Health and Dental Insurance in Ontario: Individual Plans vs Group Plans

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.

Why health and dental coverage matters in Ontario

OHIP pays for medically necessary doctor and hospital care, but a lot of everyday health spending happens outside of it. As of October 2026, the Ontario government says OHIP does not cover prescription drugs given outside hospital (such as antibiotics from your family doctor), routine dental care, or eyeglasses and contact lenses. Children and youth 19 and under can get one major eye exam every 12 months, while many adults are covered only if they have an eligible medical condition. Dental surgery is covered only in limited cases, like fracture repair or tumour removal performed in hospital.

That leaves the cleaning every few months, the filling you have been putting off, the monthly prescription refill and the massage for a sore back. Most Ontarians handle those costs through an employer plan. If you are self-employed, between jobs, retired early or no longer covered on a parent's plan, a personal health and dental policy is the usual alternative. Our page on what OHIP does not cover goes into more detail.

What an individual health and dental plan usually includes

Individual plans are personal contracts: you pick the plan, you pay the premium, and the coverage stays with you no matter where you work. Most are built in tiers or modules, so you can choose how much drug, dental and paramedical coverage you want. Depending on the plan, coverage can include:

• Prescription drugs, often reimbursed at a set percentage and sometimes with an annual cap
• Dental care, either built into the plan or sold as an optional add-on
• Vision care such as eye exams, glasses and contact lenses
• Health practitioners like physiotherapists, chiropractors, massage therapists and psychologists
• Extras on some plans, such as travel medical coverage or virtual care

How dental works on a personal plan

Dental is where individual plans differ most from workplace coverage. On many personal plans, dental is an add-on rather than a standard feature. As one example, Ontario Blue Cross lists dental as an option on its Complete Health plans rather than a built-in benefit on every tier, as of October 2026.

Dental limits on personal plans can also start low and grow the longer you stay. Manulife's FollowMe Health plan, for instance, publicly lists dental maximums on its Enhanced Plus plan of $700 in year one, $850 in year two and $1,000 in year three, as of October 2026, and dental is only included on its higher tiers. That kind of graduated maximum is designed to discourage people from buying coverage just before a big dental bill. If you are expecting a crown, a root canal or braces soon, check exactly what the plan pays in the first year before you sign. Our cost guides for dental crowns and dental cleanings can help you compare the plan maximum with what treatment might cost.

Health questions, existing conditions and switching from a group plan

How you get approved matters as much as what is covered. Some individual plans ask health questions, and the insurer uses your answers to decide which coverage level fits you. Others offer guaranteed acceptance with no medical questions. Ontario Blue Cross, for example, describes a Guaranteed Acceptance plan with no medical questions that covers existing conditions, with 70% reimbursement on prescription drugs and on dental services, as of October 2026. Guaranteed plans can be a practical choice if you take regular medication, though benefits may be leaner than underwritten options.

If you are leaving an employer plan, timing is important. Some insurers offer guaranteed acceptance to former group members who apply soon after their coverage ends. As of October 2026, Manulife says former members of its group benefits plans can apply for FollowMe Health within 120 days of losing group coverage with no medical questions. Other insurers set their own windows, so read your benefits booklet and act quickly. See coverage after leaving a group plan for more.

Individual plans vs group plans: the key differences

A group plan is a contract between an employer and an insurer that covers eligible employees and, often, their families. An individual plan is a contract between you and the insurer. The coverage categories can look similar on paper, but the way they are priced, approved and paid for is different. Here is how they generally compare:

• Who pays: with a group plan, the employer usually pays some or all of the premium. With an individual plan, you pay the full premium yourself.
• Approval: group health and dental is usually arranged for the whole eligible group, while individual plans may ask health questions or offer guaranteed acceptance with leaner benefits.
• Dental limits: individual dental coverage is often optional and may start with lower maximums that rise over time. Group dental is set by the employer's plan design and varies from plan to plan.
• Extra benefits: group plans can bundle health and dental with group life and disability coverage, an employee assistance program or a health spending account.
• Tax treatment: the Canada Revenue Agency says employer contributions to a private health services plan that meets its conditions are not a taxable benefit to the employee. Premiums you pay yourself for a private health services plan can count as eligible medical expenses for the medical expense tax credit. Rules can change, so check the current CRA guidance.
• Portability: an individual plan stays with you when you change jobs. Group coverage generally ends when employment ends.

Check government programs before you buy

Buying private coverage can change whether you or your family qualify for some public programs. As of October 2026:

• Canadian Dental Care Plan: the federal government says you are not eligible if you have access to private dental insurance, including dental insurance you purchase yourself, and your adjusted family net income must be under $90,000, among other criteria. See CDCP eligibility.
• OHIP+: covers eligible prescriptions for people 24 and under who have OHIP, but the Ontario government says that if you have a private plan, you are not eligible for OHIP+. See OHIP+.
• Healthy Smiles Ontario: provides free dental services for eligible children and youth from low-income households. Check the current age and income rules before you rely on it. See Healthy Smiles Ontario.

When a small group plan may make more sense

If you run a business, even a small one, compare a personal policy with a small group plan before you decide. A group plan can cover you and your team together, may include benefits individual plans do not, and changes the tax picture when the business pays. A health spending account is another option some owners use to pay for dental and health costs. Our guide to health insurance for the self-employed walks through those choices.

In Ontario, the Financial Services Regulatory Authority of Ontario (FSRA) regulates life and health insurance and licenses agents. It encourages consumers to check an agent's licence and compare options before buying. GroupBenefitPlans.ca does not sell insurance or give advice, and is not affiliated with any insurer named on this page. If you are weighing personal coverage against 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 buy health and dental insurance on my own in Ontario?

Yes. Several insurers sell individual health and dental plans directly or through licensed agents. Some ask health questions, while guaranteed acceptance plans do not. Dental is often an add-on or available only on higher tiers.

Why is the dental maximum lower in the first year?

Some personal plans use graduated dental maximums that increase each year you stay on the plan. As of October 2026, Manulife's FollowMe Health plan publicly lists this kind of build-up. It helps insurers manage the cost of people buying coverage right before major treatment.

Is a group plan better than an individual plan?

It depends on your situation. Group plans are often partly paid by the employer and can include life and disability coverage, while individual plans stay with you if you change jobs. A licensed advisor can compare both for your circumstances.

Will a private dental plan stop me from getting the Canadian Dental Care Plan?

As of October 2026, yes. The federal government says people with access to private dental coverage, including a plan they buy themselves, are not eligible for the CDCP.

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