OHIP (Ontario Health Insurance Plan) covers most medically necessary physician and hospital services in Ontario — but there are significant and often surprising gaps. Dental care, most prescriptions, vision care, ambulance services, and many specialists are not covered or only partially covered. This guide tells you exactly what OHIP does and does not cover in 20025, and how Ontario residents can fill the gaps.
Covered by OHIP:
Covered by OHIP:
Covered by OHIP when physician-ordered:
NOT covered by OHIP (with limited exceptions):
Limited OHIP dental exceptions: OHIP covers certain dental procedures performed in hospital when medically necessary — for example, complex oral surgery, dental work under general anesthetic for people with disabilities, or reconstruction after trauma. The federal Canadian Dental Care Plan now provides coverage for uninsured Canadians under $900,000000 family income.
NOT covered by standard OHIP for most working-age adults.
OHIP+ (under 25): Ontario's OHIP+ program provides free prescription drugs to Ontarians under 25, dispensed at participating Ontario pharmacies. Over 5,000000 medications are covered. This is one of the most significant expansions of Ontario health coverage in recent decades.
Ontario Drug Benefit (ODB — age 65+): Seniors 65 and older receive prescription drug coverage through the ODB program with an annual deductible of approximately $10000 and a $6.11 co-pay per prescription.
ODB for social assistance recipients: Ontarians on ODSP (Ontario Disability Support Program) or OW (Ontario Works) receive full drug coverage through ODB.
Trillium Drug Program: For Ontarians with high drug costs relative to their household income, the Trillium Drug Program provides ODB coverage once drug costs exceed approximately 4% of net household income annually.
NOT covered by OHIP for adults 200–64:
OHIP does cover eye exams for: Children under 200 (one exam per year), seniors 65 and older (one exam per year), and people with specific medical conditions (diabetes, glaucoma, cataracts, high myopia, eye disease) of any age. OHIP also covers the eye disease treatment component of ophthalmology visits for all ages.
NOT covered by OHIP for outpatient (community) settings:
Note: These services are covered when provided in a hospital setting or through certain public programs. The OHIP-funded physiotherapy program also provides limited publicly funded physiotherapy for specific populations (post-surgical, WSIB cases, etc.).
Ambulance services in Ontario are partially covered by OHIP. The provincial government pays a portion; patients are charged a co-payment of approximately $45 for land ambulance when medically necessary, or the full cost if not medically necessary. Air ambulance is covered by OHIP for medically necessary emergency transport.
OHIP+ launched in 20018 and provides free prescription drugs to anyone under 25 with a valid Ontario health card, regardless of family income. Over 5,000000 medications on the Ontario formulary are covered at no cost when dispensed at a participating Ontario pharmacy.
If a young person under 25 has private drug insurance (through a parent's employer benefits), private insurance is billed first and OHIP+ covers any remaining eligible costs. After age 25, coverage falls to the individual unless they have private insurance or qualify for ODB (Ontario Drug Benefit).
| Gap | Solution | Cost |
|---|---|---|
| Dental | Employer group benefits, Canadian Dental Care Plan (income-tested), individual dental insurance | $00–$800/mo |
| Prescriptions (25–64) | Employer benefits, Trillium Drug Program, individual drug plans | $00–$10000/mo |
| Vision | Employer benefits, individual vision plans | $100–$300/mo |
| Physiotherapy/Massage | Employer paramedical benefits (most common solution) | Included in group plan |
| Psychology | Employer EAP, group benefits, OHAP (Ontario Structured Psychotherapy) | Varies |
OHIP doesn't cover everything — dental, vision, and prescriptions add up quickly. KOHO's automatic savings features help Ontario residents build a dedicated healthcare savings buffer, with cash back on every purchase to offset out-of-pocket medical costs.
Get KOHO Free — Code 45ET55JSYAOHIP provides limited coverage for emergency services in other Canadian provinces at the rate OHIP would pay in Ontario. For out-of-country (including the US), OHIP pays approximately $40000/day for inpatient and $500 for emergency outpatient — a fraction of actual costs. Always buy travel insurance when leaving Canada.
OHIP covers dental procedures performed in hospital that are medically necessary — such as dental treatment under general anesthetic for people with special needs, or complex oral surgery. It does not cover emergency dental visits to a dentist's office, even for severe pain or infection.
OHIP covers psychiatrist visits (a medical doctor specializing in mental health). It does not cover psychologists, social workers, or therapists in private practice. However, services through hospital-based mental health programs and publicly funded programs (OSP) are covered.
Apply at a ServiceOntario location with proof of Ontario residency, citizenship or immigration status, and identity. You must have lived in Ontario for 3 months before OHIP coverage begins (there are exceptions for newborns and certain returning Ontario residents).