Turning 65 means having access to a wider range of services that the Ontario Health Insurance Plan (OHIP) will cover.
But certain services still require private payment or insurance unless you meet specific conditions.
It’s important to understand basic OHIP coverage for seniors as well as where other provincial programs may come into play. Then you can make a plan to fill the gaps.
What medical services for seniors does OHIP cover?
Here are some of the more common ones.
Medically necessary doctor visits
- Family doctors
- Specialists
In-patient and out-patient care in hospital
- Doctor and nursing services
- Medications given in hospital
- Emergency care
- Surgeries
- Lab services
- Basic accommodation and meals – you or your private insurance will need to pay some or all of the fees for a semi-private or private room
Tests to diagnose what is wrong
- Blood tests
- X-rays
- Ultrasounds
- MRIs
To qualify as OHIP-covered services, these diagnostic tests must be ordered by your doctor.
Ambulance services
- All or part of the costs, depending on the situation
If you have to co-pay part of the cost of ambulance coverage, private insurance can help make up the difference.
Eligible home care service
- Services coordinated through Home and Community Care Support Services.
What about prescription drug coverage?
Once you turn 65, you are automatically enrolled in the Ontario Drug Benefit (ODB) program.
The program covers most prescription drugs listed on the ODB Formulary. A drug formulary is a list of prescription drugs that a benefits plan will cover.
You may have pay a part of the cost through an annual deductible and co-payment, depending on your income. If your income is low, you may be able to get help through the Trillium Drug Program.
What vision coverage does OHIP provide?
OHIP provides free eye exams for seniors, including:
- 1 major eye exam every 18 months
- 2 additional minor follow-ups
- Exams and monitoring for conditions like glaucoma, cataracts, diabetes
Glasses and contact lenses are not OHIP-covered services. Workplace benefits often include vision coverage. If you don’t have workplace benefits, have lost your benefits or your benefits don’t include vision coverage, you can also get help covering eye exams through private health insurance like Canada Life’s Freedom to Choose health and dental insurance.
Are hearing aids and assistive devices covered?
OHIP does not cover assistive devices or specialized supplies for people with long-term physical disabilities. Among those are hearing aids, wheelchairs and ostomy supplies.
Ontario does offer partial coverage through the Assistive Devices Program (ADP). You are eligible if your doctor recommends the equipment and it comes from an authorized supplier.
Keep in mind though that this program does not cover physiotherapy.
What about dental and other services?
While OHIP does not normally cover routine dental care, the Ontario Seniors Dental Care Program (OSDCP) provides low-income seniors 65+ with full coverage for most services. Dentures are partially covered.
In 2024, the Canadian Dental Care Plan also began offering coverage to those 65+ for both basic and major services.
If you don’t qualify for either program, Freedom to Choose health and dental insurance is an option worth considering.
All seniors over 65 are covered for certain types of dental surgery done in hospital, such as removing impacted wisdom teeth.
Am I covered for vaccines and preventive screenings?
OHIP covers several services and tests to prevent and detect illness.
Vaccines
There is a wider range of vaccines covered once you turn 65:
- COVID-19
- Flu shots every fall
- Two doses of the shingles vaccine – for 65- to 70-year-olds
- The pneumococcal (pneumonia) vaccine – at age 65
- Tetanus, diphtheria and pertussis (once in adulthood)
- The Respiratory Syncytial Virus (RSV) vaccine – recommended if you are 60 and up and have high-risk medical conditions
Cancer screening
- Colorectal cancer screening for adults aged 50 – 74.
- Mammograms every 2 years for women aged 50 – 74 through the Ontario Breast Screening Program.
Bone density test
- As needed to detect osteoporosis and fracture risk for both men and women, now or in future.
What about when I’m out of the province – or the country?
Care for emergencies outside Ontario may be partially reimbursed, but coverage is limited. OHIP may also cover surgery outside the country for medically necessary treatment you cannot get in Ontario.
More often, OHIP does not cover international healthcare expenses. For greater confidence, travel insurance for seniors is highly recommended.
If you spend long periods away from Canada, remember that there is a certain amount of time you need to be in Ontario each year to receive OHIP coverage.