Navigating healthcare in Ontario can feel complex, but understanding your medical benefits is the first step to taking control of your well-being. The foundation of healthcare in the province is the Ontario Health Insurance Plan (OHIP) , a publicly funded system that provides residents with access to essential medical services. As of 2026, OHIP continues to cover a comprehensive range of medically necessary services, ensuring that all eligible residents have a base level of healthcare security .
This article breaks down exactly what is covered by your provincial health card, what is not, and how you can fill those gaps with private insurance to create a complete health protection plan for you and your family.
What OHIP Covers: The Foundation of Your Healthcare
If you have a valid Ontario health card, you are covered for a wide array of medically necessary services. This means that any doctor or hospital service required to diagnose or treat an illness or injury is fully funded by the government . Your core coverage includes:
- Doctor’s Visits: All visits to family physicians and most specialist consultations are fully covered.
- Hospital Care: This includes all necessary services if you are admitted to a hospital, from surgeries and emergency room visits to room and board, nursing services, and necessary medications administered during your stay.
- Diagnostic Testing: Medically necessary tests ordered by a physician, such as blood work, X-rays, and MRIs, are covered.
- Surgical and Dental Services: OHIP covers surgical procedures performed in a hospital. It also covers specific surgical-dental procedures that are considered medically necessary and performed in a hospital, such as the reconstruction of a jaw following an accident .
- Optometry: Eye exams are covered for children (under 19) and seniors (65 and over) once a year, as well as for those with specific medical conditions like diabetes.
- Ambulance Services: While not entirely free, ambulance services are heavily subsidized for residents. You will typically pay a co-payment fee for transport, but the bulk of the cost is covered by OHIP .
- Out-of-Canada Coverage: OHIP provides limited coverage for emergency and non-emergency physician and hospital services received outside of Canada. However, reimbursement is capped at the rate the service would cost in Ontario. For example, emergency hospital services abroad are capped at only $400 per day, which is far less than the actual cost in many countries . This makes travel health insurance absolutely essential whenever you leave the province.
Additional Government Assistance Programs
Beyond OHIP, the Ontario government offers additional assistance for specific groups. For instance, children and seniors (65+) can receive coverage for prescription medications, dental services, and vision care through various public drug and dental programs. Individuals with a long-term disability (lasting more than six months) may also qualify for funding to cover up to 75% of the cost of prosthetics, orthotic braces, mobility aids, and communication aids . Eligibility for these programs is often income-based.
The Coverage Gap: What OHIP Does NOT Cover
While OHIP provides a robust safety net, it does not cover everything. For most working-age adults (roughly 18 to 64), there are significant gaps that can lead to substantial out-of-pocket expenses. These gaps are where private health insurance becomes valuable . Common services not covered by OHIP include:
- Prescription Drugs: The cost of medications taken outside of a hospital is the largest gap for most adults.
- Dental Care: Routine dental cleanings, fillings, extractions, and major procedures like crowns and root canals are generally not covered.
- Vision Care: Eyeglasses, contact lenses, and routine eye exams for adults aged 20-64 are not covered.
- Paramedical Services: Services from physiotherapists, chiropractors, naturopaths, massage therapists, psychologists, and other allied health professionals are typically not covered or only partially covered under very specific circumstances.
- Medical Equipment and Supplies: Items like crutches, wheelchairs, and diabetic supplies are not covered by basic OHIP.
Filling the Gaps with Private Health Insurance
For many Ontarians, private health insurance is the key to comprehensive health coverage. This insurance is designed to supplement OHIP, covering the services the public plan does not. You can obtain private insurance through an employer’s group benefits plan or by purchasing an individual plan directly from a provider. According to recent market analysis, several plans stand out in 2026 for their value and coverage .
Top Private Health Insurance Plans in Ontario (2026)
If you are considering private insurance, here are some of the highly-rated options currently available, which can help you manage costs and gain access to a wider range of services :
1. PolicyMe – Guaranteed Issue Classic
- Best For: Most customers seeking the best balance of affordability and comprehensive coverage.
- Key Strengths: High reimbursement rates and generous annual maximums for paramedical services and mental health care. It also offers excellent coverage for ambulance services and most dental care.
- Monthly Premium (approx.) $95/month (for an 18-year-old)
2. GreenShield – ZONE 5 (Choice)
- Best For: Seniors, frequent travelers, or those seeking an affordable supplement to OHIP.
- Key Strengths: Highly competitive coverage for emergency dental and out-of-province/country travel. It is a good option for those who travel frequently and need that extra layer of protection.
- Monthly Premium (approx.) $112/month (for an 18-year-old)
3. ScotiaLife – Health Insurance Plan with Dental
- Best For: Existing Scotiabank customers looking for a low-priced, straightforward plan.
- Key Strengths: A simple and affordable option for those who want to supplement their existing benefits without complexity. (Note: This plan is only available to Scotiabank customers).
- Monthly Premium (approx.) $94/month (for an 18-year-old)
4. GMS – ExtendaPlan with Basic Prescription Drugs and Dental
- Best For: Budget-conscious individuals who primarily need prescription drug coverage and basic preventative dental care.
- Key Strengths: A good budget pick that focuses on covering the essentials, particularly prescription drugs.
- Monthly Premium (approx.) $98/month (for an 18-year-old)
5. Manulife – ComboPlus Basic Plan
- Best For: Families, due to its strong dental and mental health coverage.
- Key Strengths: Offers a wide range of customization options to tailor coverage to a family’s specific needs. It provides particularly strong benefits for dental work and mental health counseling sessions.
- Monthly Premium (approx.) $105/month (for an 18-year-old)
*Note: Premiums listed are approximate for an 18-year-old and can vary based on age, location, and the specific level of coverage chosen. Quotes for a 65-year-old, for example, can range from $152 to $278 per month .*
How to Choose the Right Plan for You
Finding the best medical benefits in Ontario means finding the right combination of public and private coverage. Here is a simple step-by-step approach :
- Audit Your Current Coverage: Start by fully understanding what your OHIP card covers and what it doesn’t. If you have an employer plan, list out all its benefits and annual maximums.
- Analyze Your Spending: Look back at the past year and tally up all your out-of-pocket health expenses—prescriptions, dental bills, physio appointments, new glasses.
- Identify Your Gaps: Determine which of your expenses were not covered. These are your personal coverage gaps. For instance, if you visit a chiropractor regularly, you need a plan with strong paramedical coverage.
- Compare Plans and Calculate Savings: Get quotes from multiple providers. For each plan you are considering, estimate what your out-of-pocket costs would have been last year if you had that plan. Subtract the annual premiums you would have paid. This will show you the plan’s true potential value for your specific situation.
By combining the security of OHIP with a tailored private insurance plan, you can build a healthcare strategy that protects your health and your finances in 2026 and beyond.
