While Ontario’s public healthcare system (OHIP) covers a broad range of essential services, there are gaps in coverage that could leave you paying out of pocket. This is where private health insurance comes in – filling those gaps and ensuring you’re fully covered for both routine care and unexpected medical needs.

Wondering if you should consider private health insurance? This guide will help you understand who might benefit most from private health insurance in Ontario, what it covers, and why it could be a smart addition to your healthcare plan.

What is Private Health Insurance?

Private health insurance offers additional coverage that goes beyond what the Ontario Health Insurance Plan (OHIP) provides. While OHIP covers doctor visits, hospital stays, and emergency services, it doesn’t cover expenses like prescription drugs (for most adults), dental care, vision care, or alternative therapies. Private insurance can help cover these additional healthcare costs.

Who Needs Private Health Insurance in Ontario?

Private health insurance isn’t a one-size-fits-all solution, but it can be beneficial for many groups of people. Let’s break down who might find private insurance useful:

Self-Employed and Freelancers

If you’re self-employed or work as a freelancer, you likely don’t have access to a group insurance plan offered by employers. In this case, private health insurance can provide essential coverage for:

• Prescription drugs: OHIP generally does not cover prescription drugs for those aged 25-64, leaving a significant gap.
• Dental and vision care: Private plans can include dental check-ups, cleanings, eyeglasses, and eye exams.
• Paramedical services: Coverage for services like physiotherapy, chiropractic care, and massage therapy can be added, helping you manage work-related injuries or stress.

For self-employed individuals, private insurance isn’t just about health—it’s about peace of mind, knowing that your medical needs won’t impact your financial stability.

Small Business Owners

Small business owners who want to provide benefits to themselves and their employees can use private health insurance to set up a group plan. This can:

• Attract and retain talent: A good benefits package makes your business more appealing to prospective employees.
• Offer flexibility: Private insurance plans allow customization, so you can choose the level of coverage that fits your budget and meets the needs of your team.

This makes private health insurance an investment in both the health of your business and the people who help it grow.

People Without Employer Benefits

Even if you’re employed full-time, not all employers offer comprehensive benefits. If your job doesn’t include health insurance, private plans can step in to cover:

• Prescription medications: Essential for those who require regular medications.
• Dental care: Including routine check-ups, fillings, and major dental work like crowns or orthodontics.
• Specialist care: Access to specialists like physiotherapists, psychologists, and dietitians.

If your employer offers limited or no benefits, private insurance can fill the gap and provide the care you and your family need.

Retirees Under 65

While OHIP covers most hospital and doctor visits, retirees under 65 don’t qualify for the Ontario Drug Benefit (ODB) plan that covers prescription drugs for seniors aged 65 and over. Private health insurance is especially useful for:

• Prescription medications: For chronic conditions or ongoing health management.
• Vision and dental care: Regular check-ups and treatments that are not covered by OHIP.
• Alternative treatments: Access to complementary therapies like acupuncture, which can be beneficial for managing pain or stress.

For retirees not yet eligible for senior drug benefits, private insurance can ensure that they continue to receive necessary medical care without major financial strain.

Families with Children

Raising kids comes with plenty of expenses, and healthcare is no exception. Private health insurance for families can help with:

• Pediatric dental care: Regular dental visits are crucial for kids, but not covered by OHIP.
• Orthodontic services: Braces and other orthodontic treatments can be costly, but many private plans offer partial coverage.
• Vision care: Eye exams, glasses, or contact lenses are often necessary for children and not included in public coverage.

For families, private insurance ensures that kids receive necessary medical, dental, and vision care as they grow.

Individuals with Chronic Conditions

If you have a chronic health condition that requires regular medication, ongoing therapy, or special medical equipment, private health insurance can help manage these costs by providing coverage for:

• Prescription drugs: Vital medications that OHIP doesn’t cover.
• Ongoing therapy: Physiotherapy, psychotherapy, or other treatments that support long-term health.
• Medical supplies and equipment: Such as mobility aids, which may not be fully covered by OHIP.

Private health insurance can help individuals with chronic conditions avoid significant out-of-pocket expenses.

Newcomers to Ontario

Newcomers often have to wait up to three months before they become eligible for OHIP coverage. During this waiting period, private health insurance is crucial. It can cover:

• Emergency medical services: In case of accidents or sudden illness.
• Routine doctor visits: To maintain health while waiting for OHIP eligibility.
• Prescription medications: To manage existing health conditions or new prescriptions during the transition period.

For newcomers, private insurance provides essential healthcare access during a crucial time.

What Does Private Health Insurance Typically Cover?

While coverage varies by plan and provider, here’s what you can generally expect from a private health insurance plan:

• Prescription drugs: Coverage for medications that aren’t included under OHIP, depending on the drug plan chosen.
• Dental care: Cleanings, fillings, extractions, and even orthodontics for certain plans.
• Vision care: Eye exams, eyeglasses, and contact lenses.
• Paramedical services: Physiotherapy, massage therapy, chiropractic care, and other alternative treatments.
• Medical equipment: Wheelchairs, hearing aids, and other aids that may be needed.
• Hospital accommodations: Upgraded hospital rooms, including semi-private or private rooms, which are not covered under OHIP.

How to Choose the Right Private Health Insurance Plan

If you’ve decided that private health insurance is a good fit for you, here are a few tips to find the right plan:

• Assess Your Needs: Consider the type of healthcare services you frequently use or might need in the future.
• Compare Plans: Look at different providers, their coverage options, and costs. Pay attention to what’s included and what’s not.
• Consider Your Budget: Choose a plan that offers the coverage you need while fitting into your budget.
• Read the Fine Print: Check for exclusions, waiting periods, and annual limits to avoid surprises.

Is Private Health Insurance Worth It?

While Ontario’s public healthcare system provides excellent coverage for basic needs, private health insurance can be a valuable addition for those with specific needs or gaps in their coverage. Whether you’re self-employed, retired, or managing a family, private insurance can offer peace of mind and financial protection against unexpected medical costs.

Remember, healthcare is personal, and so is the decision to purchase private insurance. Assess your needs, weigh the benefits, and consider your budget to make an informed choice that supports your health and well-being.

Contact insurance broker Olga Ryjkova for more information:

416-822-2698

info@insurancestoronto.ca