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Health benefits for people leaving ODSP

If you leave ODSP because you are getting more money from somewhere else, such as from a job or the Canada Pension Plan (CPP), you may be able to continue to get some ODSP health benefits.

What kinds of health benefits can I get?

There are two types of health benefits for people who leave ODSP:

  • the Extended Health Benefit — helps you pay for your high health costs if you no longer qualify for ODSP because you get too much money from another source, such as CPP.
  • the Transitional Health Benefit — helps you pay for your health costs if you make too much money from a job and you:
    • don’t get health benefits (or similar benefits) from your employer, and
    • don’t qualify for the Extended Health Benefit.

What is the Extended Health Benefit?

The Extended Health Benefit provides health benefits for ODSP recipients who have high health costs, but are no longer eligible for ODSP because their income is too high.

What can the Extended Health Benefit cover?

Depending on your needs, the Extended Health Benefit can cover:

  • prescription drugs
  • dental services
  • eyeglasses and hearing aids
  • diabetic supplies
  • surgical supplies and dressings
  • transportation to and from necessary medical appointments, and
  • some of the cost of an assistive device, such as a wheelchair, that is funded in part by the Ministry of Health and Long-Term Care's Assistive Devices Program.

For more information about the Assistive Devices Program visit the Ministry of Health and Long-Term Care website.

How do I qualify for the Extended Health Benefit?

To qualify for the Extended Health Benefit, your health costs must be higher than the difference between:

  • your income (e.g., money you get from your pension, your job or training after deductions like income tax), and
  • the amount of ODSP income support that you were receiving each month.

Talk to your caseworker to learn more about how to qualify for the Extended Health Benefit.

Example: Qualifying for the Extended Health Benefit

Anna, a former single ODSP recipient, didn’t qualify for ODSP because she was getting more money from CPP than she was getting from ODSP income support.

Anna used to get $600 from ODSP each month. Now, Anna gets $700 from CPP-Disability each month.

Anna also spends $25 on prescription drugs and $110 on diabetic supplies per month.

Would she qualify for the Extended Health Benefit?

Income

Monthly amount

Income from all sources

$700

Subtract previous ODSP income support

$600

Difference

$100


Health costs

Monthly amount

Prescription drugs

$25

Add diabetic supplies

$110

Total health costs

$135


Anna would qualify for the Extended Health Benefit because her health costs ($135/month) are higher than the difference between her CPP income and her ODSP income support ($100/month).

How long can I get the Extended Health Benefit for?

You can get this benefit as long as your health costs are higher than the difference between:

  • your current income, and
  • the amount of ODSP income support you would receive if you were still on ODSP.

must still qualify for ODSP in every other way, for example, having assets that fall within the ODSP limits.

If you do not qualify for Extended Health Benefits, you may qualify for the Transitional Health Benefit.

What is the Transitional Health Benefit?

The Transitional Health Benefit can help you pay for prescription drugs, dental services and vision care costs.

Am I eligible for the Transitional Health Benefit?

If you leave ODSP for a job and don’t receive the same level of health benefits from your employer, you may be eligible for the Transitional Health Benefit.

You can also get the Transitional Health Benefit if you leave ODSP because you make too much money from self-employment or from a training program.

How long can I get the Transitional Health Benefit for?

You can get this benefit until you’re able to get similar benefits from your employer. As soon as you do, you need to tell your local ODSP office.

Do I need to have high health costs to be eligible?

No. You don’t need to have high health costs to be eligible for the Transitional Health Benefit.

If I’m leaving ODSP, how can I apply for the Extended Health Benefit or the Transitional Health Benefit?

Talk to your caseworker. Your caseworker will first see if you can get the Extended Health Benefit. If you don’t qualify and you left ODSP for a paying job, your caseworker will see if you can get the Transitional Health Benefit.

If I don’t qualify for either benefit, is there another program that can help me?

If you don’t qualify for either health benefit, you may be eligible for help with your prescription drug costs through the Ministry of Health and Long-Term Care's Trillium Drug Program. This program provides coverage for prescription drugs through the Ontario Drug Benefit.

Trillium Drug Program applications are available at pharmacies or by calling the Trillium Drug Program at 1-800-575-5386.

For more information about the Ontario Drug Benefit, call 1-866-532-3161 (toll-free in Ontario only) or TTY 1-800-387-5559.

Don’t agree with a decision?

You can ask for an internal review. Someone at ODSP will review a specific decision that affects your ODSP. The review will make sure the decision followed ODSP rules.

You must ask your ODSP office for an internal review within 30 days of when you received the decision.

Need more information?

For more information, please contact your local ODSP or Ontario Works office

To find contact information for your local office and learn more about ODSP visit: ontario.ca/socialassistance.

For general questions, please call ServiceOntario at:

Telephone: 1-888-789-4199
Teletypewriter (TTY):1-800-387-5559