Private Health Insurance in Ontario for Individuals and Families

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.

Who individual health insurance is for

Most people in Ontario get extended health and dental coverage through an employer. Plenty of people do not: freelancers and sole proprietors, contract workers, early retirees, people whose job ended, and young adults who have aged off a parent's plan. For them, private health insurance bought directly from an insurer (or through a licensed agent) is the usual way to get help paying for prescriptions, dental visits, glasses and therapies like physio or massage.

Individual plans are personal contracts. You choose the plan, you pay the premium, and the coverage follows you rather than a job. That flexibility is the main appeal. The trade-off is that individual plans are priced and designed differently from group health and dental insurance, so it pays to understand what you are buying.

• Self-employed people and small business owners with no staff
• People leaving a workplace plan because of a job change or retirement
• Young adults no longer eligible as dependants on a family plan
• Spouses or families who want coverage of their own

What OHIP leaves out, and what individual plans can cover

OHIP covers medically necessary doctor and hospital care, but much of everyday health spending sits outside it. As of October 2026, the Ontario government notes that OHIP does not cover prescription drugs outside hospital, routine dental care in a dentist's office, eyeglasses or contact lenses, or eye exams for most adults aged 20 to 64 who do not have an eligible medical condition. The guide to what OHIP does not cover goes into more detail.

Individual plans are built to fill those gaps. Depending on the plan and tier you choose, coverage can include prescription drugs, dental care, vision care, and health practitioners such as physiotherapists, chiropractors, massage therapists and mental health professionals. Some plans add emergency travel medical coverage, virtual care or counselling support. Reimbursement percentages, annual maximums and which services are included vary a great deal by plan, so always read the benefit summary before you buy.

Medical questions vs guaranteed acceptance

The biggest difference between individual plans is how you get approved. Some plans ask health questions as part of the application. Insurers use the answers to decide which coverage level fits you and whether to accept the application. These underwritten plans can offer richer or more flexible options, but approval is not automatic, and the terms that apply to existing conditions depend on the contract.

Other plans offer guaranteed acceptance, with no medical questions. As one example, Ontario Blue Cross publicly describes a Guaranteed Acceptance plan with no medical questions that covers existing conditions and existing medications. Guaranteed plans are often the practical choice if you take regular medication or have a health history that could make an underwritten application harder. They may come with lower reimbursement levels or narrower benefits than underwritten options, so compare the details side by side.

Either way, ask how the plan treats ongoing prescriptions, whether any waiting periods apply, and how premiums can change over time.

Leaving a group plan? Watch the deadline

If you are coming off an employer plan, you may have a special window to buy individual coverage without medical questions. Several insurers offer plans for former group members. For example, as of October 2026 Manulife says former members of its group benefits plans can apply for its FollowMe plan within 120 days of losing group coverage, with guaranteed acceptance and no medical questions. Windows and rules differ by insurer, so check your benefits booklet or ask your former plan's insurer right away.

Missing that window can mean applying for an underwritten plan instead. The guide to health coverage after leaving a group plan explains the options, and benefits after termination covers what employers need to know.

How individual plans interact with government programs

Buying private coverage can affect eligibility for some public programs, so think it through before you enrol. As of October 2026:

• OHIP+ covers eligible prescriptions for Ontarians aged 24 and under who have OHIP and are not covered by a private plan. Once a young person has private coverage, they are no longer eligible for OHIP+ and the private plan pays instead. See OHIP+.
• The Canadian Dental Care Plan is only for people without access to private dental insurance or coverage, including insurance you buy yourself, and requires adjusted family net income under $90,000, among other conditions. See CDCP eligibility.
• Tax credit: the Canada Revenue Agency treats premiums paid to a private health services plan as eligible medical expenses for the medical expense tax credit. Self-employed people should ask an accountant how the current CRA rules apply to them.

When a small group plan may be the better fit

If you run a business, even a very small one, it is worth comparing an individual plan with a group plan before you decide. Group plans for small employers can sometimes offer benefits that individual plans do not, such as group life or disability coverage, and some small group plans accept businesses with only a few people. An employer-paid plan that meets CRA's private health services plan conditions can also be a non-taxable benefit for employees, which is a different tax picture from paying personally.

A health spending account is another route for incorporated owners and small teams. Read more on benefits for owner-operated businesses and health insurance for the self-employed.

Families weighing one combined policy should also see health and dental insurance in Ontario.

Getting help choosing

In Ontario, the Financial Services Regulatory Authority of Ontario (FSRA) licenses life and health insurance agents and insurers, and suggests consumers check an agent's licence, compare more than one option and review any existing group coverage before buying. If a complaint cannot be resolved with the insurer, the OmbudService for Life and Health Insurance (OLHI) can help.

GroupBenefitPlans.ca does not sell insurance or give advice, and is not affiliated with any insurer named on this page. If you are a business owner deciding between personal coverage and a plan for your team, you can get matched with a licensed benefits advisor who can explain the options available to you.

Common questions

Can I get private health insurance in Ontario with a pre-existing condition?

Often, yes. Guaranteed acceptance plans do not ask medical questions, and some publicly state that existing conditions and medications are covered. Underwritten plans ask health questions and may handle existing conditions differently, so read the contract terms.

Does an individual health plan replace OHIP?

No. Private plans work alongside OHIP and are designed to help with costs OHIP does not cover, such as most prescriptions outside hospital, routine dental care and glasses.

Will buying a private dental plan affect the Canadian Dental Care Plan?

Yes. As of October 2026, the federal government says you are not eligible for the CDCP if you have access to private dental insurance or coverage, including insurance you purchase yourself.

Is individual coverage cheaper than a group plan?

It depends on age, the plan tier, whether medical questions apply, and how many people are covered. There is no single answer, which is why comparing individual and small group options with a licensed advisor can help.

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.