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“Are orthotics covered by my insurance?” is one of the first questions we hear when a patient in Mississauga is told they would benefit from custom orthotics. The short answer is: usually yes, if you have extended health benefits — but the details matter. How much is covered, how often you can claim, and what paperwork your insurer requires vary from plan to plan, and getting it wrong can mean a rejected claim.
At Rishaan Physio & Wellness Clinic, we deal with orthotics claims every week and handle the documentation for our patients. This guide explains what custom orthotics typically cost in Ontario, what insurers look for, how long orthotics last, and how to make sure your claim goes through smoothly.
Does OHIP Cover Custom Orthotics?
No. OHIP does not cover custom orthotics for the general population. Coverage comes through private extended health benefits — typically from an employer, a spouse’s plan, a union, or an individual policy. Some government programs (such as the Assistive Devices Program for specific medical conditions, or Veterans Affairs and Ontario Works in certain circumstances) may provide coverage for eligible individuals, but for most people, private insurance is the route.
How Much Do Custom Orthotics Cost in Ontario?
Custom orthotics in Ontario generally cost between $400 and $600 per pair, depending on the materials, the type of orthotic (everyday, sport, dress shoe), and the clinic. This price includes the assessment, casting or scanning, manufacturing, fitting, and follow-up adjustments. Be cautious of prices dramatically below this range — they often indicate a modified prefabricated insole rather than a true custom device, which insurers may not cover.
Contact us for current pricing at our Mississauga clinic; we are happy to explain exactly what is included.
What Do Extended Health Plans Typically Cover?
Most extended health plans include custom orthotics as a benefit. Common plan structures include:
- A dollar maximum — often $300 to $500 per pair, or per calendar year, though some plans cover more
- A frequency limit — typically one pair per year, or one pair every two years; some plans allow two pairs annually
- A percentage of the cost — for example, 80% or 100% up to the maximum
- Family coverage — dependants (spouse and children) are usually covered with their own limits
Because of the annual structure, many people have unused orthotics coverage that resets every January. If you have been putting off orthotics, the last quarter of the year is a good time to use this year’s benefit.
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What Insurers Require for an Orthotics Claim
This is where most rejected claims go wrong. Insurers have tightened orthotics requirements in recent years, and the specifics vary, but commonly requested items include:
- A prescription — many plans require a prescription from a medical doctor, while others accept prescriptions from a chiropodist, podiatrist, or chiropractor. Check which professionals your plan accepts before your appointment.
- A biomechanical assessment report — documenting the examination, gait analysis, and the medical reason for orthotics (the diagnosis, such as plantar fasciitis or overpronation)
- A description of the casting method — insurers typically require a three-dimensional casting technique (foam box, plaster, or 3D scan), not a two-dimensional pressure plate or footprint
- Manufacturer information — the lab that produced the orthotics and the materials used
- Proof of payment and dispensing date
Our clinic provides all of this documentation as standard. If your plan has specific requirements, tell us at your first visit so everything is in order before you submit.
Direct Billing vs. Reimbursement
Some insurers allow clinics to bill orthotics directly, so you pay only the difference between the cost and your coverage. Others require you to pay upfront and submit the claim for reimbursement. We bill directly wherever your plan permits and, where it does not, give you a complete claim package so reimbursement is quick and straightforward.
How Long Do Custom Orthotics Last?
A well-made pair of custom orthotics typically lasts two to five years. Lifespan depends on:
- Materials — rigid or semi-rigid shells last longer than soft, cushioned devices
- Body weight and activity — heavier or highly active users wear through orthotics faster; runners may need replacement every one to two years
- Daily wear — orthotics worn all day, every day, wear faster than those used for specific activities
- Foot changes — pregnancy, weight change, aging, or surgery can alter your foot mechanics and require a new prescription
Signs your orthotics need replacing include visible cracking or flattening of the shell, worn-through top covers, a return of the symptoms they were prescribed for, or a change in your footwear or activity that they no longer suit. Bring them to any appointment and we will assess whether they still fit and function.
Can I Get Orthotics for Different Shoes?
Yes. Many patients have one pair for everyday shoes and a second, slimmer pair for dress shoes or a sport-specific pair for running or skates. If your plan covers two pairs, this is worth using. Otherwise, a single well-designed everyday pair can often be moved between similar shoes.
Are Orthotics Worth It Without Insurance?
For the right condition — persistent plantar fasciitis, overpronation-related knee or shin pain, flat feet causing fatigue, or foot pain from long hours standing — custom orthotics often provide relief that no other single intervention matches, and they last for years. If you are not sure they are the right solution, we assess first and prescribe only if they will help. Read more about when they are and are not worth it in our guides to orthotics for flat feet and custom orthotics vs. store-bought insoles.
Why Choose Rishaan Physio for Orthotics in Mississauga
- Full biomechanical assessment and 3D casting that meets insurer requirements
- Complete claim documentation prepared for you
- Direct billing where your plan allows
- Honest advice — no orthotics unless you need them
- Orthotics combined with physiotherapy and massage therapy for complete treatment
- Open 7 days a week, same-day appointments
- Free pickup and drop-off service
- Unit 7, 5105 Hurontario Street, Mississauga — Hurontario & Eglinton
Frequently Asked Questions
Do I need a doctor’s prescription for orthotics to be covered?
Many plans require a prescription from a medical doctor; others accept one from a chiropodist, podiatrist, or chiropractor. Check your plan booklet or call your insurer — and tell us what they require before your assessment.
How often can I claim orthotics through insurance?
Most plans allow one pair per calendar year or one pair every two years, with a dollar maximum per pair. Some allow two pairs per year. Your benefits booklet or insurer can confirm.
Can I claim orthotics if my spouse’s plan also covers them?
Yes. With coordination of benefits, you can submit to your own plan first and the remaining balance to your spouse’s plan, often covering the full cost.
Can orthotics be claimed as a medical expense on my taxes?
Custom orthotics prescribed by a medical practitioner are generally an eligible medical expense for the federal medical expense tax credit. Keep your receipt and prescription; consult a tax professional for your specific situation.
Use Your Benefits — Book Your Orthotics Assessment
Insurance paperwork handled • Direct billing where available • Open 7 days • Free pickup & drop-off
Call (905)-800-1661Rishaan Physio & Wellness Clinic — Unit 7, 5105 Hurontario St, Mississauga, ON L4Z 0C9