OHIP Jan 22 - Written by Krista DeKuyper
10 Services not Covered by OHIP: What You Need to Know
Did you know that there are many services that are not covered by OHIP? The Ontario Health Insurance Plan is a government-run program that provides health insurance to residents of Ontario. It covers a wide range of services, but there are some exceptions. In this blog post, we will discuss 13 services that are not covered by OHIP. This includes dental care, prescription drugs and eye exams. If you need any of these services, you will have to pay out of pocket for them.
Ambulance transportation services if not deemed medically necessary
Routine eye examinations for people between the ages of 20 and 65.
Prescription Drugs if you are over 25.
Physiotherapy for individuals over 19 and under 65.
Necessary emergency medical treatment obtained outside of Canada
Birth control pills and other contraceptives if you are over 24.
Ambulance Transportation
A lot of people think that ambulance transportation is covered by OHIP regardless of the situation. That’s not true. As of 2025, OHIP only covers ambulance transportation if it is deemed medically necessary. Any ambulance transportation not deemed necessary will need to be charged and paid out-of-pocket.
Costs vary, make sure you look into your specific municipality for information on ambulance transportation costs. For example, in Toronto, you must pay a $45 fee for ambulance transportation, even if it is medically necessary.
Routine Eye Examinations
For people between the ages of 20 and 65, routine eye examinations are not covered by OHIP as of 2025. If an eye doctor recommends any non-routine eye exams or tests, those are also not covered.
What OHIP Does Cover
OHIP covers routine eye examinations once per year for:
People under 20 or over 65.
People with an eligible condition requiring a major eye exam (ex: optic nerve disorders, diabetes, retinal diseases, corneal diseases, cataracts.etc)
Glasses and Contact Lenses
People who need glasses are out of luck. As of 2025, prescription glasses and contact lenses are not covered by OHIP. You’ll need to pay out of pocket. Contact lenses may be covered if you have a medical condition that requires them.
Dental Care
Dental care services are not covered by provincially by OHIP at all. This includes routine dental check-ups, cleanings, and fillings. If you need any of these services, you will need to pay out of pocket. Some people think that they are covered for dental care if they are pregnant or have a child under the age of 18. However, this is not the case. Prenatal and infant dental care is not covered by OHIP.
However, the government has recently introduced federal coverage options for Canadian dental care via the Canadian Dental Care Plan (CDCP). To summarize, the CDCP is available for families without private insurance coverage that meet income eligibility requirements (household income above 90k+). It fully or partially covers various dental care costs, including dental exams, oral x-rays, dental cleanings, and even dentures.
Please note that the CDCP has replaced the Canada Dental Benefit for children.
If you have a disability that affects your ability to eat, drink, or swallow, you may be eligible for dental care coverage through the Ontario Disability Support Program (ODSP).
If you’re a senior (65+) read this blog to see what 4 services OHIP covers for you.
Prescription Drugs
If you need prescription drugs, you will need to pay out of pocket. OHIP does not cover the cost of prescription drugs for most Canadians.
There are some exceptions to this rule. If you qualify for the Ontario Drug Benefit program, a portion of the cost of your prescription drugs are covered. You will need to meet one of the following requirements and possess a valid Ontario health card:
Seniors who are ages 65 and older
Residents under the age of 25
Ontario residents who are on social assistance
Ontario residents who reside in long-term care homes and homes for special care
Ontario residents who are receiving professional home care services
Residents who have high drug costs compared to their income are registered with the Trillium Drug Program.
Physiotherapy
For the most part, OHIP doesn’t cover physiotherapy. It will only cover physiotherapy under certain conditions, such as a doctor’s referral.
Government-funded community physiotherapy clinics offer free service for residents that meet the following conditions:
you are less than 20 years of age or are 65 and older AND have been referred by a physician stating that you require physiotherapy
you have been discharged as a hospital inpatient after an overnight stay and need physiotherapy to recover from your injury or condition (within 12 months)
you are a client of Ontario Works of the Ontario Disability Support program and are referred by a physician or nurse practitioner
Paramedical Services
Paramedical services, including chiropractors, massage therapists, naturopaths, acupuncturists, psychologists and osteopaths, are not covered by OHIP.
We previously spoke about physiotherapy, which is also considered a paramedical service. Physiotherapy is one of the only paramedical services known to be covered by OHIP, even though eligibility for that is extremely limited.
Ask your physician about coverage for paramedical services, there may be other options available for covering these treatments, even if it covered by OHIP specifically.
Semi-private and Private Hospital Rooms
When you get admitted to the hospital, you will not traditionally be provided with a private or semi-private room. Private and semi-private hospital rooms are not covered by OHIP. Instead you will be placed in a ward with 3-4 other beds/people, this room is covered by OHIP.
If you want a private room, you will need to request one and pay via private insurance or out-of-pocket. The out-of-pocket cost for a private room ranges from $300-500 per day.
OHIP doesn’t cover private rooms likely because of capacity issues in hospitals across Ontario, which makes it significantly more expensive to have a private room.
Treatment Outside Of Ontario & Canada
If you find yourself needing medical services outside of Ontario, OHIP will not cover anything deemed not medically-necessary or anything it wouldn’t usually cover. This means services like emergency dental, ambulance, and prescription drugs (even for treatment) are not covered in other provinces.
OHIP will not cover anything outside of Canada, so even if you have a medical emergency and need to go to the hospital, you will need to pay out-of-pocket. The Out-of-Country Traveller’s program which previously covered out-of-country care was eliminated in 2019. To protect yourself from high health care costs in other countries, you will need travel insurance from a private provider (Compare travel insurance quotes for free and without a broker here).
The Government of Canada recommends all Canadians get travel insurance if travelling outside of Canada.
Birth Control
Birth control is not always covered by OHIP. Traditional prescription birth control can be covered if you’re 24 years old or younger or you qualify for a special drug program (OHIP+).
As for alternative birth control methods (IUDs), they are usually not covered by OHIP. They are classified as a medical device, not a medication.
OHIP+ can cover hormonal IUDs but not copper IUDs.
To learn more about birth control covered through OHIP read this blog.
Private Health Insurance
Canadians are fortunate to have free health care, but their provincial plan can only cover certain medical needs. For example, above are at least 10 services not covered by OHIP. If you have a private health insurance plan it will help cover the costs of services not included in your provincial plan like dental, vision, physio and more.
We have built a instant quoting tool which allows you to browse insurance plans and costs from providers across Canada. You do not need to speak to a broker in order to view insurance quotes on our tool. However, you will need to speak to a broker if you are interested in purchasing a private insurance plan.
Common FAQs about OHIP coverage
Does OHIP cover surgery?
Yes, for the most part at least. OHIP will cover surgeries that are medically necessary. OHIP however will not cover laser eye and cosmetic surgery. These you will have to pay for yourself or be covered by your insurance provider.
Does OHIP cover x-rays?
Yes. OHIP will cover x-rays, MRI, and CT scans if it is medically necessary and you have a requisition from a doctor.
If you don’t have a private health insurance plan and are looking for one HealthQuotes can help. Use our instant quoting tool to compare quotes from leading insurance providers.