Is Oral Surgery Covered By Ohip?
Oral surgery can have a significant effect on your smile and oral health. Be sure to speak with an oral surgeon to determine if you are a good candidate for oral surgery As an Oral & Maxillofacial Surgeon, I receive this question from patients and their families often: “Is oral surgery covered by Ohip (or my insurance company)”. Ohip stands for the Ontario Health Insurance Plan. This article talks about which oral surgery procedures are covered by OHIP.
Dental problems are inevitable, and oral surgery can be scheduled to remove these problems. Many people within the state of Washington experience tooth aches and feel that in order to get rid of their pain, oral surgery is necessary. This leads them to question whether or not such procedures are covered by their insurance plans.
Is Oral Surgery Covered By Ohip
Oral surgery is a specialized form of dentistry that can be used to treat a variety of dental problems.
Oral surgery is covered by OHIP if you have low-income dental coverage. If you do not have low-income dental coverage, the cost of oral surgery will be covered by OHIP only if it’s medically necessary.
You’ll need to see an oral surgeon who is registered with the College of Physicians and Surgeons of Ontario (CPSO). To find an oral surgeon near you, visit the CPSO website at www.cpso.on.ca/find_a_doctor/search_results or call 1 800-268-4141 (toll free).
If you have low-income dental coverage and need to see an oral surgeon for a problem such as wisdom teeth removal, your dentist will refer you to a member of the CPSO who has agreed to provide services at reduced fees for people with low incomes. Your dentist will send your referral request to the office where this doctor works, and they’ll contact you about setting up an appointment for treatment.
Ohip covers low-income dental coverage in Ontario. This is a program for people who are on social assistance, disability or earning less than $23,500 per year. It provides free dentures and extractions.
Ohip also has a limited number of spaces in their emergency room dental clinics. The wait lists are long though so it’s best to make an appointment as soon as possible when you need oral surgery or emergency treatment.
Oral Surgery
Oral surgery procedures may include the removal of wisdom teeth, impacted teeth and cysts. These procedures are often performed to correct improper alignment or to treat acute pain or infection.
The following oral surgeries are covered when they’re considered medically necessary:
Removal of impacted wisdom teeth (partial or complete)
Correction of jaw deformities caused by trauma, disease or birth defects (such as cleft palate)
Free Dental Care Ontario For Adults
Ontario’s Dentistry for Children and Youth program provides free dental care to children and youth under 19 years of age who are:
living in Ontario
enrolled in a full-day kindergarten or primary school
In addition, children who are not eligible for the program may still qualify for some dental services if they meet certain criteria.
Ontario’s Adult Dental Program provides low-cost dental care to adults ages 19 to 64 who have low incomes. The program covers basic dental services such as check-ups and fillings. It does not cover more complex dental treatments like root canal therapy or crowns.
The Ontario government has a program that provides low-income adults with free dental care.
The Healthy Smiles Ontario program covers the cost of necessary dental services, including fillings and root canals. It also covers dental surgeries that are medically required and necessary for the health of your teeth, gums and bite.
You may be eligible for this program if you:
Have an income under $20,000/year (or under $35,000/year if you’re a family);
Are not a Canadian citizen or permanent resident;
Have been living in Ontario for at least three months; and
Are not eligible for any other public dental coverage (including ODSP or OHIP).
Low-Income Dental Coverage Ontario
The Ministry of Health and Long-Term Care provides dental coverage for low-income individuals, seniors and people with disabilities.
The ministry offers two types of dental benefits:
Dental Assist, a program to help children and youth who are not eligible for the Ontario Health Insurance Plan (OHIP) receive basic dental care at no charge.
Ontario Works or Ontario Disability Support Program (ODSP).
The Low Income Individuals and Families Act provides basic dental coverage for adults on social assistance who meet certain criteria. Seniors who are 65 or older may also be eligible for this program.
The Ontario Dental Program (ODP) is a free and confidential dental program that helps people with low income access dental care. The ODP provides oral health care services to eligible residents who have limited or no dental coverage.
Who is Eligible?
The ODP is open to anyone who has limited or no dental coverage, as defined by the Canada Health Act. This includes persons living on an income of less than $1,400 per month or individuals who are homeless or at risk for being homeless.
How do I Qualify for the Ontario Dental Program?
To be eligible for the ODP, you must meet all eligibility requirements set out in the legislation and regulations governing our program. Eligibility criteria include:
You must be a resident of Ontario;
You must not have private medical insurance that provides you with coverage for any dental services; and
You cannot have an outstanding balance on your account with your previous dentist.