Guide · Updated September 2026
What Ontario's health insurance pays for, the list of services it does not cover at all, who gets a covered eye exam, which programs fill the gaps for drugs, dental, physiotherapy and therapy, and what happens if you have no health card.
The short version. The Ontario Health Insurance Plan (OHIP) pays the full cost of medically necessary doctor and hospital care, including virtual visits by video or telephone. It never covers prescription drugs outside hospital, dental care in a dentist's office, eyeglasses and contact lenses, or cosmetic surgery. Eye exams, physiotherapy, drug costs and dental care are covered only for particular ages, incomes or medical conditions. Separate provincial programs fill some of those gaps, and without a health card none of it applies.
Key facts at a glance
In this guide
Medically necessary doctor and hospital care. In the Ministry of Health's words, OHIP "covers the full cost of your services – as long as they're medically necessary. This includes both medically necessary in-person visits, as well as medically necessary virtual visits delivered by video or telephone."
In hospital, Ontario says OHIP covers doctor and nursing services, services to diagnose what is wrong such as blood tests and x-rays, medications for in-patients, certain medications given to out-patients for home use, and accommodation and meals if you have to stay.
Two words carry the weight. Medically necessary is why a form your employer wants is not covered, even when your doctor fills it in. Physician is why the same treatment can be covered in one setting and not another: outside hospital, OHIP pays only physicians and a short list of other practitioners named in the legislation.
Ontario publishes the list. OHIP does not cover:
Source: Ontario Ministry of Health, What OHIP covers (page updated 22 April 2026), read 18 September 2026.
It depends on your age and your eyes.
| Who you are | What OHIP covers |
|---|---|
| 0 to 19 years old | One major eye exam every 12 months |
| 20 and over with an eligible condition such as diabetes, glaucoma, cataracts or retinal disease | One major eye exam every 12 months, plus two follow-up assessments |
| 65 and over without an eligible condition | One major eye exam every 18 months |
| 20 to 64 with no eligible condition | Nothing. You pay the optometrist |
Source: Ontario Ministry of Health, What OHIP covers, optometry section, read 18 September 2026. Glasses and contact lenses are never covered.
Drugs, dental and therapy sit outside OHIP, with separate programs attached. Each has its own eligibility rules, and each needs an Ontario health card.
| Need | Programme | Who qualifies |
|---|---|---|
| Prescription drugs | Ontario Drug Benefit, including OHIP+ and the Trillium Drug Program | People 65 and over; people 24 or younger with no private plan; long-term care and home care recipients; people on Ontario Works or ODSP; Trillium enrollees. Prescriptions must be filled at an Ontario pharmacy |
| Dental care for children | Healthy Smiles Ontario | Children 17 and under in households under the income thresholds, and children in families on Ontario Works or ODSP, who are enrolled automatically |
| Dental care for seniors | Ontario Seniors Dental Care Program | Age 65 and over, annual net income of $25,480 or less for a single senior or $42,290 or less for a couple, and no other dental coverage apart from the Canadian Dental Care Plan |
| Physiotherapy | Government-funded physiotherapy | People 65 and over; 19 and under; anyone discharged from hospital after an overnight stay or day surgery in the last 12 months who needs physiotherapy for that condition; long-term care residents 18 and over; people on Ontario Works or ODSP |
| Therapy for depression or anxiety | Ontario Structured Psychotherapy Program | Adults 18 and over with symptoms of depression or an anxiety-related disorder. Free and publicly funded; your doctor can refer you, or you can refer yourself |
Sources: Ontario Ministry of Health — drug coverage (updated 18 August 2026), Healthy Smiles Ontario (updated 2 July 2026), seniors' dental care (updated 31 July 2026), physiotherapy (updated 4 May 2026); Ontario Health — Ontario Structured Psychotherapy Program (updated 4 June 2026). Read 18 September 2026; income thresholds change, so check before applying.
Podiatry is part-covered. Ontario says OHIP covers between $7 and $16 of each visit to a podiatrist, up to $135 per patient per year, plus $30 for x-rays. Surgery by a podiatrist is not covered. You pay the rest.
Physiotherapy is covered only for certain groups, at publicly funded clinics, as set out in the table above. Everyone else pays privately or uses workplace benefits.
Outside Canada, barely. Ontario's Travellers Program reimburses out-of-country emergency care when the treatment is medically necessary, given at a licensed hospital or health facility, and for an illness that is acute, unexpected, not pre-existing and needs immediate treatment.
What it pays is the catch: the lesser of the amount actually charged or Ontario's own rates, capped at $400 a day for intensive care and $200 a day for lower levels of care. Ontario also states that OHIP does not cover the cost of transferring you to an Ontario hospital for ongoing care, and tells travellers with insurance to contact their insurer.
Hospital care abroad routinely costs many times those caps, which is why travel insurance matters. Visitors coming the other way — to Ontario — are not covered at all, and our guide for visitors to Ontario covers what they pay.
Your doctor can charge you for work OHIP does not pay for. The College of Physicians and Surgeons of Ontario (CPSO) defines uninsured services as services provided by physicians that are not publicly funded under OHIP, giving prescription refills over the phone and copying or transferring medical records as examples.
CPSO states that physicians are entitled to charge for uninsured services, and that they "must ensure that the patient or third party is directly informed of any fee that will be charged prior to providing an uninsured service", except in an emergency where that is impossible or impractical.
Some practices offer a block fee: a single fee covering a set of uninsured services over a set period. It is optional, and you can pay for services one at a time instead.
This is why a sick note usually costs money even for patients with OHIP — see what a doctor's note costs in Ontario.
Then none of the above applies and every bill is yours. That is the position for visitors, for most international students outside their own plan, and for anyone whose status is not on Ontario's eligibility list.
Our guide to seeing a doctor without a health card compares what each route costs, and finding a family doctor in Ontario explains the longer game.
Yes, when they are medically necessary and delivered by video or telephone. Ontario states that OHIP covers the full cost of medically necessary services, including virtual visits by video or telephone. Care delivered by secure messaging or any other means is not covered, and neither is any visit for someone without a health card.
Only dental surgery performed in hospital, such as fracture repair, tumour removal, reconstructive surgery and medically necessary tooth removal. Services in a dentist's office are not covered. Healthy Smiles Ontario covers children 17 and under in lower-income households, and the Ontario Seniors Dental Care Program covers seniors 65 and over with net income of $25,480 or less as a single person, or $42,290 or less as a couple, who have no other dental coverage apart from the Canadian Dental Care Plan.
Not outside hospital. Drug costs are handled by the Ontario Drug Benefit program, which covers people 65 and over, people 24 or younger with no private insurance through OHIP+, long-term care and home care recipients, people receiving Ontario Works or ODSP, and people enrolled in the Trillium Drug Program. Prescriptions must be filled at an Ontario pharmacy.
Therapy from a physician or psychiatrist is covered. A private psychologist or psychotherapist is not, because OHIP pays only physicians and other practitioners named in Ontario's legislation for care outside hospital. Ontario Health's Structured Psychotherapy Program provides free cognitive-behavioural therapy to adults 18 and over with depression or an anxiety-related disorder, and you can refer yourself.
Every 12 months for people aged 0 to 19; every 12 months plus two follow-ups for people 20 and over with an eligible condition such as diabetes, glaucoma, cataracts or retinal disease; and every 18 months for people 65 and over without such a condition. People aged 20 to 64 with no eligible condition pay for their own eye exams, and glasses and contact lenses are never covered.
Only for certain groups, at publicly funded clinics: people 65 and over, people 19 and under, anyone discharged from hospital after an overnight stay or day surgery in the past 12 months who needs physiotherapy for that condition, long-term care residents 18 and over, and people receiving Ontario Works or ODSP.
Only partly. Ontario's Travellers Program reimburses the lesser of the amount charged or Ontario's rates for acute, unexpected emergency care at a licensed facility, capped at $400 a day for intensive care and $200 a day for other care. It does not pay to transfer you back to an Ontario hospital. Travel insurance is what covers the rest.
Because a note is not a medically necessary service, so OHIP does not pay for it. CPSO says physicians may charge for uninsured services and must tell you the fee before providing the service. Some practices offer an optional block fee covering a set of uninsured services for a period.
Related guides
Every coverage rule on this page was read on the Ontario Ministry of Health's own pages — What OHIP covers (updated 22 April 2026), OHIP coverage while outside Canada (updated 16 January 2026), drug coverage (18 August 2026), Healthy Smiles Ontario (2 July 2026), dental care for low-income seniors (31 July 2026) and government-funded physiotherapy (4 May 2026) — together with Ontario Health's Structured Psychotherapy page (4 June 2026) and the CPSO policy on uninsured services, on 18 September 2026. Programme rules and income thresholds change; check the ministry's pages before you rely on a figure. This page is general information, not medical advice. In an emergency, call 911.
Speak to a physician licensed in Ontario by phone for a flat $82, with no health card needed — prescriptions, refills, referrals, lab requisitions and notes.
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