Does OHIP Cover Hearing Aids in Ontario?

The Ontario Health Insurance Plan (OHIP) is Ontario’s provincial health insurance program, providing residents with access to medically necessary services. This article clarifies OHIP’s coverage for hearing aids and related services, guiding individuals seeking financial assistance in Ontario.

OHIP Coverage for Hearing Aids

OHIP does not cover the direct cost of hearing aids. Individuals typically purchase these devices with their own funds or through other insurance. However, OHIP covers certain related medical consultations and diagnostic assessments when performed by specific medical professionals or in hospital settings. For example, diagnostic hearing assessments by an Ear, Nose, and Throat (ENT) specialist or a physician, often initiated by a family doctor referral, are covered.

Conversely, hearing tests at private centers or audiology clinics are generally not covered, and fees may apply. While OHIP covers medically necessary services, it does not typically cover audiology services from independent audiologists. This means the medical diagnosis of hearing loss might be covered, but subsequent audiological assessment and fitting services for hearing aids may require out-of-pocket payment.

Other Provincial Funding Programs

Despite OHIP’s limited coverage, the Assistive Devices Program (ADP) is a primary provincial initiative in Ontario offering financial assistance for hearing aids. The ADP helps Ontario residents with long-term, documented hearing loss by providing financial support for purchasing these devices.

Under the ADP, eligible Ontario residents can receive up to $500 per ear towards new hearing aids. This contribution lowers financial barriers. The ADP typically covers 75% of the cost up to this maximum, with the individual responsible for the remaining 25%. To qualify, applicants must be Ontario residents with a valid Ontario health card and have a disability requiring the hearing aid for six months or longer. Income is not a consideration for eligibility. Individuals receiving financial support for hearing aids from the Workplace Safety and Insurance Board or Veterans Affairs Canada for the same equipment are generally not eligible for ADP funding.

Applying for Funding Assistance

The application process for programs like the Assistive Devices Program (ADP) begins with a professional assessment of hearing needs. An individual must undergo a hearing assessment performed by a qualified health practitioner, such as an audiologist or hearing instrument specialist, who is registered with ADP. This assessment documents the specific hearing requirements and determines the suitability and type of hearing aid needed.

Following the assessment, the healthcare professional will complete the necessary ADP application forms, outlining the specific requirements. These forms require accurate and comprehensive information from both the applicant and the professional. Once completed, the forms are submitted to the ADP for approval. It is important to note that ADP will not cover assessment fees or reimburse for hearing aids purchased before ADP approval, so securing approval beforehand is necessary. Processing times can vary, so it is advisable to apply well in advance of when the hearing aids are needed.