Ontario provincial health plan

Generally, the province doesn't pay for prescription medicine if you’re between the ages of 25 and 65. The Ontario Drug Benefit programOpens a new website in a new window - Opens in a new window covers seniors 65 years and older, recipients of social assistance and adults 24 years or youth younger who aren’t covered by a private insurance plan.

The provincial plan only covers drugs listed on the Ontario drug formularyOpens a new website in a new window - Opens in a new window .

The Ontario government has launched their Biosimilars InitiativeOpens a new website in a new window - Opens in a new window which means the Ontario Drug Benefit program will only cover the biosimilar versions of eligible drugs. 

You’re covered for in-province land and air ambulance when medically necessary and responsible for a copayment. Some exceptions apply.

You’re covered for some in-hospital dental surgeriesOpens a new website in a new window - Opens in a new window in Ontario.

There is no coverage for routine or major services such as cleanings, fillings, extractions, crowns, dentures, etc. You also aren’t covered for treatment of accidental injury to teeth.

You’re covered for 1 major eye exam every 12 months if you are 19 years and younger, 65 years and older or 20-64 years old with medical conditions requiring regular eye exams.

You aren’t covered for prescription glasses or contact lenses.

You’re covered for podiatrist services up to an annual maximum of $135, with additional fees for x-rays.

You aren’t covered for chiropractor, psychologist, massage therapy or naturopath services.

The Assistive Devices Program (ADP)Opens a new website in a new window - Opens in a new window covers up to 75% of the cost for various customized equipment and supplies for people with long-term physical disabilities. You pay 25% of the cost when buying equipment and you are not covered for repairs or maintenance of equipment or supplies.

You need to qualify to be covered.

Coverage for emergencies only through the Out-of-Country Travellers ProgramOpens a new website in a new window - Opens in a new window .

The province also covers out-of-country dialysis servicesOpens a new website in a new window - Opens in a new window , for Ontarians living with kidney failure.