OHIP Mar 30, 2026 - Written by Krista DeKuyper
What’s Not Covered by OHIP?: A Complete 2026 Guide
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 guide, we cover what OHIP does cover, including MRI and CT scans, as well as the 13 services OHIP does not cover — including dental care, prescription drugs, and eye exams. If you need any of these uncovered services, you will have to pay out of pocket or rely on private health insurance.
What Does OHIP NOT Cover? (Quick Answer)
OHIP does not cover the following services for most Ontario residents in 2026:
Dental care (routine cleanings, fillings, exams — except certain hospital-based dental surgeries)
Prescription drugs (unless you qualify for OHIP+, ODB, or the Trillium Drug Program)
Routine eye exams for adults aged 20–64 without a qualifying eye condition
Physiotherapy for adults aged 20–64 (except under specific referral conditions)
Ambulance transportation if not deemed medically necessary (a $45 co-pay applies even when it is)
Paramedical Services, including:
Mental health therapy from private psychologists or counsellors outside hospitals
Chiropractic care
Birth control if you are over 24.
Out-of-country medical care, even if medically-necessary (the Out-of-Country Travellers Program was eliminated in 2019)
What Does OHIP Cover in Ontario? (2026)
Before diving into the gaps, it helps to understand what OHIP does cover. OHIP pays for medically necessary services provided by licensed physicians, hospitals, and certain other providers. Coverage is funded through Ontario's provincial budget and applies to Canadian citizens, permanent residents, and certain work permit holders who are residents of Ontario.
In most cases, OHIP does cover the following services:
Doctor visits: All medically necessary in-person and virtual visits to a family doctor, walk-in clinic, or specialist, at no cost to you
Hospital care: Medically necessary in-patient and out-patient services, including standard ward accommodations, nursing care, operating room fees, meals, and required medications during a hospital stay
Diagnostic imaging: X-rays, MRI scans, and CT scans, when medically necessary and ordered by a physician (see dedicated sections below)
Laboratory tests: Blood work and other lab tests ordered by a physician at community labs or hospitals
Mental health services: Psychiatric assessments and consultations through hospitals and referred specialists (note: private psychologists/therapists outside hospitals are generally not covered)
Emergency dental surgery: Only when performed in a hospital (e.g., fracture repair, tumour removal, medically necessary tooth removal with prior OHIP approval)
Ambulance transportation: When deemed medically necessary. There’s a $45 co-pay if transport did not originate at a medical facility
Eye exams: For children and youth under 20 (once per year); seniors 65+ (once every 18 months); and adults 20–64 with qualifying medical eye conditions
Podiatrist visits: Partially covered - $7–$16 per visit, up to $135/year plus $30 for x-rays (podiatric surgery is not covered)
Midwife services
Some prescription drugs: Through the Ontario Drug Benefit (ODB) program for seniors, low-income residents, and those under 25 (via OHIP+)
Physiotherapy: For residents under 20 or 65+ with a physician referral, through government-funded community clinics
Common FAQs about OHIP coverage
Are MRI Scans Covered by OHIP?
Yes, OHIP covers MRI scans in Ontario when they are medically necessary and ordered by a licensed Ontario physician.
To receive a covered MRI, you need a requisition (referral) from a certified doctor. If you have a valid OHIP card and a physician's requisition, your MRI at a publicly-funded hospital or approved clinic will be covered by OHIP.
However, keep in mind:
The average wait time for an MRI in Ontario is approximately 90 days, though this varies by region, urgency, and time of year. Luckily, Ontario has been expanding the number of private clinics authorized to perform publicly funded MRIs to help reduce this wait.
Private MRI clinics in Ontario cannot charge patients directly for OHIP-covered scans. If you visit an unauthorized or uninsured private clinic (or travel to the U.S. for a scan), OHIP will not reimburse you.
MRI scans done outside Ontario are not covered by OHIP, including in the United States.
Some private health insurance plans in Ontario provide access to private imaging clinics with significantly shorter wait times — if you’re interested in exploring private options, you can compare plans from providers across Canada here.
Are CT Scans Covered by OHIP?
Yes, CT (computed tomography) scans are covered by OHIP in Ontario when medically necessary and ordered by a physician.
Like MRIs, CT scans require a physician's referral and must be performed at a publicly funded hospital or OHIP-authorized clinic. When these conditions are met, there is no out-of-pocket cost.
Keep in mind:
The average wait time for a CT scan in Ontario is over 80 days for non-emergency cases. Luckily, Ontario has been expanding the number of private clinics authorized to provide publicly funded CT scans to reduce these wait times.
CT scans obtained outside Ontario (including in the United States) are not covered by OHIP.
Does OHIP cover X-rays?
Yes, OHIP will cover X-rays. Typically, the process for this is the same as with an MRI or CT scan. The X-ray must be deemed medically-necessary and you must have a requisition from a doctor.
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.
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.
13 Services Not Covered by OHIP in Ontario (2026)
Ambulance Transportation
OHIP does not cover ambulance transportation unless it is deemed medically necessary.
When transportation is deemed medically necessary, OHIP covers most of the cost, but a $45 co-pay still applies if the ambulance was called from a non-medical location (such as your home). If you are receiving social assistance, the $45 fee is waived. If a physician determines the transportation was not medically necessary, you may be charged $240 for the call.
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.
Out-of-province ambulance costs are not covered by OHIP under any circumstances.
Routine Eye Examinations (Adults 20–64)
OHIP does not cover routine eye exams for adults between the ages of 20 and 64, unless you have a qualifying medical eye condition (ex. glaucoma, cataracts, or diabetes). Eye exams are covered for:
Children and youth under 20 (once per year).
Seniors 65 and older (once every 18 months).
Adults 20–64 with a diagnosed medical eye condition (once per year).
OHIP does not laser eye surgery for any age group.
Glasses and Contact Lenses
As of 2026, OHIP does not cover eyeglasses or contact lenses. These must be paid out of pocket or through a private insurance plan. Contact lenses may be covered in limited cases where a specific medical condition requires them.
Dental Care
OHIP does not cover dental care provided in a dentist's office. This includes routine dental check-ups, cleanings, fillings, X-rays, and other standard dental services. If you need any of these services, you will need to pay out of pocket or through a private health plan.
OHIP only covers certain dental surgeries performed inside a hospital (such as fracture repair, tumour removal, and medically necessary tooth extractions with prior OHIP approval).
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.
Federal funding options that may help:
The Canadian Dental Care Plan (CDCP) now provides partial or full coverage for Canadians without private insurance and with household income below $90,000. It covers dental exams, oral X-rays, cleanings, and dentures. The CDCP has replaced the Canada Dental Benefit for children.
Additionally, people with disabilities who are on the Ontario Disability Support Program (ODSP) may be eligible for dental coverage if their disability affects their ability to eat, drink, or swallow.
If you’re a senior (65+) read this blog to see what 4 services OHIP covers for you.
Prescription Drugs
OHIP does not cover the cost of prescription drugs for most Canadian adults. The main exceptions are:
OHIP+: Covers most prescription drugs for Ontario residents under 25 years old
Ontario Drug Benefit (ODB) Program: Covers prescription drugs for: seniors 65+, residents on social assistance (ODSP/Ontario Works), long-term care home residents, home care recipients, and those registered with the Trillium Drug Program
Trillium Drug Program: Available to Ontario residents with high prescription drug costs relative to their income, regardless of age
If you don't qualify for any of the above programs and are 25 or older, you will pay out of pocket for prescription drugs unless you have private insurance.
Physiotherapy
OHIP does not cover physiotherapy for most adults between the ages of 20 and 64. There are some exceptions. publicly-funded physiotherapy may be available through government-funded community physiotherapy clinics only for:
Residents under 20 or 65 and older, with a physician referral stating physiotherapy is required
Individuals recently discharged from hospital, up to 50 visits covered post-hospitalization
Long-term care home residents, up to 100 visits per year
Those on ODSP, Ontario Works, or Family Benefits
For everyone else, physiotherapy must be paid out of pocket or through a private health insurance plan.
Paramedical Services & Private Therapy
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.
Private Therapy
We are often asked about private therapy coverage for mental health, which is a little different:
OHIP does not cover therapy or counselling from private psychologists, social workers, or therapists outside hospitals.
OHIP does cover psychiatric consultations and some mental health services delivered by physicians in hospital settings
Gaps in community-based mental health coverage is significant. While you may be able to receive some short-term mental health care, most community programs can’t support long-term counselling or treatment.
Private health insurance plans often include a psychological services benefit, typically covering a set dollar amount per year (e.g., $500–$2,000 for visits to registered psychologists or social workers).
Semi-Private and Private Hospital Rooms
OHIP covers only standard ward accommodations in a hospital (A ward with 3-4 other beds/people). Most hospitals will place you in a standard ward automatically, unless you specifically ask for a private or semi-private room.
If you prefer a semi-private or private room, you or your private insurance will need to cover the additional cost. The out-of-pocket cost for a private room ranges from $300-500 per day.
OHIP doesn’t cover private rooms because of capacity issues in hospitals across Ontario, which makes it significantly more expensive to have a private room.
Treatment Outside Of Ontario & Canada
OHIP will cover medically necessary doctor and hospital services in other Canadian provinces or territories. However, it does not cover ambulance services, prescription drugs, or home care outside Ontario.
As of January 1, 2020, the Out-of-Country Travellers Program was permanently eliminated. OHIP provides no coverage for medical care received outside Canada.
Even if you have a medical emergency and need to go to the hospital, you will need to pay out-of-pocket. 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 (Adults 25 and Over)
OHIP does not cover the cost of birth control pills or other contraceptives for residents 25 years of age and older, unless you qualify for a specialty drug program for low-income individuals.
OHIP+ covers many hormonal contraceptives for Ontarians under 25. OHIP+ can cover hormonal IUDs but not copper IUDs, as they are classified as a medical device rather than a medication.
To learn more about birth control coverage through OHIP, read this blog:
Fertility Treatments and IVF (2026 Update)
OHIP does not cover most fertility treatments, including IVF (in vitro fertilization), fertility drugs, or sperm/egg banking.
In limited circumstances, OHIP may cover one IVF cycle for individuals with a medical diagnosis of infertility — speak with your physician about eligibility.
Private health insurance coverage for fertility is limited but some employer group plans include a fertility benefit.
Hearing Aids and Audiology Testing (2026 Update)
OHIP does not cover hearing aids or routine hearing tests (audiology). The Assistive Devices Program (ADP) funded by the Ontario government may provide partial subsidy for hearing aids for eligible individuals, but the majority of costs are the patient's responsibility. Private health insurance plans sometimes include a hearing aid benefit.
Cosmetic Surgery (2026 Update)
OHIP does not cover any cosmetic procedures, including cosmetic surgery, Botox, and other elective aesthetic treatments. Coverage for reconstructive surgery (e.g., following an accident or mastectomy) may be available in some cases — consult your physician.
Read More: Can Private Health Insurance Cover Cosmetic Surgery In Ontario?
How to Fill the Gaps in Your OHIP Coverage
Canadians are fortunate to have free health care, but their provincial plan can only cover certain medical needs. Services like dental, prescription drugs, vision, physiotherapy, mental health therapy, chiropractic, and hearing care are all left to be paid for by the patient.
A private health insurance plan can cover many of these gaps, protecting you from significant out-of-pocket costs. We've built an instant quoting tool that lets you browse plans and costs from providers across Canada — including Manulife, Blue Cross, and Sun Life — without needing to speak to a broker to see your options.
Compare private health insurance plans for free by clicking the button below.