Canada is known for having a national healthcare system, but individual provinces also have health insurance and even private insurance. Ontario Health Insurance Plan or OHIP covers most medical care including emergency and preventative care costs. Notable exceptions to its coverage include dental, vision, and chiropractic services.
For those outside Canada, there is often the misconception that all healthcare is free. Even residents may not know what services OHIP covers or how it is funded. Here we will take a look at how OHIP works, what it covers, eligibility and other important questions many Ontarians have.
Is the Ontario Health Insurance Plan Really Free?
OHIP is funded by three sources: The Canadian Government, payroll taxes from employees and taxes paid by Ontario-based businesses. While there is no direct “OHIP Tax,” citizens do essentially pay for healthcare to be available.
Though OHIP may not be as socialistic as some might assume, Ontarians still spend less per person on healthcare than in countries like the United States where there is no universal healthcare.
Also, OHIP’s system allows for a more equitable distribution of healthcare access. This means a sudden job loss or other financial hardship will not prevent a person from getting medical attention the way it might in the U.S.
Who is Eligible for the Ontario Health Insurance Plan?
Eligibility for OHIP and medical coverage in Ontario is fairly straightforward in most cases. Anyone who is considered a Canadian citizen, permanent resident or who has a valid work permit is eligible to be covered under OHIP.
What about new residents?
When an individual first moves to Canada, there is typically a 3 month waiting period before their health care can be covered under OHIP. Supplemental insurance can be purchased to cover this gap.
Citizens who move from another province?
When you move from another province to Ontario, there will also be a 3 month waiting period until you are eligible for OHIP. However, you will still be covered by your previous province’s insurance during this time.
What about travelling workers?
Typically, to be considered a permanent resident, you must live in Ontario for at least 153 days a year. However, if you have a job that requires you to travel more frequently than this you may need to provide proof you are travelling for your job in order to qualify.
Are refugees covered?
Refugees and protected persons can often get coverage through the Interim Federal Health Program, a temporary kind of insurance. Coverage with IFHP is similar to provincial healthcare. OHIP coverage may become available if an individual goes through the process of becoming a permanent resident.
What Services Does OHIP Cover?
OHIP is designed to provide citizens with urgent and preventative care. This includes doctor visits, hospital stays, certain dental surgeries and costs associated with childbirth. Below you will find a partial Ohip coverage list with some of the most commonly covered and necessary services.
It is important to note that some services may not be fully covered or will only be covered if they are deemed medically necessary and/or performed in a hospital.
- Hospital stays
- Doctor visits
- In-hospital dental surgeries
- In-hospital surgical abortions
- Diagnostics including x-rays and blood tests.
- Eye exams
- Ambulance transportation
- Mental health services performed by a medical doctor
- For a complete OHIP Coverage list, visit Ontario.ca.
What is Not Fully Covered by the Ontario Health Insurance Plan?
Dental, vision, prescription and physical therapy costs are some of the least covered by OHIP. However, this is not a blanket statement that applies to every service in these categories.
For example, vision tests are covered for anyone under the age of 19 or over the age of 65. Below are some of the services that may not be fully covered by OHIP.
Dental and Vision
OHIP will cover certain dental surgeries that are performed in a hospital but will not cover basic services like regular cleanings. Plus, while eye exams are covered, eyewear is not. Many people will either get coverage through their employers or purchase supplemental insurance to cover these costs.
Cosmetic and Chiropractic
Cosmetic surgery and most medically unnecessary surgeries are not covered. Chiropractic services and some physical therapy may also require complete or partial out-of-pocket payment.
Mental Health
Canada is a country that recognizes the need for mental health services. Also, most of these mental health services are covered. However, the definition of eligible mental health services covered under OHIP is typically narrowed to only include services provided by medical professionals such as psychiatrists. Other alternative therapy forms may not be covered and you should check for costs before proceeding.
Physiotherapy
Physical therapy is most widely covered for children/teens and elderly persons. It is also covered for persons recovering from specific injuries and illnesses.
Eligible physiotherapy will be performed in-clinic and your physician will determine how many sessions you should receive.
Prescriptions
Prescriptions are typically only covered for persons under the age of 25 and for patients during hospital stays. However, the Canadian government does work to keep the cost of prescriptions affordable by negotiating better rates with drug companies when possible. Private insurance can also be purchased to cover more expensive prescriptions.
Should You Buy Supplemental Health Insurance?
While citizens have access to many free and low-cost healthcare services, there are still some that are not covered or not fully covered. Similarly, people who are in their 3 month waiting period for coverage or who do not qualify as permanent residents may also need supplemental insurance.
In many cases, employers will offer insurance to cover things like dental, vision, physiotherapy, prescriptions and other services not fully covered by OHIP. You can also purchase supplemental insurance on your own.
Supplemental insurance can be beneficial if you need regular access to specialists and therapists not covered under OHIP. Private insurance can help to reduce the costs of prescription eyewear, extensive dental work and prescription medications.
Does Ontario Health Insurance Plan Cover Pandemic Care Costs?
As of now, OHIP does cover care related to COVID-19. The Pandemic has also caused some changes in OHIP eligibility. Most notably, anyone who has applied for the insurance but is still in their 3-month waiting period for coverage can still get their care for COVID-19 covered.
However, if you have any doubts about your eligibility or coverage it is best to contact OHIP directly. This is especially true now as the Pandemic is continuing to cause changes to policies.
Need to Find out if OHIP Covers What You Need?
While OHIP fully or partially covers many types of care, procedures and treatments there are still some areas that may not be clear.
If you have questions about your health and what OHIP covers for you, BCML physicians are here to help you navigate your coverage. Contact us to schedule a consultation and we will work with you to get you the best care with maximum coverage.