Medicare and Universal Coverage in Ontario
Reviewed by the Commoner Law Editorial Team. Sourced from Canadian federal statutes and official sources. Provincial information reflects each province's own legislation and court rulings. Written in plain language for general understanding — this is educational content, not legal advice. Our editorial standards
What is this right?
The federal Canada Health Act (CHA) sets five principles that every province and territory must follow to receive federal health funding: public administration, comprehensiveness, universality, portability, and accessibility. The provinces and territories actually deliver healthcare services.
The CHA covers medically necessary hospital and physician services at no cost to patients. About 70% of total health spending in Canada is public.
However, several things are not covered under the CHA, including:
- Prescription drugs dispensed outside a hospital
- Dental care
- Vision care
- Cosmetic procedures
- Ambulance services (coverage varies by province)
If you move to a new province, your old province covers you for up to 3 months while you wait for your new coverage to start.
When does it apply?
- All residents of a province or territory who are lawfully in Canada.
- Coverage begins after a waiting period of up to 3 months (varies by province).
- Your health card confirms your enrollment in your province's plan.
What to Do If You're Charged for Medically Necessary Care in Canada
- Register for provincial health insurance as soon as you become a resident. Don't wait.
- Carry your health card whenever you visit a doctor, hospital, or clinic.
- When moving provinces, register immediately in your new province and consider buying gap insurance for the waiting period.
- Bring your health card when travelling within Canada — you're covered for emergency care in other provinces.
- Contact your provincial health ministry if you are charged for an insured service. You should not have to pay out of pocket for medically necessary care.
What should you NOT do?
- Don't let your health card expire — renew it before the expiry date to avoid gaps in coverage.
- Don't assume everything is covered — dental, vision, and prescription drugs outside hospital are generally not included.
- Don't skip gap insurance when moving provinces — you could be uninsured for up to 3 months.
- Don't assume you have adequate out-of-country coverage — provincial plans pay very little for care abroad. Buy travel insurance before leaving Canada.
How Ontario differs from federal law
Ontario delivers universal healthcare through the Ontario Health Insurance Plan (OHIP), which covers medically necessary physician and hospital services at no direct cost to patients.
- OHIP covers: visits to doctors and specialists, surgery, hospital stays, diagnostic tests (X-rays, blood work when ordered by a physician), optometry for children and youth (under 20) and seniors (65+), and most medically necessary services.
- OHIP does not cover: prescription drugs (unless you qualify for a provincial drug program), dental care, eyeglasses, physiotherapy outside hospitals, ambulance services (a co-payment of $45 applies, or $240 for medically unnecessary transport), cosmetic surgery, or most services outside Canada.
- To be eligible for OHIP, you must be a resident of Ontario and be physically present in Ontario for at least 153 days in any 12-month period. New residents face a 3-month waiting period before OHIP coverage begins.
- OHIP is administered by the Ministry of Health (Ontario). Your OHIP card is your proof of coverage — keep it valid and up to date.
- Extra-billing is prohibited: Ontario physicians who accept OHIP cannot charge patients above the OHIP fee schedule for covered services (Commitment to the Future of Medicare Act, 2004).
Additional Steps in Ontario
Apply for OHIP at a ServiceOntario location with proof of identity and Ontario residency. Renew your health card before it expires (you can renew online or at ServiceOntario). If you are denied coverage or billed for a covered service, contact the Ministry of Health at 1-866-532-3161. The Patient Ombudsman (Ontario) investigates complaints about public hospitals, long-term care homes, and home care.
Relevant Law: Health Insurance Act, R.S.O. 1990, c. H.6; Commitment to the Future of Medicare Act, 2004, S.O. 2004, c. 5; Canada Health Act, R.S.C. 1985, c. C-6
Common Questions
When does medicare and universal coverage apply?
All residents of a province or territory who are lawfully in Canada.Coverage begins after a waiting period of up to 3 months (varies by province).Your health card confirms your enrollment in your province's plan.
What should I do if a Canadian hospital or doctor is charging me for care that should be covered by medicare?
Register for provincial health insurance as soon as you become a resident. Don't wait.Carry your health card whenever you visit a doctor, hospital, or clinic.When moving provinces, register immediately in your new province and consider buying gap insurance for the waiting period.Bring your health card when travelling within Canada — you're covered for emergency care in other provinces.Contact your provincial health ministry if you are charged for an insured service. You should not have to pay out of pocket for medically necessary care.
What mistakes should I avoid with medicare and universal coverage?
Don't let your health card expire — renew it before the expiry date to avoid gaps in coverage.Don't assume everything is covered — dental, vision, and prescription drugs outside hospital are generally not included.Don't skip gap insurance when moving provinces — you could be uninsured for up to 3 months.Don't assume you have adequate out-of-country coverage — provincial plans pay very little for care abroad. Buy travel insurance before leaving Canada.
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