What Ontario’s OHIP does not cover, and what it costs you

Canadians are told, accurately, that health care here is publicly funded. What that sentence hides is how much sits outside it. Public insurance is good at what it covers — your family doctor, specialists, hospital care, surgery, diagnostics — and silent about a large amount of ordinary health maintenance.

What you pay for yourself

• Dentistry — almost entirely excluded, at roughly $120 to $400 a visit and far more for treatment.
• Psychology and psychotherapy in private practice — $120 to $260 a session, and rarely one session.
• Physiotherapy for most working-age adults — about $90 to $150 a visit, typically six to twelve visits.
• Eye examinations for adults aged 20 to 64 without a qualifying condition — around $90 to $150.
• Massage therapy, chiropractic, naturopathy, dietetics — all private.
• Prescription drugs outside hospital, unless you are covered by a public drug programme.

The exceptions worth knowing

Several of these have doors into public funding that people walk past:

• Eye exams are covered yearly for under-20s and over-65s — and at any age if you have diabetes, glaucoma, cataracts or certain other conditions. Diabetes is the one most often missed.
• Physiotherapy is publicly funded at designated clinics for people 65 and over, under 20, recently discharged from hospital, or receiving Ontario Works or ODSP.
• Therapy is publicly funded through Ontario Structured Psychotherapy for anxiety, depression and related conditions, with self-referral in most regions.
• Psychiatrists are covered — they are physicians — though a referral and a long wait are usually involved.

Why this matters more than it sounds

The care outside public coverage is disproportionately the preventive kind: the cleaning that stops the root canal, the eye exam that catches the pressure change, the physiotherapy that stops a sore back becoming months off work. Excluding it does not remove the cost; it moves the cost later and makes it larger.

That is the gap this site works in. You state what you can pay per visit, and we introduce you to verified professionals who have agreed to work within it.

Sources

• Ontario Ministry of Health — What OHIP covers
• Canadian Institute for Health Information — Out-of-pocket spending