The Ontario Health Insurance Plan provides free medical care for Ontario citizens and long term residents. However, this leaves a gap in insurance coverage for anyone who is visiting the province, has not resided in Ontario for at least three months, or who only lives in Canada part-time. Additionally, some medical services are not covered under OHIP even for residents.
Here we will look at how much a doctor visit costs without OHIP and other key facts about who is eligible for OHIP and which services are covered. Regardless of your insurance status, you can also contact the BCML walk-in clinic at 416-925-6677.
Cost of a Doctor Visit Without OHIP
When determining the cost of a doctor’s visit without OHIP, several factors will affect the cost. One of the most important factors is simply where you are seeking treatment. There is no standardized cost for doctors’ visits in Ontario and specialists will typically be more costly than a general practitioner.
Additionally, there is a different cost for uninsured Canadian residents from other provinces versus an uninsured person who resides outside the country. That being said, you can expect a walk-in clinic visit to cost an average of $100CDN. This may be higher or lower but this is an average estimate of what most patients are likely to be charged.
Who is Not Covered by OHIP?
OHIP, most notably, does not cover non-residents. However, there are several factors that may also leave you uninsured. Here are some of the most common reasons you might not be covered and what you can do to become or remain eligible.
- Part-Time Residents: In order to be considered for OHIP you must maintain Ontario as your primary residence. This means residing in the province for at least 153 days out of the year.
- Mobile Worker/Student Status: A workaround for those who will not physically be in Ontario for 153 days is to fulfill the requirements for a mobile worker or student. This includes living in the province for at least two years prior to moving and providing proof that Ontario is still your primary residence. For a complete list of requirements, consult the Ontario Ministry of Health website.
- 3-Month Residency: In most cases, you must make Ontario your primary residence for at least three months before being eligible for OHIP. You must also plan to physically reside in Ontario for 153 out of the first 183 days after becoming eligible. Additional details and requirements can also be found on the Ontario Ministry of Health Website.
- Exemptions: There are several exemptions to the 3-month rule and the 153/183 day rule. Mobile workers and students do not need to meet the requirement of living in the province for 153 out of 183 of their first days. Additionally, children under 16 years of age who have been adopted by Ontario citizens will not be subject to the 3 months rule and will receive coverage upon living in the province.
- Visitors: Visitors, travelers, and tourists will not have coverage under OHIP. Instead, Canadian residents from other provinces should receive coverage from their own province’s health plan or from Canadian Medicare, which is the national health plan.
What is Not Covered by OHIP?
While OHIP provides coverage for a wide range of services, there are items that are not covered even for those who are eligible for the program. When considering the cost of a doctor’s visit in Ontario, these potential additional costs should also be considered.
- Doctor’s Notes: If you need a doctor’s note for work, school, jury duty, or other reason, this will not be covered. For basic notes like the ones needed to verify illness or injury to a child’s school, the cost is around $20 but can range up to $80 for a jury duty note.
- Prescription Drugs: Generally, prescription drugs are only covered when administered during a hospital stay. Additionally, those over 65 will also have their prescriptions covered.
- Eye and Dental Care: With the exception of those who are on financial assistance, dental care is not covered. Eye care is also typically not covered.
- Other Treatments: A variety of other treatments may also not be covered. These include physical therapy and chiropractic sessions.
- Medical Supplies: One of the more surprising costs that OHIP does not cover includes some medical supplies such as crutches, casts, and splints.
- Mental Health Services: The rules regarding mental health coverage under OHIP can be difficult to navigate. While psychiatry, medicine based therapy, is typically covered, talk therapy may not be. Before committing to any kind of mental health therapy it is best to check if it is covered under OHIP.
Options for Coverage without OHIP
Your options for coverage without OHIP will depend on your individual situation. For those who are visiting from outside Canada, some form of traveler’s insurance is best. What will be available is dependent on your home country but is a good investment no matter the circumstances when traveling.
For those who need coverage for the three months before they are eligible for OHIP, you can choose lower cost care options such as a walk-in clinic or community health center. However, a private healthcare plan will provide the best coverage during this time. Private insurance will even help with costs that would not typically be covered by OHIP for eligible residents. Due to this, private insurance may be worth the cost if you find you continue to have many out of pocket expenses even with OHIP.
Find Treatment without Insurance in Toronto
If you are not covered by OHIP in Toronto, it can be difficult to find the treatment you need. At BCML, we understand the unique needs of all of our patients, both insured and uninsured. We will work with you to create a plan that works for your health, your schedule, and budget.
We offer everything from standard physicals and blood work to dental care and more advanced diagnostics. To schedule an appointment and learn more about what BCML can do to help you manage your health goals, call us at 416-925-6677.