As Ontarians navigate through their health coverage options, the topic of private health insurance commonly emerges. The Ontario Health Insurance Plan (OHIP) guarantees a foundation of coverage, but is it enough for individuals with more unique health concerns? Enter the realm of private healthcare – for some, it’s a safety net, for others, it’s a necessity. How can an individual know if private health insurance is worth it for them? In this article, we will explore the value of private health insurance in Ontario. 

Understanding Private Health Insurance in Ontario

Private health insurance, also referred to as personal health insurance, is an alternative form of coverage for medical care. Most private insurance plans cover a variety of health-related expenses including, but not limited to:

• Vision Care
• Dental Care
• Prescription Medications
• Physiotherapy
• Ambulance Services
• Various medical equipment. 

The main benefit of private health insurance is that it’s designed to cover eligible expenses not otherwise covered by the government health insurance plan.

The Coverage Gap: What OHIP Does and Doesn’t Cover

To figure out whether a private health insurance plan is worth it, it’s vital to understand what the Ontario Health Insurance Plan (OHIP) does and doesn’t cover. Below is a quick round-up of some of the basic medical expenses OHIP covers. 

OHIP fully or partially covers doctor’s visits, walk-in clinic visits, hospital visits, and laboratory testing, as long as they are considered medically necessary. 

Some services you will receive on a doctor or hospital visit include common diagnoses, prescriptions, and general medical insight for managing various conditions. A doctor will also be able to provide you with referrals to specialists to help with specific conditions, as well as simple treatment for common injuries or conditions.

You can refer to our full Summary of OHIP Coverage and Benefits for a more in-depth idea of OHIP coverage. 

Some of the most common health-related services that aren’t covered by OHIP include:

• Dental services conducted in a dental office
• Eyeglasses or eye contacts
• Cosmetic surgery 
• Prescription drugs that were not prescribed in a hospital 
• Psychological therapy and treatment 

If there are noticeable gaps in your OHIP coverage, a private health insurance plan may be worth the investment.

Assessing the Costs: Premiums, Deductibles, and Co-pays

The cost of insurance is not just about paying a monthly premium; it includes deductibles, co-pays, and potentially other out-of-pocket expenses. Understanding these costs is crucial for making an informed decision about private health insurance coverage.

A few of the expected costs that come with private health insurance are as follows:

Premiums are the baseline cost of having private health insurance. This is the amount you pay, typically on a monthly or yearly basis, to keep your insurance policy active. There is no specific cost range that applies here. The extent of coverage varies depending on the individual and the insurer. Additional factors that may affect the monthly and/or annual cost include age, health status, and whether the plan is for an individual or a family.

Deductibles represent the amount you need to pay out of pocket each year before your insurance company starts to pay its share for covered services. Plans with higher deductibles will usually have lower annual or monthly premiums, and vice versa. 

A Co-Pay is a fixed amount you pay for a specific service or prescription medication at the time of service, with the insurance covering the remainder of the cost.

Out of pocket maximums are the maximum amount you will have to pay out of pocket for services that are eligible for coverage. When this limit is reached, your insurer will then have to pay 100% of the costs for covered benefits.

The Benefits of Private Health Insurance: Beyond Basic Coverage

Enhanced Coverage for a Wide Range of Services: One of the most significant benefits of private health insurance is the broader spectrum of medical services covered. This includes prescription medications, dental care, vision care, physiotherapy, mental health support, and alternative therapies such as chiropractic services and acupuncture. These services are not fully covered by OHIP, and can be a costly expense if solely paying out of pocket. 

Shorter Wait Times for Certain Services: Individuals under private health insurance often experience reduced wait times for specific services. With private health insurance, you will have access to private clinics for services such as MRI and CT scans. Private clinics will often have shorter wait times than a trip to the hospital for the same medical-related tests. This helps prevent delays in diagnosis and treatment. 

Flexibility and Choice: Private health insurance provides individuals with greater flexibility and choice in their healthcare journey. Individuals can have the ability to choose specialists, the freedom to seek second opinions, and more options for personalized treatment plans. Especially for those who have specific healthcare needs, this will significantly enhance quality of care.

Preventive Care and Wellness Benefits: Many private health insurance plans offer incentives and coverage for preventive care and wellness programs. This can include coverage for vaccinations, and health screenings. There also may be coverage for programs aimed at promoting a healthy lifestyle, such as gym memberships or nutrition counseling.

Financial Protection and Peace of Mind: Private health insurance can shield individuals and families from unexpected high medical costs. If you are in a health crisis, having private health insurance can take a heavy financial burden off your shoulders. This can allow individuals to better focus on their treatment and recovery. 

Coverage While Travelling: Finally, many private health insurance plans offer coverage for medical emergencies outside Ontario or even outside Canada. This can be crucial in situations where medical care is needed in countries with high healthcare costs.

Conclusion: Finding the Right Fit for Your Healthcare Needs With Health Quotes

If you’re planning to move forward with private health insurance, the next step would be to find a plan that works for you. At HealthQuotes, we simplify the search with Quick Quotes.

Assessing costs, understanding benefits, and considering personal or family healthcare needs are pivotal steps when deciding what plan is right for you. To help guide your decision-making, we also have a blog on the 7 Essential Tips For Comparing Health Insurance Quotes. 

From filling coverage gaps left by OHIP to expanding available healthcare services, the decision to invest in private health insurance is deeply individual. Ultimately, private health insurance is a pathway to accessing a broader range of healthcare services. Whether a broadened level of private health insurance coverage is worth it is up to the individual.