What Does OHIP Not Cover?

Current as of October 2026. Government programs, tax rules and prices change. Check the official sources listed at the end of this page before making a decision, and confirm details with a licensed advisor.

OHIP covers the essentials, not everything

The Ontario Health Insurance Plan pays for insured services like visits to your family doctor, medically necessary hospital care and many specialist services. You can read more in this OHIP coverage overview. What surprises many people is how much of day-to-day health spending sits outside the plan.

The Government of Ontario publishes a list of services OHIP does not cover. As of October 2026, that list includes prescription drugs provided in non-hospital settings, dental services in a dentist's office, eyeglasses and contact lenses, and cosmetic surgery. Program rules can change, so always check ontario.ca for the current version before making a decision.

A quick list of common OHIP gaps

Here are the services that working-age Ontarians most often end up paying for themselves or through a benefits plan, as of October 2026:

• Routine dental care: cleanings, fillings, checkups and other services in a dentist's office are not covered. OHIP only covers certain dental surgery done in hospital.
• Glasses and contact lenses: not covered at any age, along with eye surgery for vision correction.
• Routine eye exams for most adults aged 20 to 64: covered only when you have an eligible medical condition.
• Prescription drugs outside hospital: not covered for most adults aged 25 to 64 unless they qualify for a specific provincial program.
• Most paramedical care: massage therapy, private physiotherapy for most working-age adults, and private-practice psychology or counselling are generally paid out of pocket or through benefits.
• Private or semi-private hospital rooms: you or your private insurance pay some or all of the extra fees.
• Ambulance co-payment: a fee usually applies to medically necessary ground ambulance trips within Ontario.
• Most of the cost of emergency care outside Canada: OHIP pays only a limited daily amount.

Dental and vision: the biggest everyday gaps

For most families, the dentist is the first place they notice OHIP's limits. As of October 2026, OHIP covers only certain in-hospital dental surgery, such as fracture repair, tumour removal, reconstructive surgery and medically necessary extractions with prior approval. Your six-month cleaning, a filling or a crown is not part of it. That is why group dental coverage is one of the most valued parts of a workplace plan.

Eye care follows age and health rules. As of October 2026, OHIP covers one major eye exam every 12 months for people aged 19 and under, and one every 18 months for people 65 and over. Adults aged 20 to 64 are covered only if they have an eligible condition such as diabetes, glaucoma, cataracts or retinal disease. Eyeglasses and contact lenses are not covered at any age. A group vision care benefit can help with exams, frames and lenses, depending on how the plan is set up.

Some public programs fill part of the dental gap for certain people, such as the federal Canadian Dental Care Plan and Healthy Smiles Ontario for eligible children and youth. Eligibility depends on income, age and access to other coverage, so check the current rules.

Prescription drugs for working-age adults

OHIP itself does not pay for prescriptions you fill at a community pharmacy. Ontario does run drug programs, but as of October 2026 they focus on specific groups. OHIP+ covers eligible prescriptions for people aged 24 and under who are not covered by a private plan, and that coverage stops on the 25th birthday or when a private plan starts. The Ontario Drug Benefit covers people 65 and over, and adults under 65 only in certain situations, such as receiving Ontario Works or ODSP, living in long-term care, receiving home and community care, or being enrolled in the Trillium Drug Program.

For a healthy 35-year-old with a monthly prescription, that usually means paying at the counter unless they have workplace or individual coverage. Employer prescription drug benefits are often the main way working adults get help with these costs. Federal pharmacare coverage for certain contraception and diabetes medications depends on bilateral agreements with each province or territory, and Health Canada's published list of signed agreements does not include Ontario as of its most recent update. Check the current status rather than assuming your medications are included.

Physio, massage, therapy and other paramedical care

Ontario funds physiotherapy at community clinics for certain people. As of October 2026, eligibility includes people 65 and over, people 19 and under, people within 12 months of an overnight hospital stay or day surgery that needs follow-up physiotherapy, and people receiving Ontario Works or ODSP. Most working-age adults with, say, a sore back from a weekend hockey game do not fit those categories and pay privately.

Massage therapy and chiropractic care are generally paid out of pocket or through a benefits plan. Podiatry is only partly covered: as of October 2026, OHIP pays a small portion of each visit to a registered podiatrist up to an annual limit, and you pay the rest. Psychologists' services are not funded by provincial health insurance plans, according to the Canadian Psychological Association, so private counselling is usually paid out of pocket or through benefits.

This is where paramedical benefits and employee mental health benefits make a real difference. Plans usually set a per-visit amount or an annual maximum for each practitioner type, and those limits vary by plan.

Ambulance, hospital rooms, devices and travel

A few other gaps tend to show up at stressful moments. As of October 2026, the City of Toronto notes that Ontario residents with a valid health card are generally billed a $45 co-payment for a medically necessary ground ambulance trip that starts and ends in Ontario, unless an exemption applies. In hospital, a standard ward bed is covered, but a private or semi-private room comes with extra fees that you or your insurance pay.

Equipment such as hearing aids, mobility aids and some medical supplies is not paid by OHIP directly. Ontario's Assistive Devices Program typically pays 75% of the approved price for eligible devices as of October 2026, leaving the remaining 25% and any extras to you or your benefits plan.

Travel is a big one. As of October 2026, OHIP pays emergency outpatient care outside Canada at up to $50 (Canadian) per day, and inpatient care at up to $400 per day for higher levels of care or $200 per day for lower levels. Hospital bills abroad can be far higher, and the province recommends buying private travel medical insurance. Some employers add group travel medical insurance to their plans.

How workplace benefits fill the gaps

A group benefits plan is built around exactly these gaps: dental, vision, prescriptions, paramedical practitioners, private hospital rooms, medical equipment and travel emergencies. Each plan sets its own percentages, maximums and exclusions, so two plans can look similar on paper and still pay out very differently. Some employers also add a health spending account so employees can direct funds to the gaps that matter most to their household.

If you are an employer thinking about which gaps your team feels most, it can help to compare public coverage side by side with plan options. A guide comparing OHIP and employer health benefits is listed in the related links below. When you are ready, you can get matched with a licensed benefits advisor who can explain options that fit your budget and your people. GroupBenefitPlans.ca is a referral and information service and does not sell insurance.

Common questions

Does OHIP cover dental cleanings or fillings?

No. As of October 2026, dental services provided in a dentist's office are not covered by OHIP. OHIP only covers certain dental surgery performed in hospital, such as fracture repair or medically necessary extractions with prior approval.

Does OHIP cover eye exams for adults?

For adults aged 20 to 64, OHIP covers an eye exam only if you have an eligible medical condition, such as diabetes, glaucoma or cataracts, as of October 2026. People 19 and under and 65 and over have routine exam coverage at set intervals. Glasses and contact lenses are not covered at any age.

Does OHIP pay for prescriptions?

Not for drugs filled outside hospital for most adults aged 25 to 64. As of October 2026, provincial drug programs cover specific groups, such as people 24 and under without a private plan (OHIP+), people 65 and over, and people in certain programs like Ontario Works, ODSP or Trillium.

Is physiotherapy covered by OHIP?

Only for certain people at government-funded community clinics, as of October 2026: those 65 and over, 19 and under, within 12 months of an overnight hospital stay or day surgery, or receiving Ontario Works or ODSP. Most other adults pay privately or use paramedical benefits.

Do I need travel insurance if I have OHIP?

Ontario recommends it. As of October 2026, OHIP pays only limited daily amounts for emergency care outside Canada, and does not cover the cost of a transfer back to an Ontario hospital for ongoing care.

GroupBenefitPlans.ca is a referral and information service. Advice and coverage are provided by the licensed professional and relevant providers. An enquiry does not activate insurance.