What Podiatry Services Are Covered by OHIP?

The Ontario Health Insurance Plan (OHIP) provides coverage for medically necessary services in Ontario, Canada. Many individuals seeking foot care services often wonder about the extent to which OHIP covers podiatry, a specialized field focused on diagnosing and treating conditions of the foot, ankle, and lower leg.

OHIP Coverage Specifics for Podiatry

OHIP’s coverage for podiatry services is not comprehensive and primarily focuses on medically necessary interventions rather than routine care. Generally, OHIP provides limited coverage for services rendered by a registered podiatrist.

For instance, visits to a podiatrist may be covered for issues such as diabetes-related foot complications, including ulceration or infection. Podiatry services addressing severe medical conditions like vascular disease or chronic arthritis can qualify for coverage.

The plan outlines specific financial limits for these covered services. OHIP may contribute between $7 and $16 for each visit to a registered podiatrist, up to an annual maximum of $135 per patient. Additionally, OHIP can cover up to $30 for x-rays performed by a podiatrist. These allowances apply to consultations and assessments of foot or ankle conditions that significantly impact mobility, posture, or quality of life.

Podiatry Services Not Covered by OHIP

While OHIP offers some support for medically necessary podiatry, many common foot care services are not included in its coverage. Routine foot care, such as basic nail trimming, callus removal, or general maintenance, is typically not covered by OHIP. This means patients often incur out-of-pocket expenses for these services.

Custom orthotics, specialized footwear, and orthopedic support devices are also explicitly excluded from OHIP coverage. Patients needing these items for conditions like alignment issues or chronic foot pain must bear the full cost, though private health insurance plans may offer partial or full reimbursement. Furthermore, while minor surgical procedures performed by a podiatrist might receive partial OHIP coverage if medically necessary, more extensive surgeries performed by podiatrists are generally not covered.

Accessing Podiatry Care

Patients seeking podiatry care in Ontario have several avenues to explore, depending on the nature of their foot condition and their insurance coverage. For services that may be partially covered by OHIP, consulting a family physician for an assessment and potential referral to a podiatrist is a common initial step. This referral helps ensure the service aligns with OHIP’s medically necessary criteria.

It is important to note the distinction between podiatrists and chiropodists, as OHIP’s coverage differs. While podiatrists may bill OHIP for certain services, chiropodists generally do not bill OHIP. However, chiropodists are primary healthcare providers for foot care, and a doctor’s referral is not typically required to see one. Many community health centers and family health teams also offer chiropody services, sometimes at no charge, prioritizing individuals with conditions like diabetes or visual impairments. For services not covered by OHIP, patients often utilize private health insurance plans, which can cover a broader range of podiatric services, or arrange direct payment with the clinic.