Health Insurance in Ontario

Ontario residents are covered by the Ontario Health Insurance Plan, OHIP, for medically necessary physician and hospital care. OHIP does not pay for routine dental, vision, most outpatient prescription drugs for working-age adults, or paramedical services, so private health and dental insurance is widely used to fill those gaps.

Ontario funds two of the better-known provincial dental programs: the Ontario Seniors Dental Care Program for eligible low-income residents aged 65 and over, and Healthy Smiles Ontario for eligible children and youth aged 17 and under from lower-income households. Both are income-tested, so most working-age adults fall between them. The federal Canadian Dental Care Plan is the public backstop here: it covers eligible residents under the $90,000 family-income line who have no private dental insurance, and now spans all ages.

Ontario also has the largest concentration of self-employed workers, contractors and small-business employees in Canada, many without group benefits. For them, individual plans from Canada Life, Manulife and Sun Life are a mainstream purchase; Alberta Blue Cross does not sell in Ontario.

Ontario’s public safety net for drugs, physiotherapy and eye care is built around age. OHIP+ covers prescriptions for residents 24 and under, the Ontario Drug Benefit starts at 65, and OHIP-funded physiotherapy covers people 19 and under, 65 and over, those recovering from a recent hospital stay or day surgery, and people receiving Ontario Works or ODSP. Most working-age adults between 25 and 64 fall outside all of it, which is why they make up most of the people buying individual health and dental plans here.

Within that group, the most exposed are the self-employed, contractors and gig workers, employees of small firms that do not offer group benefits, people between jobs, and early retirees who have left a workplace plan but are not yet 65. Families are a second large group: OHIP covers a child’s doctor visits and one eye exam a year, but not their glasses, routine dental work or braces.

OHIP itself only pays for drugs given in hospital. Outside hospital, Ontario has three public drug programs. OHIP+ covers eligible prescriptions for residents 24 and under who are not covered by a private plan. The Ontario Drug Benefit enrolls residents automatically at 65, with an annual deductible and a small co-payment per prescription. The Trillium Drug Program is for households with high drug costs relative to income, at any age.

Two details matter when you buy a private plan. First, OHIP+ only covers young people who have no private coverage, so once your children are on a family plan with a drug benefit, that plan pays for their prescriptions instead. Second, Trillium is a backstop, not a substitute: its deductible is about 4% of your household’s after-tax income, and only money you paid out of pocket counts toward it, so for most working households it only helps once drug costs are already large. For a working-age Ontarian without group benefits, a private drug benefit is usually what covers ordinary prescriptions.

Healthy Smiles Ontario covers check-ups, cleanings, fillings and urgent care for children and youth 17 and under in lower-income households. The Ontario Seniors Dental Care Program covers routine dental care, and part of the cost of dentures, for residents 65 and over with low incomes. Both are income-tested each year, so most working-age adults fall between them.

Buying a private dental plan can affect your eligibility for public programs, so check this before you enrol. The Ontario Seniors Dental Care Program is only open to seniors with no other dental benefits apart from the Canadian Dental Care Plan, and the federal Canadian Dental Care Plan itself excludes anyone with access to dental insurance, including a plan you buy yourself. The federal Canadian Dental Care Plan is the public backstop here: it covers eligible residents under the $90,000 family-income line who have no private dental insurance, and now spans all ages. If your household is near those income lines, compare what the public programs would pay against what a private plan adds before choosing.

The Ontario Dental Association publishes a suggested fee guide each year, but dentists are not bound by it. Under the rules of the Royal College of Dental Surgeons of Ontario, a dentist must tell you in advance if they plan to charge more than the guide. That matters for insurance, because individual plans typically reimburse their percentage of a reasonable and customary fee rather than whatever the clinic charges, so at a clinic that bills above the guide you pay the difference on top of your co-insurance. Asking for a pre-treatment estimate before major work is the simplest way to see your real cost.

Other gaps are smaller but add up. A land ambulance trip to hospital carries a $45 co-payment under OHIP. Glasses and contact lenses are never covered, and adults 20 to 64 only get an OHIP eye exam if they have a qualifying medical condition such as diabetes or glaucoma. Paramedical care such as massage therapy, chiropractic and psychology is paid privately, as is physiotherapy for most working-age adults. Vision and paramedical benefits on a private plan are built for exactly these costs, each with its own annual cap.

Ontarians buying individual coverage through Aeva can compare Canada Life, Manulife and Sun Life, each with its own range: Canada Life with Freedom to Choose, Manulife with FlexCare and the FollowMe plans for people leaving a group plan, and Sun Life with its Personal Health Insurance and Health Coverage Choice lines. The same plans are sold across the province, so the comparison is about reimbursement levels, annual maximums and whether drugs, major dental and orthodontics are included.

The practical split is between guaranteed-acceptance plans, which skip medical questions but cap coverage more tightly, and medically-underwritten plans, which ask health questions in exchange for higher limits. If you are leaving a workplace plan, a conversion plan such as FollowMe can accept you without medical questions, but usually only if you apply within a short window after your group coverage ends, so it is worth acting on before that window closes.

The least expensive individual plan in Ontario leaves out prescription drugs at each of the ages we price. Because of how Ontario’s public drug programs are split by age, that trade-off is not the same for everyone. A 22-year-old with no private plan already has prescription coverage through OHIP+, and a 66-year-old has the Ontario Drug Benefit, so a plan without drugs can be a reasonable way to buy dental, vision and paramedical coverage alone. For someone between 25 and 64 without workplace benefits, drugs are usually the largest gap, and the cheapest premium may not cover the cost that matters most.

Premiums also rise with age on most individual plans, and at different rates, so the gap between the cheapest plan and the rest tends to widen through your fifties. Comparing plans against your own age and household gives a better answer than any single ranking.

OHIP pays very little for emergency care outside the country: at most $400 a day for intensive or surgical inpatient care, $200 a day for other inpatient care, and $50 a day for outpatient visits, against hospital bills that can run far higher, particularly in the United States. The Ontario government itself recommends buying private coverage before you leave. Some individual health plans include emergency travel medical coverage, which is worth checking when you compare, especially for snowbirds and frequent travellers.

The same carriers and the same public programs apply everywhere in Ontario, but dental fees and the mix of work vary by city. Toronto and Mississauga have large numbers of self-employed professionals, contractors and small-business employees without group benefits. Ottawa’s large public-sector workforce is mostly covered at work, which leaves the consultants, contractors and small-firm employees around it as the people most likely to buy their own plan.

Outside the big cities, the plans on offer are the same, but it can take more planning to reach a nearby dentist or specialist. The city pages below add local context; plan availability does not change between them.