What Does OHIP Cover?

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Every Ontario resident is entitled to OHIP for their medical care, but Canada’s “Free Healthcare” that so many envy doesn’t cover everything.

The following is a simple snapshot of the Health, Dental and paramedical services it does cover: (For more specifics you can contact them at 1.800.268.1154 www.gov.on.ca)

Medical Supplies: Some assistance through the Assistive Devices Program (ADP) for a variety of devices, including electric and manual wheelchairs to a maximum of 80%. The full amount of an insulin pump is covered every five years, as of September 1, 2008. Insulin pump supplies are covered annually up to a maximum of $2,400.

Podiatry: When performed in an approved facility, you get $135 maximum (plus $30 X-Ray) per benefit year ($16.40 for the initial visit and $11.45 for every subsequent visit).

Travel: In-patient services are coverd up to $400 a day and out-patient services are covered up to $50 a day for emergencies only.

Nursing and Home Care: Based on needs.

Hearing Aids: $500 per aid every three years.

Chiropractic: Not covered.

Physiotherapy: Allowed in OHIP approved clinics and long-term care facilities for ages 19 and under, as well as 65 and over to a maximum of $12.20 per visit for 100 visits a year. All others a maximum of $12.20 per visits for up to 50 visits a year if required due to overnight hospitalizations.

Osteopathy: $155 max benefit per year: $12 for initial visit, $9.50 for every subsequent visit and $25 for X-ray. Note: Very few OHIP approved practioners.

Speech Therapy: Only when performed in hospitals.

Dental: Only surgical procedures performed in hospitals.

Eye examination: One exam every 12 months for ages 19 and under, as well as 65 and over. Those receiving social assistance or with an approved medical condition are also eligible for an eye exam every 12 months.

Intraocular Lens: Standard hard/rigid and soft/foldable IOL’s are covered once per lifetime per eye.

Ambulance: $45 patient co-pay.

Accommodation: A standard ward = no charge. The daily rate for semi-private is $110 to $235 and a daily rate for a private room costs $200 to $325 (not legislated).

Lab and Diagnostic Tests: See OHIP list of eligible tests. PSA tests are covered as of January 1, 2009.

Prescription Drugs: The Ontario Drug Benefit Program covers seniors and social assistance recipients. Low income recepients and seniors are responsible for a $2 co-pay per prescription. Higher income seniors must satisfy a $100 deductable, followed by a co-payment of up to $6.11 per perscription. The Trillium Drug Program is available to all Ontario residents covered by OHIP with high drug costs in relation to your income. Eligibility requires that private insurance doesn’t cover 100% of their drug costs. Approved applicants are responsible for an income based deductable, in addition to a co-payment of up to $2 per perscription. ODB drugs can fall under the full benefit or be Limited Use Drugs, where the patient must meet specific medical criteria. As of January 2008, there is a new drug status called ‘Conditional Listings’. Drugs with this status are considered under the full benefit. In some cases, drugs not covered at all may be considered based on need as part of a clinical review. The benefit year falls between August 1 and July 31. The Special Drugs Program provides certain drugs at no cost to patients meeting certain clinical criteria. It is approved by a designated centre/physican for the drug. Conditions covered maybe Cystic Fibrosis, Thalassemia, HIV, end stage renal disease, growth hormone failure Schizophrenia, Gaucher’s Disease and some transplant patients. Cancer Care Ontario provides some cancer treatment drugs to patients meeting specific criteria.

Source: GreenShield Canada

Individual health and dental insurance is available to protect you and your family from items not covered Health and Dental Insurance. We also offer company benefit plans for small, mid size and large businesses – you can get more details here or a Group Insurance Quote here.

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  • Jane
    October 21, 2016 at 5:28 pm

    Does OHIP cover Breast Reduction Surgery?

    • Syed Raza
      October 25, 2016 at 10:59 am

      Hi Jane,

      Thank you for your question. In some cases this procedure can be covered by OHIP.

      Here is a good answer from Dr. Mitchell Brown on his website:

      Dr. Brown answers: “A breast reduction procedure may be performed for functional reasons (back pain, neck pain, shoulder grooving, rashes under the breast) or for non functional/aesthetic reasons including personal desire for smaller or lifted breasts, discomfort with exercise, problems with fitting clothes or an upper body that is out of proportion with the rest of the body.

      OHIP will consider coverage on a case by case basis when the indications for surgery are primarily functional. An approval form must be submitted by the surgeon directly to OHIP. If approved, the goal of the breast reduction will be to remove enough breast tissue to effectively treat the symptoms and the functional concerns of the patient.”

      Hope that helps!

      Regards,
      Syed

  • Ron
    July 20, 2016 at 8:28 pm

    Syed. Thank you for the information. Much appreciated.

  • Ron
    July 20, 2016 at 12:09 pm

    Does OHIP cover any Medical cannabis and supplies which is physician approved with documentation for seniors. If anyone could direct me to any information would be appreciated

    • Syed Raza
      July 20, 2016 at 4:18 pm

      Hi Ron, Thanks for the question. Currently, medical marijuana and devices such as vapourizers are not covered under basic provincial health plans. It’s worth noting though, as of a recent change of policy medical marijuana now qualifies as a medical expense under CRA guidelines.

  • chrissie
    November 9, 2014 at 3:04 am

    Does ohip cover a hysterectomy? Three kids later while on birth control and using condoms. I also have cysts on my ovaries.

  • Anna Sun
    September 30, 2014 at 11:40 am

    Hi Missy,

    I’m sorry to hear of the discomfort you are having. In regards to OHIP, you can view the link I have posted as it will contain the questions you are seeking: http://www.health.gov.on.ca/en/public/publications/pub_ohip.aspx

  • missy
    September 27, 2014 at 11:28 pm

    I have 3 children. After my third child I lost a lot of my breast and they went oddly shaped and now doesn’t fit properly in any of my existing bras. Esp when I lay down I now have to take the bra off due to extreme discomfort. Not only has this affected me physically but has emotionally and mentally. Is there anywhere in the system of ohip that I can find any coverage for breast implants? I would appreciate any advice in this embarrassing issue. Thank you kindly in advance.

  • pam
    September 8, 2014 at 8:35 pm

    If have a lump 5 cm, chemo happening, Dr recommend a lumpectomy but I want a double mastedctomy, with no family background of problems, will ohip cover a double mastectomy.

  • Charlie
    September 7, 2014 at 1:38 pm

    Wondering if a psychiatrist is covered after having brain surgeries?

    • Anna Sun
      September 8, 2014 at 3:32 pm

      Hi Charlie,

      Psychiatric care is covered under OHIP in Ontario provided you get a referral by your family physician. Psychiatrists’ fees are covered by provincial and territorial health plans. If you want to get more information, please view this website: http://www.cmha.ca/

  • DIANE
    September 4, 2014 at 7:41 pm

    Is footcare done by a General Practioner (MD) covered by OHIP?

  • Sara
    August 4, 2014 at 10:22 pm

    I am diabetic and can’t seem to lose any weight in my mid section I always look pregnant even though I don’t have my overuse anymore does OHIP cover tummy/surgery to help with lose this

    • Anna Sun
      August 6, 2014 at 10:41 am

      Hi Sara,

      Thanks for your comment! Unfortunately, OHIP does not cover services that are not medically required, such as cosmetic surgery.

  • Kerry
    August 4, 2014 at 4:23 pm

    Does OHIP cover private rehab centres for alcohol abuse and addiction or only the public ones?

  • p hagan
    March 18, 2014 at 10:20 am

    does OHIP cover airlifting a person from one hospital to another thanks

    • syed
      March 19, 2014 at 6:28 pm

      Hi,

      That’s a great question. I’ve looked into it a bit and cannot find any specific coverage for ‘hospital to hospital’. Your best bet is to contact the Emergency Health Services Branch or Ornge (formerly the Ontario Air Ambulance Services Co.) which is the Ontario Air Ambulance Program service provider. They should be able to tell you what is covered in specific situations.

      Best of Luck!

  • zafar
    February 16, 2014 at 11:21 pm

    My mother needs her hearing aid to be replace by new because the current one is no more working.she is above 70years and they are saying the original cost is $1500 and my mom has to pay $1000
    Is there any way she can get some discount

  • Kristin Molnar
    February 9, 2014 at 12:29 pm

    Is gastric bypass covered?

  • Larry
    October 12, 2013 at 11:47 am

    Does OHIP cover the cost of hearing tests?

    • LSM Insurance
      October 13, 2013 at 11:47 am

      Hi Larry, Behind the ear hearing aids are covered as well in the ear haring aids. Things like batteries are not covered

  • Sue
    July 2, 2013 at 8:13 pm

    Many thanks Syed….will do as you suggest.

    I find it very dishearting when a professional advises you that you wont have to pay for the medication due to OHIP. You then get discharged and there is no medication available because everywhere is closed. We did find one open a Rexall however they wouldnt fulfill one part of the prescription without the other ( and you guessed it, it was a specialised drug they didnt hold lol) You really couldnt make this up.

  • Sue
    July 2, 2013 at 1:20 pm

    Hi, I’ve just been discharged from hospital after having a total hip replacement. Not only was the hospital pharmacy closed Rexall and Shoppers refused to fill the prescription as it was a specialised medication. In the meantime I’ve had to survive on Tylenol….btw going back to the ward was pointless they must have known the pharmacy was closed even though the nurse on duty told me otherwise.

    My husband was made redundant over 6 months ago and has just started a very much lower paid job to keep us ticking over. My main beef is having to pay out $300 for a month’s worth of drugs that surely should have been covered on OHIP.
    Where do I take this further?

  • Crissy
    May 14, 2013 at 8:56 pm

    I have had the gastric bypass and it was and it was covered by Ohip. I am now onl 30 pounds awa from my highest weight. I didn’t lose as much as most and I’ve gained quite a bit back. Does ohip cover a revision?

  • Wendy
    April 30, 2013 at 3:40 am

    I was wondering if anybody knows if Ohip will cover Breast implants along with surgery to have loose skin tighten. ? After having gastric bypass to loose weight for medical reasons

    • syed
      April 30, 2013 at 5:38 pm

      Hi Wendy,

      Thanks for the great questions and congratulations to you on your road to better health. I am not an expert on the subject but was able to do some research for you.

      OHIP will cover breast implants surgery for breast reconstruction after a mastectomy resulting from breast cancer and for cases of extreme congenital disorders. I was not able to find any other situations where OHIP coverage would be applicable for breast augmentation procedures.

      Regarding the removal of excess skin, Pannilectomy surgeries are usually not covered under OHIP. However, OHIP has covered this procedure in some cases of rash or infection.

      You can find more information from the OHIP website here:

      http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/append.pdf

      Hopefully that helps answer your questions. Best of luck. Thanks.

  • Bill
    January 16, 2013 at 2:54 pm

    Does OHIP cover private rehab centres for alcohol abuse and addiction or only the public ones?

  • Joel Cadesky
    January 7, 2013 at 7:32 pm

    Mary:I am not positive this is covered.The best person to contact would be your podiatrist who should be able for sure to tell you if covered or not.

  • Mary MacVittie
    January 7, 2013 at 11:18 am

    I have a bone spur, facitis and would like to know if I am covered for orthopedic shoes

  • Vincent
    October 26, 2012 at 12:44 pm

    I am a senior citizen aged 75, living in the province of Ontario. I have a cavity in a tooth. Am I covered by OHIP towards treatment by a dentist or Hospital?
    I live with my daughter who has sponsored me and my wife to live in Canada.

  • LSM Insurance
    January 25, 2012 at 1:31 pm

    Thanks for the note Bella – it is hard to say if you need Critical Illness insurance without doing a needs analysis. Critical Illness insurance provides valuable protection which pays out a lump sum if the insured is diagnosed with an illness such as cancer stroke or heart attack.

  • Bella
    January 25, 2012 at 11:28 am

    Do I need critical insurance?

  • LSM Insurance
    June 26, 2011 at 2:05 pm

    See Greenshelds Canada quick reference:

    Prescription Drugs: The Ontario Drug Benefit Program covers seniors and social assistance recipients. Low income recepients and seniors are responsible for a $2 co-pay per prescription. Higher income seniors must satisfy a $100 deductable, followed by a co-payment of up to $6.11 per perscription. The Trillium Drug Program is available to all Ontario residents covered by OHIP with high drug costs in relation to your income. Eligibility requires that private insurance doesn’t cover 100% of their drug costs. Approved applicants are responsible for an income based deductable, in addition to a co-payment of up to $2 per perscription. ODB drugs can fall under the full benefit or be Limited Use Drugs, where the patient must meet specific medical criteria. As of January 2008, there is a new drug status called ‘Conditional Listings’. Drugs with this status are considered under the full benefit. In some cases, drugs not covered at all may be considered based on need as part of a clinical review. The benefit year falls between August 1 and July 31. The Special Drugs Program provides certain drugs at no cost to patients meeting certain clinical criteria. It is approved by a designated centre/physican for the drug. Conditions covered maybe Cystic Fibrosis, Thalassemia, HIV, end stage renal disease, growth hormone failure Schizophrenia, Gaucher’s Disease and some transplant patients. Cancer Care Ontario provides some cancer treatment drugs to patients meeting specific criteria.

    Source: GreenShield Canada

  • Dora
    June 26, 2011 at 1:14 pm

    Does ohip cover crestor?