What OHIP Covers for Seniors
OHIP offers many necessary health care benefits to Ontarians, but it doesn't cover everything seniors may need. If you are trying to figure out whether OHIP covers health care services such as physiotherapy, eye exams, blood tests, prescriptions or dental care, it will depend on the service and your eligibility criteria.
For senior citizens, OHIP will provide coverage for medically required doctor visits, hospital visits and stays, many laboratory tests, some eye care, some podiatry services and ambulance coverage in certain situations. However, many day-to-day healthcare costs such as prescription medications purchased outside of the hospital, dental care within a dentist's office, eyeglasses and certain types of private therapy services are not covered.
Doctor Visits and Hospital Care
OHIP provides coverage for medically necessary visits to doctors through either in-person appointments or virtual visits online.
For seniors who are being admitted to a hospital, the doctor, nursing care, diagnostic procedures including blood and X-ray tests, accommodation, and any meals or medications administered in the hospital, are usually covered through OHIP. If one wishes for a private room, this may cost extra unless it is covered by their own private insurance.
Blood Work and Lab Testing
OHIP provides coverage for a variety of medically required laboratory services within hospital or community labs when ordered by an eligible provider. Not all laboratory services are covered under OHIP, however.
Vitamin D or PSA tests may have to meet certain criteria to be covered. Seniors can prevent any surprises regarding costs by consulting their doctor, nurse practitioners, or lab prior to receiving any testing.
Does OHIP Cover Eye Exams?
Under OHIP, individuals ages 65 and over receive one major eye examination every 18 months along with two minor assessments to follow. Individuals 65 years old and over are entitled to receive one major eye examination every 18 months, along with two minor assessments. In addition to this, seniors who have particular medical conditions affecting their eyes could potentially be covered for one major eye examination every 12 months along with additional follow-up care.
Other conditions which could be eligible for additional coverage include diabetes, glaucoma, cataracts that meet certain criteria, and diseases of the retina, cornea, and optic tract. To learn more about this subject, read one of our other blog posts Does OHIP Cover Eye Care for Seniors.
Does OHIP Cover Physiotherapy?
Physiotherapy coverage through OHIP would depend on the environment and the reason for requiring the care. The OHIP coverage for physiotherapy services is dependent on the situation and context in which it is required. Some seniors may be eligible to access government funded physiotherapy programs through certain clinics, hospitals, or home-care facilities.
However, not all appointments for physiotherapy are covered by OHIP. For instance, private physiotherapy, massage therapy and wellness treatments are paid out of pocket or from private insurance. Always make sure you know if the treatment you're seeking is publicly or privately funded, or covered through insurance before booking anything.
What OHIP Does Not Usually Cover
Prescription medications that are provided outside of a hospital setting, dental services provided in a dentist's office, eyeglasses, contact lenses, cosmetic surgeries, and numerous services offered outside of hospital by providers that are not covered under OHIP rules are often excluded from OHIP coverage.
Travelling could also become confusing. Even though OHIP could provide assistance in paying for certain health travel expenses for qualified Northern Ontario residents, it is not a replacement for travel insurance. If you are traveling out of Ontario, please visit our other post Going South? Check Out Changes to OHIP for Travelers for more information.
Where Home Care Fits
OHIP is helpful, but it doesn’t cover all forms of assistance that seniors might require at home. Families may still need extra assistance with personal care, companionship, meal preparation, mobility, dementia care or recovery from illnesses.
Living Assistance Services can help families figure out how private home care services would fit along with other publicly funded services. Click here for more information about OHIP coverage: What OHIP Covers
Contact us to learn more
If you’d like to know more about high quality homecare services in Toronto, Mississauga and the surrounding communities, please contact us. A member of our care team would be glad to answer your questions and make personalized recommendations. We look forward to speaking with you soon.