Who needs private health insurance in Ontario?

In Ontario, lots of people think that with OHIP you don’t need any private health insurance. For some it’s true, for some it’s not. Let’s consider some key points.


OHIP is funded by taxpayers and covers most healthcare and medical services. OHIP doesn’t cover prescription drugs provided in non-hospital settings (e.g. antibiotics prescribed by your family doctor), dental services provided in a dentist’s office, vision care, eyeglasses, contact lenses, laser eye surgery, rehabilitation services, and cosmetic surgery.

Workplace benefits

Workplace benefits are provided by many employers or associations to help employees cover the cost of things OHIP may not pay for, including prescription drugs, dental, hospital, vision, paramedical and ambulance services. Because costs are shared with a group, they’re often more affordable than a personal health and dental plan. Many workplace benefit plans allow you to customize your coverage to your needs.

Personal health and dental insurance

This insurance is most often used by people who are retired, who are self-employed or not eligible for group benefits, or who are losing their previous group benefits coverage. It’s similar to group benefits because it helps pay for things OHIP may not cover. There are plans that suit your needs and budget. Coverage is guaranteed for some plans and you can even qualify with pre-existing medical conditions.


Who may not need private health insurance in Ontario?

In some cases, you may not need private health insurance to cover your prescription drugs, vision and dental care:

  • Prescription drugs: OHIP+ makes more than 5,000 drug products free for anyone age 24 years or younger who is not covered by a private health insurance plan.
  • Prescription drugs for seniors: If you are 65 or older, OHIP covers your prescription drugs.
  • Vision care: OHIP covers the cost of one major eye exam (for vision and general eye health) every 18 months, plus any minor assessments you need, but only if you are: 19 years and younger or 65 years and older.
  • Dental care: OHIP does not cover dental care. The exceptions are complex jaw bone surgeries such as tumour removal, fracture repairs and jaw reconstruction. In extremely rare cases and with prior approval by OHIP, tooth removal may be covered under OHIP. Even though OHIP dental coverage is limited, there are 7 other programs in Ontario that do provide a wide range of dental services for free.
  • Dental care for low-income seniors: In Ontario, free dental care for low-income seniors is administered through the Ontario Seniors Dental Care Program (OSDCP) NOT through OHIP. Launched on Nov.20, 2019, OSDCP aims to deliver regular dental services for low-income seniors. OHIP dental coverage for seniors is the same as for everyone else in Ontario: only for major surgeries done in hospital.
How private health insurance work in Ontario
  • You pay a fee (also known as a premium) for coverage, usually monthly.
  • Some health insurance plans have a deductible (the amount you pay out of pocket before your health insurance coverage takes effect).
  • Some health insurance pays 100% of costs after deductible, others pay a percentage (coinsurance).
What does private health insurance typically cover?
  • Prescription drugs
  • Dental care
  • Vision care and prescription eyewear
  • Paramedical services such as physiotherapy, massage and chiropractic
  • Ambulance services
  • Medical supplies
  • Hearing aids
  • In-home nursing and health aide care
  • Emergency travel medical
  • Major dental care
  • Accidental death and dismemberment
  • Hospital accommodation and cash
Do you really need private health insurance?

It depends on your eligibility to be covered by OHIP for prescription drugs, vision and dental care. It also depends on how much you and your family currently spend on various types of healthcare and how concerned you are about the risk of potential future healthcare expenses.

If you spend a lot on healthcare that’s not covered by OHIP, or you have health concerns which may lead to expenses down the road, personal health insurance may be worth it.

how can we help you?

Please let us know how we can help. Whether it is a free no-obligation quote or just a question – we will be happy to provide you with detailed answers.


Please let us know how we can help. Whether it is a free no-obligation quote or just a question – we will be happy to provide you with detailed answers.

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