Private Health Insurance in Ontario:
What OHIP Doesn't Cover, and What a Plan Costs

1What OHIP Leaves Out for Adults 25 to 64

OHIP pays for medically necessary doctor visits and hospital care. Ontario's own page on what OHIP covers is just as clear about what it does not pay for once you leave the hospital. For a working-age adult with no workplace benefits, these are the costs that land on you.

From ontario.ca pages on OHIP coverage, physiotherapy, ambulance fees and coverage outside Canada, read November 4, 2026.

Drugs are usually the largest of these costs, because a regular prescription repeats every month. Dental comes next for most households, then therapists and glasses. The ambulance and hospital room rows are small or rare, and the last row is a separate product: a plan bought for Ontario is not travel insurance, although some include a short travel benefit.

2Public Programs That Already Fill Some of These Gaps

Before paying for a private plan, check whether a public program already covers you. Several do, and some of them are lost the moment you buy private coverage.

From ontario.ca and canada.ca, read November 4, 2026. Income limits change every year; check the program page before you apply.

Trillium is the one most people have never heard of, and it matters if your drug costs are high. It has no age limit and no medical questions. Your deductible is roughly 4% of household after-tax income, paid in four quarterly amounts, and after that you pay up to $2 per prescription.

3Check This First: A Private Plan Can Cost You a Public One

Two public programs end when private coverage starts. This is the most expensive mistake people make with individual health plans, and no insurer's sales page points it out.

• The Canadian Dental Care Plan. You do not qualify if anyone in your family has access to dental insurance, and canada.ca says that includes coverage bought by yourself or a family member, even if you never use it or it pays only part of the cost. A household under $90,000 that buys a plan with dental can trade a government plan for a smaller private one. Our Canadian Dental Care Plan vs private insurance guide walks through who should keep the federal plan.
• OHIP+ for anyone 24 or under. OHIP+ covers eligible prescriptions only for young people who are not covered by a private plan. Once a family plan covers a 22-year-old's drugs, the private plan pays first.
• The Ontario Seniors Dental Care Program. It is for seniors with no other dental benefits apart from the Canadian Dental Care Plan, so a private dental plan can rule it out.

If your household is under $90,000 and nobody has dental coverage through work, the better move can be a health plan without dental, or a drug-only plan, and the federal plan for teeth. Most insurers sell health and dental separately or as add-ons, so this is usually possible.

4What Individual Plans in Ontario Cover, Insurer by Insurer

Each insurer sells several levels. The figures below are the plan summaries the insurers publish for Ontario, read on November 4, 2026. Percentages are the share of each claim the plan pays; maximums are per person per year unless the plan says otherwise.

Summaries only. Each insurer's policy wording sets the exact terms, exclusions and waiting periods.

Desjardins also sells individual plans in Ontario. Its February 2026 SOLO brochure lists a drug add-on with a $5,000 or $10,000 yearly maximum, takes applicants aged 18 to 64 who meet its medical underwriting, and renews each year to age 70.

Three patterns hold across all of them. Entry plans have low maximums: $400 to $600 for drugs and $350 to $500 for dental. Among plans anyone can buy, drug maximums of $5,000 and up come with medical questions. Dental maximums stay modest even on the higher plans, usually $750 to $1,000 in the first year, so a plan rarely pays for major dental work in its first years.

5Medical Questions, Pre-Existing Conditions and Waiting Periods

Plans fall into two groups, and the difference matters most if you already take a regular medication.

• Plans that ask health questions give higher maximums but can leave out what you already have. Canada Life's Select plans, apart from its assured acceptance version, do not cover drugs you already take or future prescriptions for a pre-existing condition. GreenShield's ZONE 4 to 7 plans exclude medications for pre-existing conditions.
• Plans with guaranteed acceptance ask nothing, cover existing conditions, and pay less. GreenShield ZONE Fundamental includes pre-existing medications with a $550 drug maximum in year one. Ontario Blue Cross Guaranteed Acceptance covers pre-existing conditions and pays 80% of drugs up to $625 a quarter, which is at most $2,500 a year.

Waiting periods are the other trap. Sun Life's plans wait 3 months before preventive dental, 1 year for restorative dental and vision, and 2 years for orthodontics. Desjardins waits 24 months before enhanced major dental. Other insurers state that waiting periods may apply to some benefits. Read the waiting periods before you book the dentist.

Age limits differ too. GreenShield ZONE takes applicants under 80 and Desjardins SOLO 18 to 64, while Sun Life says its personal plans are open to Canadian residents of all ages. Manulife's catastrophic drug plans are not available at 65 and up.

6Leaving a Job? You Have 60 or 90 Days Without Medical Questions

If you are losing workplace benefits, you have a better option than everyone else: a plan with no medical questions at all, if you apply in time. The window is the deadline that matters.

From each insurer's own page, read November 4, 2026.

These plans cover existing conditions because nobody asks about them. In exchange, their maximums are usually lower than an underwritten plan's: Manulife FollowMe pays $500 to $2,800 a year for drugs depending on the level, and dental only on the two higher levels. Manulife's page also says to apply by November 30 to lock in your rate for coverage starting on or before December 1, 2026.

What ends, how fast, and what else to replace, life and disability included, is covered in our guide to group benefits when you leave a job.

7What a Plan Costs a Month, and When It Pays for Itself

Most insurers do not publish prices. Manulife, Sun Life, GreenShield, Ontario Blue Cross and Desjardins show a price only through a quote. Canada Life is the exception: it publishes worked examples, and two of them are for Ontario.

From Canada Life's own page on the average cost of health insurance, which does not show a date. Price depends on age, province and the coverage chosen.

Age moves the price most. Desjardins prices Ontario plans in age bands, 18 to 24, 25 to 44, 45 to 54, 55 to 59, 60 to 64 and 65 to 69, so the same plan costs more at each step.

Whether a plan pays for itself is simple arithmetic. Select plus at $139 a month is $1,668 a year. The most it can pay back on dental is $750 and on vision $200 every two years, so a person who only needs check-ups and glasses pays more in premiums than the plan can return. The plan earns its premium on drugs and therapists: 80% of a $200 monthly prescription is $1,920 a year, more than the premium. But Select plans do not cover a drug you already take for a pre-existing condition, so that example only works for a new prescription.

If the main cost is a drug you already take, compare the plan with the Trillium Drug Program before you buy. A household with $40,000 of after-tax income would face a Trillium deductible of about $1,600 a year, then up to $2 per prescription. That is arithmetic on Ontario's 4% rule for illustration; Ontario calculates the actual deductible.

8The Tax Side: Credit for Employees, Deduction for the Self-Employed

The Canada Revenue Agency treats premiums for a private health services plan as an eligible medical expense. You claim the part of your total medical expenses above the lesser of 3% of your net income or $2,834, the figure on CRA's page for the 2025 tax year.

Self-employed people can do better. CRA lets you deduct the premiums from business income on line 9270 of form T2125 if you work in the business regularly and, in this year or last, self-employment income is more than half your total income or your other income is $10,000 or less. Without employees, the limit is $1,500 a year for you, your spouse and each household member 18 or older, and $750 for each younger household member, prorated by the days covered. A premium you deduct this way cannot also be claimed as a medical expense.

For a self-employed person, health cover sits beside two other gaps: income if you cannot work and a lump sum after a serious illness. Our guides to disability insurance for the self-employed and critical illness insurance cover those.

9How to Choose in Five Steps

• List what you actually spend. Last year's prescriptions, dentist, glasses and therapist bills. The plan has to beat that, not an imagined worst case.
• Check the public programs. Canadian Dental Care Plan, OHIP+, Trillium and the senior programs. If one covers you, do not buy a plan that removes it.
• If you are leaving a job, act inside the window. 60 or 90 days, depending on the insurer, with no medical questions.
• Match the plan to your health. On regular medication, compare guaranteed plans that include pre-existing drugs with the Trillium deductible. In good health, an underwritten plan gives higher maximums for the same money.
• Read the maximums and waiting periods. Dental and vision maximums are low on every plan, and some benefits wait 3 months to 2 years.

EGE Insurance compares individual health and dental plans from several Canadian insurers. Tell us what you spend and which programs you already have, and we will say plainly if a plan is not worth buying.

10Where These Numbers Come From

Every figure on this page was read at the source on November 4, 2026. Programs update their income limits and insurers change plans, so check the source before you rely on a number.

• Ontario, What OHIP covers: drugs, dental, glasses, eye exams, podiatry, hospital rooms.
• Ontario, Get physiotherapy and OHIP coverage while outside Canada.
• Ontario, Get coverage for prescription drugs (OHIP+, Ontario Drug Benefit) and Trillium Drug Program.
• Ontario Seniors Dental Care Program, Healthy Smiles Ontario and the Assistive Devices Program.
• Government of Canada, Canadian Dental Care Plan eligibility.
• Canada Revenue Agency, eligible medical expenses and guide T4002, private health services plan premiums.
• Insurers' own plan pages: Manulife Flexcare, Manulife FollowMe, Sun Life Personal Health Insurance, GreenShield ZONE, Ontario Blue Cross, Canada Life and Desjardins.

11Frequently Asked Questions