Does OHIP Cover Physiotherapy? (2024)
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In Ontario, about 6.8 million people would potentially have access to free physiotherapy covered by OHIP if they applied for it. Yes, that’s right, you could be eligible for OHIP-funded physiotherapy, but the rules are quite specific. Plus, even though free physio might sound very appealing, benefitting from OHIP-covered physiotherapy does not always get you the best treatment.
Do you know if you’re eligible for OHIP physiotherapy coverage? Have you experienced a recent flare-up of symptoms for a chronic condition? Have you recently had surgery? Then you might have access.
In this guide, you will learn all there is to know about OHIP physiotherapy: how to apply, what is covered and when it’s not worth it.
Is physiotherapy covered by OHIP?
Yes, OHIP covers physiotherapy. The Ontario Health Insurance Plan (OHIP) funds physiotherapy treatment through the Ontario Community Physiotherapy Clinic Program. Treatment is entirely covered by OHIP, which means it’s always free to the patient.
A doctor or nurse must first refer you to the program. A physiotherapist will then determine whether or not you are eligible through an assessment and diagnosis of your condition. Finally, you will get a treatment plan.
Your physiotherapy sessions will end when you’ve achieved your treatment plan’s goals or when you can reach that goal on your own.
Good to know
Being referred to the program by a healthcare practitioner does not automatically mean you are eligible for OHIP-covered physiotherapy. Only OHIP physiotherapy clinics can confirm if have access to the government program.
What physiotherapy is covered by OHIP?
OHIP covers physiotherapy in two broad situations:
- A recent illness, injury, accident or surgery that has resulted in decreased function or movement
- A flare-up or worsening of symptoms from a previous illness, injury, accident or chronic condition that has led to reduced function or movement
Expert advice
Before going to a physiotherapy clinic covered by OHIP near you, you must first be referred by a doctor or nurse, so your first step should be to see your main healthcare provider. This is true for any case.
People who suffer from a chronic condition, like arthritis, osteoporosis or Parkinson's disease, might also be eligible for physiotherapy covered by OHIP, but there are considerable constraints.
OHIP will only fund physiotherapy that addresses worsened symptoms or acute episodes and only if the recent symptoms have impacted your mobility or ability to function in your daily life. Under OHIP coverage, physiotherapists are not allowed to provide additional care or services beyond what is required to treat the condition outlines in your prescription.
Due to the nature of the program, physiotherapy funded by OHIP is not for long-term rehabilitation or continued treatment of chronic disease. Instead, it focuses on periodic, goal-based episodes of care, so any sustained treatment is not covered.
People who do not fall under these criteria may get them covered by a private insurance plan.
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What physiotherapy isn’t covered by OHIP?
OHIP does not cover physiotherapy if the objective of your treatment is:
- Maintainance of your current level of function or ability to move
- Mid or long-term rehabilitation
- Specialized treatment such as stroke or heart attack recovery
Watch out!
If you receive other physiotherapy services funded through any insurance or government-funded healthcare programs, you are not eligible for OHIP-funded physiotherapy.
Although long-term care is not covered by OHIP, you might still have access to some, or even full, funding. Pelvic floor therapy, for example, is a treatment many people need after pregnancy or because of urinary dysfunction. Pelvic floor therapy is not covered by OHIP; however, you might have health insurance from your employer or if you have extended health benefits, pelvic floor therapy is likely covered.
How do I get my physiotherapy covered by OHIP?
The first thing you’ll need to get OHIP-covered physiotherapy is an OHIP health card. You are required to show your OHIP card every time you see a doctor, visit an emergency room or have a medical test or surgery. It proves that you have coverage and is requested by participating doctors and healthcare providers throughout Ontario.
The next step is securing a prescription, or referral, for physiotherapy covered by OHIP. You can get one from your doctor or nurse practitioner.
Watch out!
Be cautious when choosing your OHIP physiotherapy clinic as each referral can only be used at a single clinic.
You’ll also need to fit into one of the following four categories:
- Be 65 years old or older
- Be 19 years old or younger
- Have recently been admitted to a hospital for an overnight stay for an injury or condition that could benefit from physiotherapy — no age limits
- Be approved for Ontario Works (OW) or Ontario Disability Support (ODSP) — no age limits
Good to know
If you have access to OHIP through OW or ODSP, you do not need an OHIP health card.
Remember that OHIP only covers recent illnesses, conditions, injuries or sporadic flare-ups that reduce mobility or make you unable to perform your daily life.
The final step to getting OHIP-funded physiotherapy is selecting a clinic. Not all clinics can provide services covered by governmental insurance. OHIP physiotherapy clinics are private healthcare providers that have a partnership with the government of Ontario for physiotherapy. The clinic must then provide you with enough treatment to address your prescription; in other words, when you’ve achieved the goals of your treatment or when you can reach that goal on your own.
How much does OHIP cover for physiotherapy?
OHIP physiotherapy works through Episodes of Care (EOC). An EOC is the physiotherapy treatment necessary to address a specific condition or group of symptoms. Every EOC is time-limited and goal-oriented. Each EOC covered by OHIP requires a separate prescription.
According to the OHIP physiotherapy fee schedule, for each EOC, the physiotherapy clinic receives a lump sum of $312. With that amount, the clinic must provide all the treatment required to handle the reason for the EOC, including supplies and equipment.
Watch out!
No other OHIP funding is available to clinics. Unfortunately, with such a limited budget, OHIP clinics are often forced to provide group treatment, shorten appointments and rely on self-directed movements, which ultimately affects the quality of the treatment.
Although there is no limit to the number of EOCs a single patient can receive in a year, it is unlikely that you get more than one, unless your second EOC is entirely unrelated to the first.
When does OHIP stop covering physiotherapy?
Because OHIP-funded physiotherapy is goal-oriented and specific to loss of mobility, every Episode of Care (EOC) will inevitably end sooner rather than later. Your EOC ends when any one of the following criteria is met:
- Your physiotherapist deems your rehabilitation goals have been accomplished for this EOC.
- You can achieve the therapy goals on your own through self-directed exercise or classes such as Falls Prevention.
- Your physiotherapist determines that you will unlikely improve any further as a result of more physiotherapy.
Good to know
Since OHIP pays clinics for overall treatment (instead of per session), OHIP physiotherapy clinics push to end your treatment quickly, to keep your treatment as cost-effective and profitable as possible. As the payment for an EOC is usually lower than the average market rate, clinics are not economically encouraged to extend your treatment or provide anything above basic therapy or quick fixes.
If you still require physiotherapy after your EOC, you may already be eligible through your employer's insurance plan or if you have access to extended benefits. The truth is that OHIP-covered physiotherapy is quite limited, and you might need private health insurance to truly improve your well-being.
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Does OHIP cover physiotherapy for seniors?
If you are 65 years old or more, you are probably eligible for physiotherapy covered by OHIP. Note, however, that your eligibility hinges on whether or not you have suffered a recent illness, injury, accident or surgery that has resulted in decreased function or movement. Otherwise, you are also eligible if you experienced a flare-up or worsening of symptoms from a previous illness, injury, accident or chronic condition that has led to reduced function or movement.
Any other reasons for requiring physiotherapy, such as chronic illnesses, are not eligible for OHIP coverage.
Good to know
The treatment plan outlined by your OHIP physiotherapist will usually include specific goals that are reasonable and measurable, for example, walking to the grocery store again or climbing stairs. Keep this in mind when you first visit the physiotherapist.
Does OHIP cover physiotherapy after surgery?
Yes, if you recently had surgery that led to a decline in function or movement, you may be eligible for OHIP-funded physiotherapy.
As a standalone criterion, however, having had surgery is not enough to get you covered by OHIP. You’ll also need to be older than 64 or younger than 20, have been admitted to a hospital for an overnight stay in the last 12 months or benefit from the Ontario Works (OW) or Ontario Disability Support (ODSP).
If you do not fall under any of the categories above, your physiotherapy will not be covered by OHIP, even if you did recently have surgery.
The good news is that if you had surgery, you likely stayed in the hospital overnight, and if the physiotherapy you need is related to the surgery, then you are likely able to be covered by OHIP.
When is OHIP-covered physiotherapy not worth it?
Even though it’s free, OHIP-covered physiotherapy is not always worth it. There are several reasons why government funding might not be suitable for you, even if you are eligible.
Limited Criteria
Despite many people being eligible for OHIP physiotherapy on paper, it all depends on what your doctor or nurse practitioner thinks. If they deem that physiotherapy is unlikely to improve your situation, then OHIP coverage is out of the question, and you’ll have to seek other options to ease your pain and discomfort.
Restricted Treatment
OHIP’s Episode of Care (EOC) structure means that your treatment is necessarily temporary. After a few sessions, your coverage will end, regardless of whether you’ve actually improved or not. If your condition requires any longer-term treatment or if you have a chronic issue, you’ll also have to seek other options to fund your physiotherapy.
Basic Physiotherapy
Not only is OHIP physiotherapy treatment time-sensitive, but it also tends to be basic. Given the discounted rates the Ontario Government pays — up to ten times less than what auto insurance offers, for example — clinics provide inexpensive care. OHIP physiotherapy might mean double or triple bookings, rushed sessions, leaving you alone with a heat pack or doing self-directed exercises and using support staff more. For example, your OHIP physiotherapy might end up being a physiotherapist assistant monitoring you and two other patients while you do self-directed exercises.
Waiting Times
You might end up waiting weeks (or on rarer occasions, months) for the physiotherapy covered by OHIP to start. Waiting lists are an unfortunate reality because OHIP-approved clinics are limited in number and often have strained staff.
Nevertheless, despite its flaws, OHIP-funded physiotherapy is an option for people who cannot afford better care. It provides a quick fix with specific objectives, and for some people, such treatment will be enough to get them back to wellness.
Ultimately, if you live in Ontario and qualify for OHIP-funded physiotherapy, but you also have extended health benefits or the means to pay for your physiotherapy out-of-pocket, then you should consider these options. Physiotherapy not covered by government insurance will probably lead to higher quality care and maybe even faster recovery.
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