Many people have been struggling with their mental health due to the events of the last few years, but is therapy covered by OHIPtherepyPandemic restrictions, job losses, and social isolation are all factors that have hurt people’s sense of well-being. Various services and service providers are available for those who want help. The Ontario Health Insurance Plan (OHIP) covers some therapy services, but not all. This post will look at what OHIP covers and other payment options for therapy.
- Does OHIP cover therapy?
- Therapy covered by OHIP
- Other service providers
- Other types of therapy covered by OHIP
- Occupational therapy
- Speech therapy
- How to cover the costs of therapy if OHIP doesn’t
- Workplace benefits
- Private plans
- Income-based fees and charities
- Accessing free services
- Paying out-of-pocket
- OHIP coverage for therapy
- FAQs About OHIP Coverage
Does OHIP cover therapy?
OHIP is the Ontario Health Insurance Plan run by the government and funded by taxes. OHIP funds medically necessary services for those holding OHIP cards. The cards from OHIP are free for those who meet the eligibility criteria. Having health coverage is beneficial, but OHIP doesn’t cover everything.
Therapy covered by OHIP
OHIP will typically cover mental health services a medical doctor or psychiatrist provides. Medical doctors and psychiatrists may offer online services, or they might want to have in-person visits. They bill OHIP for any therapy they provide.
Other service providers
Medical doctors and psychiatrists aren’t the only sources of therapy. So choosing a service provider will depend on the type of services you want. For example, psychologists, social workers, nurses, nurse practitioners, and counsellors can offer mental health services too.
You might choose to receive therapy from someone other than a medical doctor or psychiatrist for several reasons:
- You may want someone who specializes in a particular area and has experience helping patients resolve similar issues to the ones you are experiencing.
- You may find that a medical doctor or psychiatrist doesn’t allow enough time for your treatment.
- The waiting list for mental health services for a medical doctor or psychiatrist may be longer than you are comfortable with.
So, does OHIP cover therapy if it’s not from a medical doctor or psychiatrist? This can be tricky because it depends on the situation. OHIP may cover the costs of services provided by psychologists, social workers, nurses, or others if the agency or institution they work for is government-funded such as a hospital, employee assistance program, or clinic.
OHIP usually doesn’t cover the costs if they work for a private practice or are in private practice for themselves. It’s important to note that you typically need a referral from a medical doctor to get OHIP coverage from another source.
Other types of therapy covered by OHIP
OHIP covers other types of therapy besides mental health, providing the patient meets the criteria. If you don’t fall under the categories OHIP covers or you require additional services, you can access them but you will need to pay for them yourself. Some examples are physiotherapy, occupational therapy, and speech therapy.
OHIP will cover physiotherapy for people 19 years of age and under or 65 years and older. It will also cover physiotherapy if you are a recipient of either the Ontario Disability Support Program (ODSP) or Ontario Works, and a medical doctor or nurse practitioner has referred you. Additionally, you can expect OHIP coverage if you have been recently discharged as an inpatient for a condition that required physiotherapy in the last 12 months.
You can access a private practitioner for occupational therapy (OT), or you could be eligible for OHIP coverage. OHIP will cover OT if provided by:
- A rehabilitation centre or hospital
- Community health centres and the Local Health Integration Networks (LHIN)
- Family Health Teams
- Assertive Community Treatment Teams
Patients can receive OT services at school, in their homes, or in long-term care facilities such as nursing homes. As with physiotherapy, if you cannot get a referral for OHIP coverage but want Occupational Therapy, some private practitioners can help.
Speech therapy is an example of a therapy that OHIP does not cover. Children who need speech therapy may find support in school with one or several other approaches. In addition, many private insurance plans also offer speech therapy coverage.
How to cover the costs of therapy if OHIP doesn’t
Not having coverage for services you need can be stressful and upsetting. Health issues, including mental health issues, can leave you unable to work and severely affect your finances. Fortunately, there are several ways to access services that can help you with your needs.
Some common ways to pay for health care services are through benefits from your employer, private plans, using providers who charge fees based on your income, charities, accessing free services, and paying out-of-pocket.
Many workplaces offer benefits that cover a percentage of costs for therapy, physiotherapy, occupational therapy, speech therapy, and other services. However, the percentage of the cost of care they cover can vary. For example, your workplace benefits may cover 80% of physiotherapy but only 60% of other types.
Your plan may limit the types of service to specific issues, and you may need a physician’s referral. Therefore, you must review your benefits carefully to understand your coverage. This way, an unexpected bill will not surprise you.
Some people don’t have benefits through their workplace, or their benefits package may not provide enough health coverage. Others are self-employed or retired but want health benefits to cover some out-of-pocket health care expenses.
People in these situations can buy private health insurance. Private plans offer different levels of coverage at various price points. If you want to purchase private insurance, be sure to decide on what you want and then compare plans, features, and rates.
Income-based fees and charities
There are private clinics that charge clients fees based on their income, often called sliding scale fees. This offer is usually for those who don’t have insurance and may not be able to afford the care they need. Additionally, some organizations, like the Speech Therapy Centres of Canada, partner with charities that provide financial assistance for those who meet their criteria.
Accessing free services
Ontario offers several mental health services that you can access free of charge. Most programs target specific groups, such as Bounceback®, which provides cognitive behavioural therapy (CBT) for those 15 years and older, and Kids Help Phone, which serves those who are 5 to 20 years old.
You can use your own resources to pay private practitioners. You may need to pay for services yourself if OHIP doesn’t cover the cost of your care and you don’t have other sources of health care insurance.
OHIP coverage for therapy
OHIP does cover many health-care-related issues, including some types of therapy. Having additional insurance or resources can give you better access to services you may need. Since health issues can cause financial problems, you should see what OHIP and any work or private insurance you have will cover. Having an emergency fund is essential, too, because it can help you offset the costs caused by medical concerns.
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FAQs About OHIP Coverage
Therapy is covered by OHIP if the provider is a medical doctor or psychiatrist. In addition, if you receive treatment from a psychologist, nurse, nurse practitioner, social worker, or other mental health service provider, OHIP may cover your treatment if they work for a government-funded institution such as a hospital or clinic. However, private practitioners are usually not covered by OHIP.
OHIP doesn’t cover speech therapy, but many private insurance plans and workplace benefits will cover part of the cost.
OHIP doesn’t cover massage therapy.
The Ontario government offers a free program called BounceBack® for those 15 years and older. According to the website, participants can ”access guided mental health self-help supports.”
OHIP does cover occupational therapy in some circumstances. The treatment is covered if it’s provided by a rehabilitation centre or hospital, community health centres and the Local Health Integration Networks (LHIN), Family Health Teams, and Assertive Community Treatment Teams.