Yes, OHIP Covers Physiotherapy But You Need to Know This

Is physiotherapy covered by OHIP?  If you’re like most people, you probably think that OHIP covers physiotherapy treatments. Unfortunately, that’s not always the case – there are a lot of restrictions on who is eligible for physiotherapy OHIP coverage and what treatments are covered. 

In this blog post, we’ll explain the eligibility criteria and tell you about (many, many) some limitations on getting physiotherapy under OHIP. Keep in mind that this information is subject to change at any time, so it’s best to check with your doctor or on OHIP’s website. 

(Don’t worry, if you’re looking for ways to get physiotherapy without having to pay out of pocket, we’ll tell you all about that at the end of the blog.)

When Is Physiotherapy Covered by OHIP?

If you have an Ontario Health Insurance Plan health card, OHIP may cover physiotherapy if you:

1. Are 65 years or older 
2. Are under 19 years old 
3. Are over 18 years old in long-term care 
4. Have been discharged from an overnight hospital stay in the last one year and require physiotherapy for the illness or injury for which you had been hospitalized
5. Are receiving income from Ontario Works or the Ontario Disability Support Program 
6. Are 65 years old or over and need in-home physiotherapy 
7. Are living in a long-term care home (your doctor must refer you and the physiotherapist will decide if you need physiotherapy)
8. Have suffered an injury or illness recently that has led to a decline in function or ability to move around
9. Are experiencing a flare-up or worsening of symptoms (see: Ontario Community Physiotherapy Clinic Program) of a previous injury, surgery, or chronic condition that’s leading to a decline in function or movement

Those are just the eligibility criteria. If you don’t qualify under any of these, OHIP will not pay for your treatment. 

Once you know your physio is covered by OHIP, the next step is…

…Getting a Referral From a Doctor

Of course, you also need a referral from a doctor or nurse practitioner in most cases, saying you have a condition or injury that’s affecting your mobility or ability to perform day-to-day tasks.

So, does OHIP cover physiotherapy?

The long and short of it is this: the vast majority of people can’t just walk into a physiotherapy clinic and expect OHIP to pay for their treatment.

There Are Downsides Even if Physiotherapy Is Covered by OHIP

There are a few things you should know about OHIP-funded physiotherapy clinics.

1. If your doctor doesn’t feel you need physiotherapy for the pain and discomfort you’re suffering, you’re out of luck. Even if you do get a note from a doctor, it’s quite likely you don’t fall within the narrow eligibility criteria.

2. Then there is often a long waiting list to get treatment. This is because there is a limited number of OHIP clinics and they are often understaffed. This can mean that you have to wait weeks or even months to get an appointment at an OHIP funded physiotherapy clinic near you.

3. OHIP only covers a certain number of treatments – called an “episode of care” – after that, you’re on your own. The maximum number of funded treatments is 20 per episode, and this applies to all age groups. That means if you need a long-term ongoing treatment plan or have a chronic issue, you’ll have to pay for yourself.

4. Physiotherapy clinics receive a very discounted rate for OHIP treatments (as low as $15 per session). No surprise then that they try to provide care as inexpensively as possible. What can that mean? Double- or triple-bookings, non-personalized “group physiotherapy”, rushed sessions. 

5. Finally, keep in mind that the eligibility criteria for OHIP-funded physiotherapy are subject to change at any time. So even if you qualify for physiotherapy OHIP coverage today, there’s no guarantee that you’ll still be an eligible patient tomorrow. 

So How Can You Get “Free” Physiotherapy Treatments in Ontario Without OHIP Coverage for Physiotherapy

There is no such thing as “free” physiotherapy. But if you’re looking for ways to get your health coverage to pay, there are a few options: 

• Group health insurance plans: Many workplaces offer group health insurance plans that will cover some or all of the cost of physiotherapy treatments. Check with your HR department to see if this is an option.
• Private health insurance plans: Similar to group health insurance, private health insurance plans often cover the cost of physiotherapy treatments. Again, check with your provider to see what is covered. 
• Workplace accident insurance: If you’ve had an accident at work, your workplace may have accident insurance that will cover the cost of physiotherapy. 
• Disability insurance: If you have a disability, you may be eligible for government-funded disability insurance that will help pay for physiotherapy treatments. 
• First Nations health benefits: If you are a First Nations person, you may be eligible for health benefits that will cover the cost of physiotherapy treatments. 
• Veterans Affairs: If you are a veteran, you may be eligible for health benefits that will cover the cost of physiotherapy treatments. 

So as you can see, there are ways to get your health coverage to pay for some or all of the cost of physiotherapy treatments – even if OHIP doesn’t fund them. It just takes a bit of research and some effort to find the right plan for you.

Stop Searching for “OHIP Covered Physiotherapy Near Me”

At White Pine Health we also offer direct billing, which saves you from having to pay anything out of your pocket. Cut the hassle of trying to get OHIP physio, talk to us today. We’ll tell how you can use your health care insurance or employment benefits to cover your treatments and achieve your goals.

Talk to us today.