How OHIP Works: What\'s Covered and What\'s Not

The Ontario Health Insurance Plan (OHIP) covers a wide range of medically necessary services at no direct cost to residents. However, many health services are not covered, which leads to confusion. What OHIP covers includes visits to physicians (family doctors and specialists), hospital stays and services, most laboratory tests ordered by a physician, surgical procedures deemed medically necessary, emergency room visits, mental health services provided by a physician, and telehealth consultations with OHIP-billing physicians. What OHIP does not cover includes prescription medications (unless you qualify for Ontario Drug Benefit or OHIP+), dental care for adults, vision care for adults (ages 20 to 64), physiotherapy (most outpatient services), cosmetic procedures, and ambulance services ($45 co-pay in Ontario, more if deemed medically unnecessary). Some gaps can be filled by private insurance through your employer, or by provincial programs. For example, OHIP+ covers prescription medications for those under 25 without private insurance. The Trillium Drug Program helps those with high drug costs relative to income. To maintain OHIP coverage, you must reside in Ontario for at least 153 days in any 12-month period. New residents face a 3-month waiting period before coverage begins. Travel insurance is recommended during this gap. *This article is for informational purposes only.*

This article is for informational purposes only and does not constitute medical advice. Content reviewed by licensed Canadian physicians. Last updated February 2026.