Does OHIP Cover Physiotherapy?
Do I Need Physiotherapy?
Through a variety of approaches including massage, laser therapy, and acupuncture, physiotherapy helps with treating the following conditions:
- Bone fractures
- Spinal cord injuries
- Multiple sclerosis
You might find yourself suffering from a musculoskeletal injury at work, through sports, or at home due to a sudden accident; you might discover a condition that has developed through repetitive motion over time, like carpal tunnel.
In these instances, you should seek physiotherapy treatment.
Physiotherapy can be expensive. If you are living in Ontario, you might wonder if OHIP covers physiotherapy to treat your back and neck-related healthcare needs.
Am I eligible for OHIP-covered physiotherapy?
Luckily, OHIP covers many physiotherapy services for a number of Ontario residents.
If you are suffering from back and neck-related pain issues, or understand that you are vulnerable to certain related conditions due to genetics or the nature of your work, it is important to promptly seek help.
There are a few exceptions, and procedures to follow. Some application processes might take some time, so it is important to start as soon as you identify a problem.
See below to understand the eligibility requirements for promptly meeting your needs and finding OHIP covered physiotherapy in Toronto.
Who is eligible for OHIP-covered physical therapy in Toronto?
Currently, 90,000 Ontarians receive OHIP-covered physiotherapy treatments.
Here is a chart that will help you assess if you are eligible for OHIP-covered physiotherapy.
To be eligible, you must:
- Have a doctor’s referral
- Be under 19 or over 65
- Be receiving benefits under the Ontario Disability Support Program (ODSP) or Family Works
- A refugee, on ODSP or FW (without a health card)
If you qualify, you will be receiving an episode of care coverage. This means that OHIP covers the entire course of treatment for your condition or injury, not just single visits.
Visits are not capped by number, but are determined by the physiotherapist based on the patient’s needs.
The government allots $312 per episode of care, but allows for multiple episodes, depending on your needs. You can also be referred for physiotherapy to treat more than one condition at the same time, at the same clinic.
If you are eligible for OHIP covered physiotherapy, but are new to Ontario and therefore cannot access OHIP-covered physiotherapy for the first 3 months, it is recommended that you invest in private insurance to cover these months.
Using the public register tool, you can find OHIP-covered physiotherapy clinics near you.
There are a limited number of OHIP covered physiotherapy clinics in Toronto, but they are well-distributed through the GTA. If you live in northern Ontario and need to travel considerable distances for care, OHIP may pay some travel costs.
If you are unable to go to a clinic due to mobility issues and require physiotherapy in your home, contact your local LHIN (Local Health Integration Network) to discuss home visits.
Similarly, if you are a long-term home care resident, OHIP-covered physiotherapy will be provided to you in your home facility free of charge.
Are there any exceptions made for eligibility for OHIP covered physical therapy?
Yes: an exception is made after an overnight hospital stay for a condition that will require physiotherapy in order to heal. This exception is available to you no matter your age.
As with other OHIP-covered physiotherapy, you will need a doctor’s referral to start your course of treatment. Speak to your doctor, or have a loved one speak on your behalf, to set this option in motion before you are discharged from the hospital.
What if I’m not eligible for OHIP covered physiotherapy in Toronto?
If you work in an environment that has a high chance of inducing physiotherapy-related injuries or conditions, you might qualify for workplace compensation, both for injuries and for preventative care.
If this description fits your situation, speak with your employer right away.
Since insurance plans and coverage are not immediate, do not wait until you are in pain to seek help.
Note that OHIP does not cover physiotherapy for Ontario residents that receive care coverage from another source, such as worker’s compensation.
There are also prevention classes available through the government to help you gain strength and mobility, and to ensure your home is as safe as possible. Like a balanced diet and regular moderate exercise, physiotherapy treatment is part of a holistic approach to a healthy life.
Please note: services provided by HealthMax Physiotherapy are not covered by OHIP.
HealthMax offers physiotherapy, chiropractic, massage therapy, and medical devices which are usually covered by Extended Health Coverage, Motor Vehicle Accident, OR Work Related Accidents (WSIB). Some medical devices may be covered under your ODSP plan. Call us today for more details or book your online appointment here
Not eligible for OHIP’s physiotherapy coverage? Talk to one of our specialists today to find a treatment plan that makes sense for your budget.