Ontario Health Insurance Plan (OHIP): A Guide For Seniors

Wil Thomas
Wil Thomas
Editor at Seniors Bulletin

Aging is an inevitable and natural process that we and our parents face. It can be a positive experience but it can also hold many challenges. Maintaining good physical health and mental acuity is the key to stay healthy and maintain wellness over the years. It is fortunate that in Ontario, the health system consists of health professionals and community services that can provide health services for older adults at no or little cost to the patient.

Highlights

  • Exploring the comprehensive coverage provided by OHIP for seniors in Ontario, including eligibility requirements and benefits covered.
  • Highlighting various healthcare programs available for seniors in Ontario, such as vision care, prescription coverage, dental services, assistive devices, home and community care services, and long-term care.
  • Key points of OHIP coverage for seniors and the importance of accessing healthcare services to maintain well-being and quality of life in aging populations.

The Ontario Health Insurance Plan (OHIP) is a comprehensive, publicly-funded health insurance program that serves as the cornerstone of healthcare in the province of Ontario, Canada. Administered by the Ontario Ministry of Health, OHIP ensures that all eligible residents have access to a wide range of medically necessary healthcare services without incurring direct costs at the point of service. Through OHIP, the Ontario government funded care strives to promote equitable access to healthcare, safeguarding the well-being of its diverse population and fostering a healthier, more resilient community.

With an emphasis on preventive care, chronic disease management, and support for independent living, OHIP aims to foster an age-friendly environment that empowers seniors to lead healthy, active, and fulfilling lives.

Ontario seniors benefits from OHIP but low-income seniors, and seniors without private insurance benefit the most as it provides comprehensive care regardless of income status.

Requirements for seniors coverage under Ontario Health Insurance Plan (OHIP)

To qualify for the Ontario Health Insurance Plan (OHIP), an individual must meet specific eligibility requirements. These include:

  1. Residency: The person must be a Canadian citizen, permanent resident, or among one of the specific groups of people with a valid immigration status, such as certain work permit holders, convention refugees, or protected persons. Temporary residents, such as visitors and tourists, typically do not qualify for OHIP coverage.
  2. Physical presence: The individual must be physically present in Ontario for at least 153 days in any given 12-month period and at least 153 days in each of the first two 12-month periods after establishing residency in the province.
  3. Primary place of residence: The person’s primary place of residence must be in Ontario. This means that the individual mainly lives and maintains a home in the province.
  4. Waiting period: New residents or individuals who have lost their OHIP coverage and are returning to Ontario typically need to complete a waiting period before becoming eligible for coverage. This waiting period usually consists of the balance of the month in which they establish residency in Ontario, plus an additional two months.

You can apply online for an OHIP card here.

Which Health Care Programs Are Available For Older Canadians?

Older Canadians looking for information regarding healthcare coverage under the Ontario Health Insurance Program should read this article to learn about what benefits are covered at age 65+.

Here are some things OHP offers seniors.

Vision Care

OHIP provides coverage for routine eye examinations once every 18 months for seniors aged 65 and over.

Aging seniors need to take great care of their vision, because it helps them stay independent. Visits to an ophthalmologist are a wonderful way to begin taking care of their sight.

Prescriptions

Seniors aged 65 and over receive coverage for more than 4,400 prescription medications, select over-the-counter drugs, and nutritional supplements through the Ontario Drug Benefit (ODB) Program. This benefit helps cover some costs associated with medications. OHIP covers some medication costs for seniors, but not all prescriptions. Some medications prescribed require patients to purchase those items on their own.

Dental Services

The Ontario Seniors Dental Care Program (OSDCP) is a program that offers free, routine dental care for low-income seniors aged 65 and over, ensuring access to essential oral health services.

Assistive Devices

Assistive Devices Program (ADP): ADP helps cover the costs of various assistive devices for eligible seniors, such as mobility aids, hearing aids, and respiratory equipment.

Home And Community Care Services

OHIP covers various home and community care services for seniors, including nursing, personal support, and therapy services, to help them maintain their independence and quality of life. They promote seniors living at home by providing services to them without needing long term care homes.

Some health care professional services that Home And Community Care Support Services include:

  1. Nursing care: Registered nurses (RNs) or registered practical nurses (RPNs) provide various nursing services, such as wound care, medication management, and chronic disease management.
  2. Physiotherapy: Licensed registered physiotherapist(s) provide assessment, treatment, and rehabilitation services for individuals experiencing mobility issues, injuries, or recovering from surgery. Often services can be done in the patients’ own homes.
  3. Occupational therapy: Occupational therapists help individuals improve their ability to perform daily tasks, such as self-care, household chores, and community activities, by recommending assistive devices, home modifications, or adaptive strategies. Often services can be done in the patients’ own homes.
  4. Speech-language therapy: Speech-language pathologists assess and treat communication and swallowing disorders, providing therapy and strategies to improve speech, language, and swallowing function.
  5. Social work: Social workers provide counseling, support, and resources to help individuals cope with emotional, social, or financial challenges associated with their health conditions. They can help apply for programs and services that may provide financial help or relief to the individual.
  6. Dietitian services: Registered dietitians offer nutritional counseling and education, helping individuals manage health conditions through dietary modifications or plan balanced meals.
  7. Medical supplies and equipment: Home and Community Care Support Services may provide necessary medical supplies, such as wound dressings, incontinence products, or ostomy supplies, as well as loan equipment, like walkers or wheelchairs, for short-term use.

Some personal support services that Home And Community Care Support Services include:

  1. Personal support: Personal support workers (PSWs) assist with activities of daily living, including bathing, dressing, grooming, toileting, and mobility support.
  2. Homemaking services: Home care services specifically for household activities such as housecleaning, laundry, paying bills, planning and preparing meals are included.

Some respite services that Home And Community Care Services include:

  1. Personal emergency response systems: In some cases, support services may offer personal emergency response systems that allow individuals to call for help in case of a fall or medical emergency.
  2. Adult day programs: Structured group programs offer social, recreational, and therapeutic activities for individuals with cognitive or physical impairments, providing a safe and engaging environment.
  3. Respite services: Temporary relief for caregivers is provided through respite services, allowing them to take a break while a qualified professional takes care of their loved one.

Note: You may have to pay a fee for some of these programs or you may find there is funding or subsidies available.

Long-Term Care

Long-term Care: Ontario funds long-term care homes, providing seniors with access to 24-hour nursing care, personal care, and various support services when they can no longer live independently.

Conclusion

Ontario Health Insurance Plan (OHIP) covers basic healthcare services for those 65 years old and over. This means that OHIP pays for doctor visits, hospital stays, prescription drugs, dental work, vision exams, hearing aids, home care, nursing homes, rehabilitation centres, and physiotherapy sessions. Although there are few limits

The opinions expressed in this publication are those of the author(s) and they do not purport to reflect the opinions or views of the providers being reviewed. The providers and SeniorsBulletin assume no responsibility or liability for any errors or omissions in the content of this site. The information contained in this site is provided on an “as is” basis with no guarantees of completeness, accuracy, usefulness or timeliness and without any warranties of any kind whatsoever, express or implied.
The opinions expressed in this publication are those of the author(s) and they do not purport to reflect the opinions or views of the providers being reviewed. The providers and SeniorsBulletin assume no responsibility or liability for any errors or omissions in the content of this site. The information contained in this site is provided on an “as is” basis with no guarantees of completeness, accuracy, usefulness or timeliness and without any warranties of any kind whatsoever, express or implied.

24 thoughts on “Ontario Health Insurance Plan (OHIP): A Guide For Seniors”

    • Hi Deborah – In Ontario, OHIP usually doesn’t cover acupuncture since it’s seen as an alternative therapy. But, if a doctor performs acupuncture as part of a necessary medical treatment, there might be some cases where it’s covered. The best way to know for sure is to chat with your doctor or give OHIP a quick call to find out the specifics about coverage for acupuncture done by medical doctors.

      Reply
    • Hi Shirley – In Ontario, you generally do not need a doctor’s referral to see a physiotherapist. You can directly book an appointment with a registered physiotherapist. However, if you plan to have the costs covered by OHIP, you usually need a referral from a doctor to qualify for funded services, especially if you’re seeking treatment at an OHIP-funded physiotherapy clinic.

      For those 65 and over, or for certain medical conditions, OHIP might cover physiotherapy, but it’s best to check with both your doctor and the physiotherapy clinic about any specific requirements for referral and coverage. Hope that helps!

      Reply
  1. Can I get my pre authorization for drugs covered under the plan approved for 6 months prior to spending winter months in Florida and without having to go through Canada Life. I have been trying to reach Canada Life for 3 months. We are leaving for Florida on November 10, 2023.

    Reply
    • Hi Carole, sorry this is too late for you, but it might be helpful for others –

      For pre-authorization of medications to be covered while you’re in Florida, it’s usually possible to arrange this in advance, often up to 3 to 6 months before you need the medication. However, the specific time frame and process can vary depending on your insurance plan. Since you’ve had trouble contacting Canada Life directly, it might be helpful to:

      Check your policy documents: They might provide information on how to handle pre-authorizations for extended periods.
      Use online portals: If Canada Life has an online service or member portal, you might be able to submit your pre-authorization request or find additional contact options there.
      Contact your pharmacy or doctor: They can often help facilitate the pre-authorization process by contacting the insurer on your behalf.
      Seek alternative contact methods: Besides calling, consider reaching out via email, social media, or through a local office if that’s an option.

      Reply
  2. I am 66, I require a hearing aid for my right ear. Will OHIP cover the cost for this, I have already gone to a specialist Dr. Fox, st josephs hospital, letter provided recommending hearing aid.

    Reply
    • Hi James – OHIP generally does not cover the cost of hearing aids. However, there are other programs in Ontario that may help with the costs associated with hearing aids, especially for those who are seniors or have a specific medical need. Since you are 66 years old, you might be eligible for assistance through programs like the Assistive Devices Program (ADP), which can cover up to 75% of the cost of a hearing aid, provided you meet certain criteria.

      Here’s what you can do:

      Contact the Assistive Devices Program: They can provide detailed information on eligibility and the application process. Your audiologist or the specialist who recommended the hearing aid (like Dr. Fox) can help you with the ADP application process.
      Check for additional coverage: If you have private health insurance or a supplemental plan, check to see if it might cover the remaining cost of the hearing aid.
      Explore community resources: Some local organizations and charities offer support or funding for hearing aids for seniors.
      It’s great that you’ve already seen a specialist and have a recommendation, as this will likely be necessary for any assistance program you apply to.

      Don’t forget to check out our hearing aid page as well. https://seniorsbulletin.ca/hearing-aids-canada/

      Reply
  3. I am 66 and need a dental bridge for 1 tooth I have no insurance and only income is CPP. May i have this tooth fixed asap as there is a gap with missing tooth for 9 months. I would really appreciate your assistance. Thank you.

    Reply
    • Hi again James – Since you’re 66 and on a fixed income from the Canada Pension Plan (CPP), there might be some financial assistance available for your dental needs through Ontario’s programs for seniors. Here’s how you can get help:

      Ontario Seniors Dental Care Program (OSDCP): This program provides free, routine dental services for eligible low-income seniors. Given your age and income situation, you might qualify for this program. It covers procedures like exams, X-rays, cleanings, fillings, and dentures, which could potentially include support for your dental bridge.
      Community Health Centers and Public Health Units: Some local health centers and units offer dental services on a sliding scale based on income. These might be a good option if you need immediate help and are waiting for approval from other programs.
      University Dental Clinics: Dental schools often provide services at a reduced cost, where treatment is performed by supervised students. This can be a cost-effective way to get the dental bridge you need.
      To apply for the OSDCP or find out more about your options:

      You can visit the website of the Ministry of Health or the local public health unit for application details and eligibility criteria.
      You could also call or visit a community health center to inquire about dental services they offer.
      It’s important to address this as soon as possible, especially since the tooth has been missing for several months, and you’re experiencing discomfort from the gap.

      Reply
  4. I hope and pray that all seniors get all the help that the need for everything they need the deserve it from basic to medical needs and much more

    Reply
  5. I am 71 year old, I require a hearing aid, and I have my prescription from specialist Dr. I don’t have income to pay this. Will OHIP cover the cost? Please advise

    Reply
    • In Ontario, OHIP generally does not cover the cost of hearing aids.

      Please look in these –
      Assistive Devices Program (ADP): You should contact the ADP to apply for coverage. Your audiologist or the specialist who provided the prescription can assist you with the application process.
      Community Support and Other Programs: Check with local community health centers, senior centers, or social services to see if there are additional local programs or charitable organizations that might help cover the remaining cost.
      Alternative Funding Sources: If you have a pension or are part of other government programs for seniors, there might be additional benefits or subsidies available that could help.

      If you need immediate assistance, reaching out to the ADP or visiting a local community health center can be a good starting point.

      Reply
  6. My name is Rupak Datta. I am 84 and have bad hearing problem, I also have Serious Health Problem including Sugar Problem-on Insuline. For last 3-4 months I have been trying to get information and help. I contacted Peel Region Several times and also help//211 ontario but did not get any answer. They were just passing the buck. I like to know who I should contact for help. My head spins real bad. I know I should het help from OHIP but don’t know who to Contact. Thank you

    Reply
    • Hello Mr. Rupak Datta, I’m sorry to hear about the challenges you’ve been facing. It sounds frustrating to not get the answers you need. Given your situation and health issues, here are some steps you can take to get the necessary support:

      Local Health Integration Network (LHIN): For issues related to healthcare services, including home care and other health-related inquiries, your Local Health Integration Network can be a helpful resource. Since you mentioned being in the Peel Region, you can contact the Central West LHIN. They can provide direct assistance or guide you to the right services.
      Community Care Access Centre (CCAC): Contact your local CCAC office. They are part of the LHIN and specifically help individuals like yourself navigate healthcare needs and connect with required services, including those covered by OHIP.
      Senior Support Services: Since you have multiple health issues and require more comprehensive support, consider reaching out to organizations such as the Ontario Seniors’ Secretariat or similar local senior services which offer guidance and support for health care, including dealing with chronic conditions like diabetes.
      OHIP Coverage Inquiry: For specific questions about what OHIP covers, especially if you think you’re missing out on entitled benefits, you can directly contact the ServiceOntario OHIP office. They provide detailed information about coverage and can guide you on how to proceed with any claims or additional coverage queries.
      Patient Ombudsman: If you feel that your concerns are not being adequately addressed, the Patient Ombudsman for Ontario is another resource. They help resolve complaints about healthcare services and can intervene when standard routes are not effective.
      Here are some contact details for immediate action:

      Central West LHIN: 1-877-336-9090
      ServiceOntario OHIP Inquiries: 1-866-532-3161
      Please consider reaching out to these resources as soon as possible to discuss your specific needs and get the help you require.

      Reply
    • Hi Gordon – OHIP covers ear wax removal if it is deemed medically necessary by a doctor. For seniors over 80, the same criteria apply. This procedure would generally need to be performed by a healthcare professional, such as a doctor or a nurse practitioner, in a medical setting like a clinic or a doctor’s office.

      Reply
  7. I’m at home recovering from a brain hemorrhage after falling in my home.
    I have needed the help of PSWs as I am still recovering.
    Will OHIP cover this cost.?

    Reply
    • Hi Carol – I’m sorry to hear about your recovery challenges. Regarding your question about coverage for Personal Support Workers (PSWs), OHIP itself does not typically cover in-home services like those provided by PSWs.

      It would be beneficial to connect with your local LHIN or Home and Community Care Support Services office to discuss your situation and get an assessment. They can provide guidance on what services are available to you and help coordinate the necessary care to support your recovery at home.

      Reply
    • Hi John – OHIP does not generally cover the cost of the shingles vaccine for all individuals. However, Ontario offers free shingles vaccination for seniors between the ages of 65 and 70 as part of its publicly funded immunization program. If you are outside this age range, you might have to pay for the vaccine yourself, or it might be covered under a private or group health insurance plan if you have one.

      Reply
  8. I am over 75 and travel to different provinces, does OHIP cover if I was to be hospitalized in a different province?

    Reply

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