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

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.

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