Private Health Insurance in Ontario
Ontario’s provincial health insurance plan, OHIP, is the foundation of health coverage for residents of the province. But it was never designed to cover everything. OHIP pays for medically necessary physician and hospital services, but it leaves significant coverage gaps that affect millions of Ontarians every year. Prescription drugs, dental care, vision care, physiotherapy, chiropractic treatment, hearing aids, mental health services, and many other health-related expenses are not covered by OHIP and the costs add up quickly.
Private health insurance fills exactly those gaps. Whether you are self-employed with no group plan, an employee whose employer benefits do not fully cover your needs, or an international student living and studying in Ontario, a private health insurance policy provides the coverage that OHIP does not — giving you access to the care you need without paying entirely out of pocket. We work with multiple leading insurers to find the policy that best complements your existing coverage and fits your budget.
What OHIP Does Not Cover
Understanding exactly where OHIP coverage ends is the first step to understanding what private health insurance can do for you. The following health-related services and expenses are not covered or are only partially covered by Ontario’s provincial health plan:
Prescription medications: OHIP does not cover the cost of most prescription drugs for working-age adults. Ontario’s Trillium Drug Program offers some assistance for individuals with very high drug costs relative to their income, but the majority of prescription drug expenses must be paid out of pocket or through private coverage.
Dental care: Routine dental exams, cleanings, fillings, crowns, extractions, orthodontics, and most other dental procedures are not covered by OHIP. A single dental emergency can easily cost hundreds or even thousands of dollars without private coverage in place.
Vision care: OHIP covers eye exams only for children under 20 and adults 65 and older. Working-age adults must pay for their own eye exams, prescription eyeglasses, and contact lenses expenses that recur regularly throughout life.
Physiotherapy: Private physiotherapy is not covered by OHIP. If you sustain an injury or require rehabilitation following surgery, the cost of ongoing physiotherapy sessions, which can range from $80 to $150 per visit, must be paid privately unless you have group or individual health insurance.
Chiropractic care: Chiropractic treatment is entirely outside of OHIP coverage for most adults. For those who rely on regular chiropractic care to manage chronic pain or musculoskeletal conditions, the annual out-of-pocket cost without coverage can be substantial.
Hearing aids and audiology: Hearing aids are among the most expensive medical devices that OHIP does not cover for most adults. A single quality hearing aid can cost $2,000 to $4,000 or more, and most people require two. Private health insurance plans often provide a benefit toward hearing aids on a recurring schedule.
Mental health services: OHIP covers psychiatric services provided by a physician, but private psychologist and registered psychotherapist services — which are often more accessible and timely are not covered. Private health insurance plans typically include a benefit for psychological and counselling services.
Massage therapy and other paramedical services: Registered massage therapy, naturopathy, acupuncture, speech therapy, and other paramedical services are not covered by OHIP but are regularly included in private health insurance plans
Who Needs Private Health Insurance?
Private health insurance is not just for people with significant health needs. It is a practical financial tool for anyone who regularly pays out of pocket for health-related services that OHIP does not cover. The following groups in particular benefit most from individual health insurance coverage:
Self-Employed Individuals
When you are self-employed, you have no employer providing a group benefits plan. Every dollar you spend on prescription drugs, dental work, eye exams, or physiotherapy comes directly from your own pocket. Private health insurance gives you access to the same type of comprehensive health coverage that salaried employees take for granted at a premium you pay yourself. In many cases, self-employed individuals can also deduct health insurance premiums as a business expense, making coverage even more cost-effective.
Employees Without Group Benefits
Many employees, particularly those working part-time, on contract, or for smaller employers, are not covered under a workplace group benefit plan. Others have group coverage but find it inadequate: low maximums, high co-payments, or limited paramedical benefits that leave significant expenses uncovered. A private individual health plan fills those gaps and provides the comprehensive protection your employer plan does not.
International Students
International students studying in Ontario are not eligible for OHIP coverage during their first three months in the province, and many remain uninsured or inadequately insured throughout their studies. A private health insurance policy designed for international students provides comprehensive coverage including emergency medical care, prescription drugs, dental, and vision, ensuring that a health issue does not derail your academic experience or create a financial crisis far from home.
Retirees and Seniors
When you retire, your employer group benefits plan typically ends. While OHIP covers eye exams for seniors, prescription drug costs for those 65 and older are partially covered through the Ontario Drug Benefit (ODB) program, but dental and other paramedical services remain uncovered. A private health insurance plan for retirees ensures continued access to the health services you rely on without the shock of paying full price out of pocket.
What Private Health Insurance Typically Covers
The specific benefits included in a private health insurance policy vary by insurer and plan level, but most comprehensive individual health plans in Ontario include some or all of the following:
- Prescription drug coverage up to an annual maximum
- Dental care including preventive, basic restorative, and major services
- Eye exams, prescription eyeglasses, and contact lenses
- Physiotherapy and occupational therapy
- Chiropractic care
- Registered massage therapy
- Hearing aids and audiology services
- Psychological and counselling services
- Acupuncture and naturopathy
- Emergency travel medical coverage
- Hospital accommodation upgrades (semi-private or private room)
How We Help You Find the Right Health Insurance Plan
Not all private health insurance plans are created equal. Benefit maximums, deductibles, co-insurance percentages, waiting periods, and eligible services vary significantly from one insurer and plan level to the next. Choosing the wrong plan can leave you paying for coverage you do not need or underinsured for the services you use most.
As independent advisors working with multiple leading insurers, we assess your existing coverage, your actual health spending, and your budget, then identify the plan that provides the best value for your specific situation. We recommend a policy that complements your provincial OHIP coverage and fills the gaps in any existing group benefits plan, rather than simply selling you the most expensive option available.
We also help clients who are transitioning from a group plan due to retirement, job loss, or leaving an employer — to convert or replace their coverage without gaps or lapses. Timing matters in these situations, and we ensure your transition to individual coverage is smooth and uninterrupted.
Frequently Asked Questions
Yes, in most cases. Many private health insurance plans in Canada are available on a guaranteed-issue basis with no medical questions — particularly if you apply within a certain period after losing group coverage. For plans that do require health underwriting, pre-existing conditions may be excluded from coverage while all other benefits remain fully in force. We will identify the best available option based on your health history.
The cost of a private health insurance plan varies based on your age, the level of coverage you choose, the deductible you select, and whether the plan covers one person or a family. Basic plans for a healthy individual can start at under $100 per month, while comprehensive family plans with robust drug, dental, and paramedical coverage will cost more. We will present you with options across multiple price points so you can choose the level of coverage that fits your budget.
For self-employed individuals, premiums paid for private health insurance may be deductible as a business expense or eligible for the Medical Expense Tax Credit, depending on how the coverage is structured. Incorporated business owners have additional options, including setting up a Private Health Services Plan (PHSP) that allows the corporation to deduct health-related expenses. We work closely with our tax team to ensure your coverage is structured as tax-efficiently as possible.
Yes. We have access to health insurance plans specifically designed for international students studying in Canada, providing comprehensive coverage that includes emergency medical care, prescription drugs, dental, and vision. These plans are available regardless of your country of origin and can be put in place quickly upon your arrival in Ontario.