Care, Cost and Privacy · Ontario
What Does OHIP Cover in Men's Health, and What Is Private Care?
The short answer
What does OHIP cover in men's health? In Ontario, OHIP covers medically necessary physician and hospital services and many lab tests ordered for a medical reason. Treatments at private clinics such as MAMBA Men's Clinics, including cosmetic injectables, laser and elective procedures, are generally paid privately, and OHIP does not pay prescriptions for most adults.
In this article
Key takeaways
- OHIP covers medically necessary physician and hospital services.
- Cosmetic and elective treatments are generally not insured.
- OHIP+ and the Ontario Drug Benefit cover some prescriptions for some age groups.
- MAMBA provides a written, itemized quote before treatment.
What does OHIP cover in men's health?
OHIP covers medically necessary physician and hospital services in Ontario, including many lab tests ordered for a medical reason. Cosmetic and elective treatments are generally not insured.
The Ontario Health Insurance Plan pays for insured services, such as:
- Visits with a family doctor or specialist for a medical problem
- Referrals to specialists such as urology or endocrinology
- Many blood tests ordered for a medical reason
- Hospital care
What is usually paid privately at a men's clinic?
Most treatments at a private men's clinic are paid privately, because they are cosmetic, elective or outside the list of insured services.
At MAMBA Men's Clinics, privately paid treatments include Botox for men, fillers, laser hair removal, PRP treatments, focused shockwave for ED, Shaft & Scrotum Enhancement, Girth Enlargement and hair restoration. The same service can fall on either side of the line depending on why it is done. A service provided for a medical reason is treated differently from one chosen for appearance.
How do OHIP and private men's health care compare?
OHIP-funded care focuses on medically necessary services paid by the province, while private men's health care focuses on elective and men's-specific services paid by you or a private plan.
| Topic | OHIP-funded care | Private men's clinic |
|---|---|---|
| Who pays | The province, for insured services | You, or a private plan where eligible |
| Focus | Medically necessary care | Elective, cosmetic and men's-specific care |
| Access | Often through a referral | Booked directly |
| Prescriptions | Not paid by OHIP for most adults | Same rules apply |
Does OHIP pay for prescription drugs?
OHIP itself does not pay for prescriptions for most adults. Two Ontario drug programs fill some of that gap.
OHIP+ covers many prescriptions for people aged 24 and under who do not have a private plan. The Ontario Drug Benefit program covers many prescriptions for people aged 65 and older and some other groups. For other adults, prescriptions are paid privately or through a workplace or private drug plan. Read more in using insurance or a health spending account.
What drives the cost of private men's health care?
The cost of private men's health care is driven by the treatment, the product and the clinician time a plan involves. Common cost factors include:
- The type of treatment and any product used
- How many visits the plan includes
- Clinician time for assessment and follow-up
- Maintenance visits over time
Treatments start at $99, and MAMBA provides a written, itemized quote before anything begins. Your clinician walks through your quote at a complimentary consult.
How do I book a complimentary consult with MAMBA?
You can book a complimentary consult online or by calling or texting 647-947-0605 from anywhere in Ontario. You can also take the free MAMBA Health Score, which takes about 2 minutes, or choose the optional $1 virtual consultation.
Frequently asked questions
Does OHIP cover ED treatment?
A doctor visit to assess erectile dysfunction as a medical problem is generally an insured OHIP service. ED treatments offered privately, such as focused shockwave or penile PRP, are paid out of pocket, and ED medication coverage depends on your drug plan.
Can a private clinic charge for OHIP-insured services?
No. Ontario rules prevent clinics from charging patients for OHIP-insured services. Private clinics like MAMBA charge only for uninsured services, such as elective and cosmetic treatments, and list them on a written, itemized quote.
Is hair restoration covered by OHIP?
Hair restoration for male pattern hair loss is generally not insured by OHIP when done for cosmetic reasons. PRP hair restoration, scalp microneedling and mesotherapy at MAMBA are paid privately, with an itemized quote first.
How do I get an itemized quote from MAMBA?
MAMBA provides a written, itemized quote after your consult that lists each treatment, the visits involved and any products. An itemized quote helps you compare options and submit receipts to a private plan if you have one.
Your next step.
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