive coverage, many important services are left out for most Ontarians. Private health insurance plans can help fill these gaps by covering services such as:

Vision Care: Routine eye exams, glasses, and contact lenses. However, OHIP may cover routine eye exams for residents under 20, over 65, or with specific medical conditions like diabetes.
Dental Services: Routine cleanings, filling, advanced procedures, and orthodontics.
Prescription Medications: Most medications are not covered by OHIP unless you’re over 65 or qualify for the Ontario Drug Benefit program.
Rehabilitation Therapies: Physiotherapy, chiropractic care, and massage therapy.
Alternative Therapies: Acupuncture, naturopathy, reflexology, and other therapies.

Choosing between public and private insurance—or both—depends on your needs. Combining OHIP with private health insurance gives you access to a wider range of healthcare services and allows you to manage your health on your own terms.

Eligibility Criteria for Health Coverage in Ontario

Wondering if you qualify for OHIP? Here are the basic eligibility requirements:

Permanent Residents and Citizens: Ontario must be your primary home, and you need to physically live in the province for at least 153 days in a 12-month period. Spend too much time elsewhere and you could risk losing your benefits.
Temporary Workers: If you hold a valid work permit and are employed full-time in Ontario for at least six months, you can apply for OHIP. Spouses and dependents may also qualify.
International Students: Only some long-term study permits that meet specific conditions are eligible.

How to Apply for Public Health Insurance in Ontario

Getting covered by OHIP is easier than you might think. Simply visit a ServiceOntario center with the right documents to prove your identity, residency, and citizenship. Once you’ve applied, it typically takes around three months for your coverage to kick in. During this waiting period, newcomers should consider short-term private health insurance to avoid unexpected medical bills.

Supplemental Health Insurance Options in Ontario

Since OHIP doesn’t cover everything, supplemental insurance is a popular way for Ontarians to fill healthcare coverage gaps. Here are your two main options:

Employer-Sponsored Health Plans: Many employers provide health benefits packages that include dental, vision, prescription drugs, and paramedical services like physiotherapy and massage therapy. The best part? You can easily add your dependents to your plan, and since costs are shared across the organization—you get access to comprehensive coverage for less.
Personal Health Insurance Plans: For freelancers, self-employed individuals, or retirees without employer-sponsored benefits, private personal plans provide a flexible option. With customizable options, you can find the plan that suits your needs and budget.

Without supplemental coverage, healthcare costs can quickly add up. Exploring private insurance options allows you to access the care you need while keeping these costs under control.

Tips for Choosing the Right Health Insurance Plan

Looking for the best health insurance plan in Ontario? Finding the right plan depends on your personal and family needs. Here’s how to make the best decision:

Think About Your Needs: Does your family need orthodontic and vision care? Do you have a recurring injury that requires physiotherapy? Consider your health needs and look for plans that match your requirements.
Compare Costs: The cheapest plan might seem appealing, but don’t forget to consider the bigger picture—like deductibles, co-pays, and how much coverage you’re getting for the price. Remember, limited coverage in cheaper plans could mean higher out-of-pocket costs later.
Check Plan Limits: Some plans cap coverage for services like physiotherapy or dental treatments. Knowing these details upfront can save you from unexpected expenses down the line.

Summary: Ontario Private vs Public Coverage

OHIP Limitations: While OHIP covers essential health services, it excludes important areas like dental, vision, and prescription coverage.
Private Insurance Benefits: Private insurance bridges the gap by covering services not provided by OHIP—giving Ontarians more control over their healthcare options.
Choosing Wisely: From individual plans to family packages, Ontario’s private health insurance options are flexible enough to meet diverse needs and budgets.

FAQs: Public and Private Health Insurance Ontario

What is covered under Ontario’s public health insurance?

Ontario’s OHIP provides coverage for a range of essential medical services, including hospital visits, surgeries, and primary care consultations. But it doesn’t cover dental, vision, or prescription medications for most residents. For extended coverage, many Ontarians rely on private health insurance or employer-sponsored benefits.

Does Ontario’s health insurance cover alternative treatments like acupuncture?

OHIP does not cover alternative treatments such as acupuncture, chiropractic care, or naturopathy. These services are often included in private health insurance plans, so if you’re interested in alternative treatments, it’s worth exploring a plan that offers this coverage.

Are prescription drugs covered by health insurance in Ontario?

Prescription drugs are not covered under OHIP for most residents. However, seniors aged 65 and older qualify for the Ontario Drug Benefitprogram, which helps with prescription drug costs. For everyone else, coverage is typically provided by employer-sponsored or private health insurance plans.

Are physiotherapy, chiropractic, or massage therapy services covered?

OHIP only covers physiotherapy in specific cases, such as for seniors, individuals in long-term care, or patients receiving care in certain facilities. For most Ontarians, paramedical treatments like chiropractic care, massage therapy, and physiotherapy require additional coverage through a private health insurance plan.

How can students and young adults access health coverage in Ontario?

Ontario students who aren’t eligible for OHIP may need private health insurance. Fortunately, many universities offer health plans that include dental, vision, and prescription coverage. Depending on the policy, young adults under 25 may still be covered under their parents’ health insurance plans. Be sure to check with your parents’ provider to confirm eligibility.

Does health insurance cover travel outside of Ontario?

OHIP provides limited coverage for emergency medical services outside of Ontario, but it doesn’t cover all expenses. For frequent travelers, travel insurance is a better option, offering comprehensive coverage for emergency services like transport and international hospital care.

Is there support for low-income individuals who can't afford private insurance?

Yes, Ontario offers programs like the Trillium Drug Program, which helps low-income residents afford prescription drugs. Some community health clinics also provide free or low-cost services for those who meet eligibility requirements.