What OHIP Doesn't Cover in Ontario (and How to Fill the Gaps)

Ontarians are lucky to have OHIP — but it’s easy to overestimate what it actually covers. OHIP is built around physician and hospital care. A huge range of everyday health costs fall outside it, and for most working-age adults, those costs come straight out of pocket.

Here’s exactly what OHIP doesn’t cover — and how to fill each gap before it costs you.

What OHIP does cover

Let’s be fair first. OHIP covers:

• Visits to your family doctor and most specialists
• Hospital stays, surgeries, and emergency care
• Medically necessary diagnostic tests and lab work
• Maternity and newborn care

That’s genuinely valuable. But notice what’s missing.

What OHIP does NOT cover

Prescription drugs (for most adults)

This surprises people most. If you’re between 25 and 64 and don’t have a private plan, you generally pay for your own prescriptions. OHIP+ covers those under 25 without private coverage, and the Ontario Drug Benefit covers seniors 65+ — but the large working-age middle is on its own. A single ongoing medication can cost hundreds or thousands a year.

Dental care

Routine dental — checkups, cleanings, fillings, root canals, crowns, orthodontics — is not covered for adults. A single crown can run $1,000+. Limited public programs exist for children and low-income seniors, but most Ontarians pay privately.

Vision care

Eye exams for adults 20–64 are generally not covered, and glasses and contact lenses are almost never covered. (Children under 20 and seniors 65+ get routine exams covered.)

Paramedical services

Physiotherapy, chiropractic, massage therapy, registered psychotherapy, naturopathy, podiatry — largely out of pocket. If you see a physio weekly after an injury, that adds up fast.

Mental health (outside a doctor’s office)

A psychiatrist (a physician) is covered, but sessions with a psychologist or registered psychotherapist usually aren’t — and those are what many people actually need.

Medical equipment and other extras

Ambulance co-payments, prescription eyewear, hearing aids, mobility aids, and semi-private/private hospital rooms are typically not fully covered.

Care outside Ontario

OHIP pays very little in other provinces and almost nothing abroad. An out-of-country hospital stay can cost tens of thousands of dollars — see does OHIP cover travel below.

How to fill the gaps

The good news: nearly every gap above can be covered affordably with the right plan.

Personal health & dental insurance covers prescriptions, dental, vision, and paramedical services in one plan. It’s modular — you pick the coverage and level you’ll actually use — and it’s especially valuable if you’re self-employed, retired, or working without benefits. We cover this in detail in our guide to health & dental insurance for the self-employed.

Travel insurance covers the enormous out-of-country medical costs OHIP won’t touch — essential for any trip outside the province.

Critical illness insurance provides a lump sum that can pay for treatments and drugs not covered provincially, plus everyday costs during recovery.

Who’s most exposed?

You’re most at risk of these gaps if you:

• Are self-employed or a contractor with no group benefits
• Are retiring and about to lose employer coverage
• Work part-time or on contract without a benefits package
• Take regular prescriptions or see paramedical providers often
• Travel outside Ontario, even within Canada

The bottom line

OHIP is a strong foundation for doctor and hospital care — but prescriptions, dental, vision, paramedical services, and out-of-province care are largely on you. For a manageable monthly premium, a personal health & dental plan turns those unpredictable bills into a predictable cost.

Want to see what a plan would cost you? Get a free quote — we’ll build coverage around the gaps that actually apply to your life, with no pressure.