Core OHIP Coverage for All Residents
Regardless of age, OHIP covers a wide range of medically necessary services for all Ontario residents with a valid health card. These essential services remain in place after you turn 65, providing a foundation for your healthcare.
General Medical Services
- Doctor visits: OHIP covers medically necessary appointments with family doctors and specialists, both in-person and virtually.
- Hospital services: Coverage includes hospital stays, emergency care, diagnostic tests like X-rays and MRIs, and medications administered while an inpatient.
- Ambulance services: A portion or all of the ambulance fee is covered if the trip is deemed medically necessary by a doctor.
- Laboratory tests: Most medically necessary tests conducted in community labs or hospitals are covered.
Specialized Services
- Podiatry: OHIP provides partial coverage for certain foot-related health services.
- In-hospital dental surgery: Select dental surgeries performed in a hospital are covered, such as fracture repair and medically necessary tooth removal with prior approval.
- Mental health: Essential mental health services, including consultations with psychiatrists, are included.
Expanded OHIP Benefits and Programs for Seniors
Upon turning 65, Ontario residents receive several expanded health benefits, particularly concerning prescription drugs, vision, and additional supportive care programs.
Ontario Drug Benefit (ODB) Program
This program provides coverage for over 5,000 prescription drugs for seniors 65 and over. Enrollment is automatic on the first day of the month after your 65th birthday. Most seniors have an annual deductible and a co-payment per prescription, but a program exists to reduce costs for low-income seniors.
Enhanced Vision Care
OHIP provides enhanced vision coverage for seniors. This includes a major eye exam every 18 months, with up to two minor follow-up assessments annually. Seniors with certain medical conditions are covered for an exam every 12 months.
Other Supportive Services
Home and Community Care offers support for eligible seniors, and OHIP covers physiotherapy sessions, typically for recovery from injury or surgery. Additionally, an expanded range of vaccines is covered, such as for the flu, shingles, and pneumococcal.
What OHIP Does NOT Cover After 65
Several services are not covered by OHIP, which is important for seniors to consider for financial planning.
Comparison of Covered vs. Not Covered Services for Seniors
| Service Category | Covered by OHIP (Seniors 65+) | Not Covered by OHIP |
|---|---|---|
| Prescription Drugs | Over 5,000 eligible medications via the ODB program. | Most drugs not listed on the ODB Formulary. |
| Dental Care | Limited in-hospital surgeries (e.g., tumor removal). | Routine dental services (cleanings, fillings, extractions in-office). |
| Vision Care | One major eye exam every 18 months, or 12 months if medically necessary. | Eyeglasses, contact lenses, and corrective lenses. |
| Assistive Devices | Devices like wheelchairs and ostomy supplies are not directly covered by OHIP. | Covered partially by the Assistive Devices Program (ADP). |
| Cosmetic Procedures | Medically necessary surgeries only. | Any procedure considered not medically essential. |
| Out-of-Country Care | Very limited emergency services only. | Travel, accommodation, and most health services while outside of Canada. |
Additional Programs for Ontario Seniors
To help cover services not included in OHIP, provincial and federal programs offer additional support.
Ontario Seniors Dental Care Program (OSDCP)
Low-income seniors aged 65 and over may qualify for free routine dental care through the OSDCP, which includes check-ups, cleanings, and fillings. Eligibility is based on income.
Canadian Dental Care Plan (CDCP)
This federal plan is being introduced and provides dental coverage for seniors 65 and older who meet income criteria and do not have private insurance.
Assistive Devices Program (ADP)
The provincial ADP provides partial funding for various assistive devices like hearing aids and wheelchairs, with a doctor or authorized supplier's recommendation.
Conclusion
For Ontarians over 65, OHIP covers essential medical services and provides significant added benefits like the Ontario Drug Benefit program and enhanced vision care. However, routine dental and vision correction costs are not covered. Seniors should be aware of supplementary programs such as the OSDCP and ADP that can help bridge these gaps. Consulting available resources, including the official Ontario government website, is important to understand and maximize benefits.
