Surgery can be one of the most significant and costly medical treatments you’ll face.
Understanding what’s covered by the Ontario Health Insurance Plan (OHIP) is an important first step. Private insurance may help fill the gaps where your OHIP coverage ends.
Knowing how you will meet all your expenses can help make a stressful situation easier – so you can focus your energy on getting ready for the surgery and on healing afterwards.
Does OHIP cover surgery?
Yes, OHIP covers most surgeries people have in hospitals or health centres the province approves. The surgery must be seen as medically necessary to be covered.
Surgeries are often referred to as “surgical procedures.”
OHIP surgery coverage extends to most of the care and services you receive in Ontario during hospital visits and stays:
- Pre-operative assessments before the surgery
- The surgical procedure itself
- Anesthetic if needed
- Post-operative care in hospital after the surgery
What types of surgery does OHIP cover?
Here are some examples.
Emergency surgeries
- Removing a ruptured appendix
- Setting broken bones
- Treating trauma from an accident
Medically necessary surgeries
- Heart surgery
- Joint replacement
- Cancer surgery
- Organ transplants
Surgeries related to chronic conditions or complications
- Foot surgery for a person with diabetes
- Hernia repair
Certain eye surgeries
- Removing cataracts
- Treating glaucoma
Dental surgery
- Only if medically necessary and done in a hospital, such as removing impacted wisdom teeth
What surgeries does OHIP not cover?
OHIP does not cover cosmetic or plastic surgeries that are only being done to improve appearance. Examples of what is not covered:
- Liposuction for weight loss
- Rhinoplasty to change the shape of the nose
Elective surgeries are usually surgeries that a person can book in advance and are being done to improve quality of life. If they are not being done to address an urgent health concern, they are not considered medically necessary.
OHIP also doesn’t cover certain surgeries done outside of public hospitals or OHIP-approved clinics.
Are there exceptions that OHIP will still cover?
You would likely be covered for cosmetic surgery if it was needed after an accident. You may also be covered for cosmetic surgery to treat an underlying health condition. For example, OHIP would likely cover a person needing rhinoplasty surgery to correct breathing problems.
Here are some other costs that need to meet special conditions for OHIP coverage to apply:
- Gender-affirming surgeries: Covered under OHIP but need to be approved through the Ministry of Health
- Bariatric surgery: Covered only for patients meeting specific clinical guidelines
- Some ophthalmologic or ENT procedures: May need an assessment first or be referred by a specialist
- Private clinics: If contracted by the government
- Travel costs: For people in northern and remote communities
Am I covered outside of Ontario?
If you are out of the province or country, your surgery may be covered if approved under special referral programs. Certain guidelines apply if you are in another province.
If you are studying, working or doing charitable work outside Canada, you are covered for up to $400 per day for emergency services in a hospital, including surgery.
OHIP may also cover out-of-country surgery for medically necessary treatment you cannot get in Ontario.
Remember that there is a certain amount of time you need to be in Ontario each year to receive this OHIP coverage.
If you are a retired “snowbird” who spends several months out of the country, having travel medical insurance while you’re away is also crucial. And it is becoming even more so with the number of Canadians over 65 being the fastest growing in recent years and surgeries for this group up by 14% during 2023-2024.
How do I access an OHIP-covered surgery?
Your first stop is your doctor or a specialist. They will decide if surgery is medically necessary and refer you to the right health centre.
Surgeries are usually scheduled through the Ontario hospital system. You may have to wait, depending on how urgent the surgery is and how many appointments are available.
Make sure you have a valid OHIP card when you go to your appointment.
What costs will I need to pay out of pocket?
Even when the surgery itself is covered, certain related expenses may not be. Some of these out-of-pocket expenses are:
- TV or phone at the hospital
- Private or semi-private hospital rooms if not medically necessary
- Assistive devices or equipment needed after the operation, such as crutches or wound care supplies
- Physiotherapy or other rehabilitation
- Travel medical insurance for surgeries taking place outside of Ontario
You may also choose to pay for upgraded services or faster access through private clinics.
What other options are there?
Some community organizations offer subsidies for equipment or travel.
Workplace benefits often include coverage for many more out-of-pocket surgery costs.
If you don’t have workplace benefits, have lost your benefits or your benefits don’t include the coverage you need, you can also get help covering your surgery through private health insurance like Canada Life’s Freedom to ChooseTM health and dental insurance.