Your Guide to Getting the Best Health Insurance Coverage in Ontario

Posted on December 23, 2018

Ontario's population has grown a whopping 11.2% in a span of 10 years -- from 2007 to 2017. Today, it's home to almost 14.2 million people. At the time this article was updated which was in June of 2021, the population of Ontario now sits at a mega 14,745,040 million! It shouldn't be a surprise though, as it's also home to both the capital and the most populous city in the country.

It's also for this reason that visits Ontario's emergency departments have gone up 11.3% in six years. Between 2017 and 2018 alone, ED staff attended to 5.9 million patients. Once again, in June of 2021 we've actually found through much research that across Canada, as of March 2020, visits to the emergency room actually decreased.

Luckily, the majority of Ontarians have access to free health insurance coverage in Ontario. The keyword here is the majority, as there are still half a million uninsured people in the province.

If you're one of these 500,000 uninsured folks, now is the best time to get health insurance. It's bad enough to get into an injury-causing accident, but it's worse to face it without insurance.

Don't worry. This post will help make finding the right health coverage a lot easier.

Getting Access to Free Health Insurance Coverage in Ontario

Canada's public health insurance makes healthcare more accessible and affordable. Each province has its own version of publicly-funded healthcare services.

For instance, Ontarians have the Ontario Health Insurance Plan (OHIP). British Columbia's version is the Medical Services Plan (MSP). In Alberta, there's the Alberta Health Care Insurance Plan (AHCIP).

They may have different names, but they share the same goal of making people in the country healthier. Plus, they all help reduce healthcare costs, so there's little to no reason to not take advantage of them. Furthermore, both Canadian citizens and permanent residents (PRs) can get access to them.

Once you qualify for OHIP, it'll start paying for most of the healthcare services you need. Keep in mind that there's a three-month waiting period though.

So, what does OHIP cover?

It covers visits to OHIP-registered doctors, hospital visits, and hospitalization. Some dental surgery procedures too, as long as they're done in a hospital. There are also certain eye health and foot health services covered.

OHIP also provides coverage for ambulance services as well as surgical/medical abortions. If you're from northern Ontario and you require health services, OHIP also has you covered.

In essence, anything that is medically-necessary falls under OHIP coverage. Anything not deemed medically necessary, you have to pay for out of pocket.

In short, that means out-of-pocket expenses to get preventative health and dental services. Restorative dental procedures, like fillings and crowns, are also not covered. You also have to shoulder the costs of prescription medicines.

There's no denying that Canada's health cards contribute to the welfare of the nation's residents. Especially considering that estimated healthcare spending in 2018 is $6,839 per person. To add even more to that budget, as of June 2021 the Government of Ontario spent a staggering $63.5 billion on healthcare.  But as you can see, all those exclusions make it limited.

This is where getting extra health insurance comes into play.

Making the Choice Among Your Private Health Insurance Options

Two-thirds of Canadians own private health insurance. These plans help further bring healthcare costs down. Over 130 companies offer these insurance programs.

Of these, the top names in the industry are Manulife, Sun Life, GreatWest Life, Blue Cross, and Green Shield. The best way to decide which health insurer is best is to base it on your needs. Factor in the OHIP exclusions that you'd need more coverage for.

Let's say your priority is to get more coverage for prescription medicines. After all, the average Canadian spends almost $1,100 a year on prescription drugs alone.

In that case, make sure the plan you'll get offers this without charging very high deductibles. A deductible is an amount you need to first pay before your insurer shoulders the rest.

Don't forget to check the limits of the coverage too. If you spend $1,500 on prescription drugs every year, you wouldn't want a plan that only covers $300 or less.

That's only one example, but you get the gist. What's important is to get a private health insurance plan that'll help pay for services you have an actual need for. Be it prescription drugs, vision aid (eyeglasses, contact lenses, etc.), or dental services.

Look at Coverage Level and the Associated Deductibles

Getting a basic health insurance package may seem tempting, given its lower cost. But if it'll do little to help pay for your healthcare needs, then it's not much use, is it? That's why you should take the time to do the math and gauge how much coverage you need.

A more extensive coverage would, of course, come with a higher monthly cost. But that also means you'll have lower deductibles to worry about. Plus, you'll get more covered costs, as opposed to a lower coverage with higher deductibles.

Coverage for Pre-Existing Medical Conditions

Pre-existing conditions are any health conditions you have before applying for insurance. There's high blood pressure, for instance, which affects over six million Canadians. Diabetes is another example, affecting more than three million people. That number is only expected to rise as according to the same referencing article above, approximately 200,000 Canadians are diagnosed with diabetes each year.

In any case, you should know that many health insurers don't cover these ailments. But that doesn't mean they'll reject your application right away. Some may still provide you coverage, albeit limited.  

That also doesn't mean you should omit this information from your application. That would only put you at risk of having your entire coverage invalidated when you make a claim.

It'll take more time to find an insurance company that'll cover you, but it's worth the search. Note though that you may have higher insurance premiums, so make sure you prepare for that too.

Start Your Search for the Best Health Insurance in Ontario Now

The best health insurance coverage in Ontario is different for everyone. What works great for a colleague may not necessarily be the best for you too. This is why you need to do your homework and compare as many health insurance plans as possible.

Health comparison is the most effective way to find out which health plan will best suit your health needs. It's also key to determining which are the most cost-effective programs in the market. It may seem like a tedious task, but remember, it's your health on the line.

Plus, we can help make this far less tedious and time consuming. All you need to do is request a free quote and we'll get it to you ASAP.  Our expert, transparent and highly experienced agents are looking forward to working with you!

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