Most Ontarians assume OHIP covers everything. The reality is more complicated — and the gaps can be very expensive. Here is a complete guide to what OHIP covers and does not cover in 2026.
The Ontario Health Insurance Plan provides publicly funded health care to eligible Ontario residents. OHIP covers most medically necessary hospital and physician services — meaning services that a doctor determines are required for your health.
OHIP covers visits to family doctors and specialists, hospital stays including surgery, emergency room visits, most diagnostic tests ordered by a physician including blood tests and X-rays, obstetrical care during pregnancy and childbirth, and most mental health services provided by a physician or psychiatrist.
To be eligible for OHIP, you must be a Canadian citizen, permanent resident, or other eligible person who is physically present in Ontario for at least 153 days in any 12-month period and makes Ontario your primary place of residence. New residents of Ontario face a three-month waiting period before OHIP coverage begins — private insurance is recommended during this period.
Many Ontarians are surprised to learn how many common health services are not covered by OHIP. Understanding these gaps helps you plan for private insurance or out-of-pocket costs.
Dental care is not covered by OHIP for most adults. Routine dental cleanings, fillings, extractions, crowns, and orthodontics are entirely out-of-pocket or covered by private insurance unless you qualify for the new Canadian Dental Care Plan. Prescription drugs are not covered for most working-age adults — Ontario's Trillium Drug Program provides assistance for high drug costs relative to income. Vision care including eye exams is only covered for children under 20 and adults over 65 — working-age adults pay out of pocket. Physiotherapy, chiropractic, massage therapy, and most paramedical services require private insurance or self-payment.
Additional services not covered by OHIP include cosmetic procedures, private hospital rooms, most ambulance fees, hearing aids, most psychological services not provided by a physician, medical notes and forms for employers or insurance, and travel vaccinations.
The federal Canadian Dental Care Plan launched in 2023 and expanded through 2025 provides dental coverage to Canadians without private dental insurance whose family income is below $90,000 per year. This landmark program fills a major gap in Canadian public health coverage.
Eligible Ontarians can access covered dental services including cleanings, fillings, extractions, and dentures through participating dentists. The coverage level depends on income — families earning below $70,000 receive 100% coverage for eligible services, with co-payments increasing for higher incomes up to $90,000.
Q: Does OHIP cover mental health services in Ontario?
A: OHIP covers mental health services provided by a physician including family doctor consultations and psychiatrist visits. However services provided by psychologists, social workers, and other regulated mental health professionals are generally not covered by OHIP. Ontario's Structured Psychotherapy program provides free cognitive behavioral therapy for anxiety and depression through community mental health organizations — search Ontario Structured Psychotherapy to find a provider near you.
Q: Is OHIP valid when I travel outside Ontario?
A: OHIP provides limited out-of-province coverage within Canada — it covers emergency physician and hospital services in other provinces but at Ontario rates which may be lower than what other provinces charge. OHIP provides very limited coverage outside Canada. Travel health insurance is strongly recommended for any international travel and for travel within Canada if you have significant health needs.
Q: What is the Ontario Drug Benefit program?
A: The Ontario Drug Benefit (ODB) program covers the cost of most prescription drugs for eligible Ontarians including those 65 and older, residents of long-term care homes, recipients of Ontario Works or Ontario Disability Support Program, and children and youth under 25. Eligible ODB recipients pay a small dispensing fee and in some cases a small co-payment per prescription.
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