Understanding Health Insurance in Canada

Canada's healthcare system covers medically necessary hospital and physician services, but many Canadians are surprised by what's not covered: dental care, prescription drugs, vision care, and mental health services.

What Provincial Health Insurance Covers

Every province/territory provides basic health insurance through:

Ontario: OHIP
BC: MSP (Medical Services Plan)
Alberta: AHCIP
Quebec: RAMQ

Covered:

Doctor visits and specialists
Hospital stays (ward accommodation)
Emergency services
Diagnostic tests (X-rays, MRIs, blood tests)
Surgery

NOT Covered:

Prescription drugs (outside hospitals)
Dental care (except in-hospital oral surgery)
Vision care (except eye exams for children/seniors in some provinces)
Mental health counseling (only psychiatrists covered, not psychologists)
Physiotherapy, massage therapy, chiropractic
Ambulance rides (partially covered, typically $45–$250)
Private/semi-private hospital rooms

The Gaps: What You Need Private Insurance For

1. Prescription Drugs

Cost: Average Canadian spends $1,200/year on prescriptions Coverage gaps: No national pharmacare program (yet)

Provincial programs:

Ontario: OHIP+ (free prescriptions for under-25s)
BC: Fair PharmaCare (income-based assistance)
Quebec: Mandatory drug insurance (through employer or RAMQ)

Solution: Private drug plan or discount programs (e.g., Pocket Pills, Well.ca)

2. Dental Care

Cost: Cleanings $150–$300, fillings $200–$400, root canals $800–$1,500 Government coverage: Only for low-income children and seniors in some provinces

New: Canadian Dental Care Plan (CDCP) launched 2024

Covers uninsured Canadians with income under $90,000
Phased rollout: Seniors first, then children, then adults

Solution: Private dental insurance ($50–$150/month) or dental schools (50% discount)

3. Vision Care

Cost: Eye exams $100–$150, glasses $200–$800 Provincial coverage: Eye exams covered for kids (under 19) and seniors (65+) in most provinces

Solution: Vision insurance (often bundled with health plans) or discount retailers (Clearly, Warby Parker)

4. Mental Health

Covered: Psychiatrists (medical doctors) NOT covered: Psychologists, therapists, counselors

Cost: Therapy sessions $150–$250/hour Waitlists: Public mental health services have 6–12 month waits

Solution: Employee Assistance Programs (EAPs), sliding scale therapists, or private insurance

Private Health Insurance Options

1. Employer-Sponsored Plans

Covers 60–70% of Canadians
Typical coverage: $3,000–$5,000/year for drugs, $1,500/year for dental, $500/year for vision
Cost: Employer pays 50–100%

2. Individual/Family Plans

For self-employed, gig workers, or those without employer coverage
Cost: $150–$400/month for family of 4
Providers: Green Shield, Blue Cross, Manulife, Sun Life

3. Health Spending Accounts (HSAs)

Pre-tax dollars for health expenses
Covers what provincial/private insurance doesn't
Great for self-employed

Newcomers to Canada

Waiting period: Most provinces have a 3-month wait for health card eligibility Coverage during wait: Buy private visitor insurance ($50–$150/month)

How to apply:

Visit Service Canada or provincial health office
Bring proof of residency (lease, utility bill)
Bring work permit or PR card
Receive temporary card immediately, permanent card mailed in 4–6 weeks

Cost-Saving Strategies

Use generic drugs (same as brand-name, 50–80% cheaper)
Shop around for prescriptions (prices vary 30% between pharmacies)
Preventive care (regular checkups prevent expensive treatments)
Flex spending accounts (pre-tax health dollars through employer)
Government programs (apply for low-income drug/dental programs)

Emergency Travel

Out-of-province: Provincial coverage provides minimal emergency coverage in other provinces Out-of-country: Provincial plans pay almost nothing for US/international care

Solution: Travel insurance mandatory for trips outside Canada ($50–$200/trip or $200–$600/year for annual plan)

Tax Deductions

Medical expenses over 3% of income (or $2,635, whichever is less) are tax-deductible:

Prescriptions
Dental
Vision
Mental health (psychologists)
Medical devices (wheelchairs, hearing aids)

Keep all receipts!

Frequently Asked Questions

Do I need private insurance if I have provincial coverage?

Yes, for most Canadians. Provincial plans only cover medically necessary services (doctors, hospitals, surgery). They don't cover:

Prescription drugs (outside hospital)
Dental care
Vision care (except kids/seniors)
Mental health (psychologists, therapists)
Physiotherapy, chiropractic

60-70% of Canadians have employer-sponsored private insurance. If you don't, consider buying individual coverage for drugs and dental.

How much does private health insurance cost?

Individual: $100-$200/month Couple: $200-$300/month Family of 4: $300-$400/month

Employer plans: You typically pay 0-50%, employer covers rest

What it covers: Prescriptions ($3,000-$5,000/year), dental ($1,500/year), vision ($500/year), paramedical services

What happens if I get sick while visiting another province?

Your provincial health card works across Canada for medically necessary services.

But: Coverage is limited to what your home province pays, which may be less than the actual cost. Some provinces require you to pay upfront and get reimbursed.

Recommendation: Get travel insurance even for interprovincial travel ($50-$100/trip)

Can I get health insurance if I'm self-employed?

Yes, several options:

Individual/family plans: Blue Cross, Green Shield, Manulife, Sun Life ($150-$400/month)
Health Spending Account (HSA): Pre-tax dollars for health expenses (no premiums, pay as you go)
Professional associations: Some offer group rates (check if your industry has one)

Tax deduction: Premiums are tax-deductible for self-employed

Is dental coverage worth it?

Do the math:

If you need routine care only:

2 cleanings/year: $400
1 filling every 2 years: $200/year average
Total: $600/year
Insurance cost: $600-$1,800/year
May not be worth it (cleanings cheaper out-of-pocket)

If you need major work:

Crowns: $1,500 each
Root canals: $1,000 each
Insurance pays for itself quickly

Alternative: Dental schools offer 50% discount

What's the Canadian Dental Care Plan (CDCP)?

Launched 2024 - government program for uninsured Canadians

Eligibility:

Household income under $90,000
No access to private dental insurance
Canadian resident with valid health card

Coverage:

Preventive care (cleanings, exams)
Restorative care (fillings, crowns)
Limited cosmetic work

Phased rollout:

Seniors 65+ (2024)
Children under 18 (2024-2025)
Adults 18-64 (2025-2026)

How do I claim medical expenses on my taxes?

You can claim expenses exceeding 3% of your net income or $2,635 (whichever is less)

What qualifies:

Prescriptions
Dental work
Eye exams, glasses
Physiotherapy, chiropractic (with referral)
Medical devices
Private health insurance premiums (if self-employed)
Mental health (psychologist, therapist)

How to claim:

Keep all receipts
Claim on line 33099 of your tax return
12-month period ending in tax year (not just calendar year)

Example: Net income $60,000

Threshold: 3% × $60,000 = $1,800
Medical expenses: $3,000
Claimable: $3,000 - $1,800 = $1,200

What if I can't afford my prescriptions?

Options:

Ask for generic: 50-80% cheaper than brand-name
Shop around: Prices vary 30% between pharmacies (Costco often cheapest)
Provincial programs:
- Ontario: Trillium Drug Program (income-based)
- BC: Fair PharmaCare
- Quebec: Mandatory drug insurance through RAMQ
Patient assistance programs: Many drug manufacturers offer free/discounted meds for low-income
Split pills: Some medications can be safely split (ask pharmacist)

When to Get Professional Help

Consider consulting professionals if:

Insurance broker: Self-employed, comparing private plans, maximizing coverage
Benefits advisor: Understanding employer plan options, making elections
Tax professional: Claiming large medical expenses, self-employed health deductions
Provincial health office: Questions about coverage, eligibility, health card
Patient navigator: Chronic condition, multiple specialists, complex care needs

Costs:

Insurance broker: Free (paid by insurer)
Tax professional: $150-$300/hour
Provincial help lines: Free

ROI: Good insurance broker saves you hundreds annually on premiums

Your Health Coverage Checklist

Coverage basics:

Have valid provincial health card
Know what your provincial plan covers and doesn't cover
Enrolled in employer health plan (if available)
Considered private insurance if self-employed
Travel insurance for trips outside Canada

For prescriptions:

Ask doctor for generic alternatives
Compare prices at 3+ pharmacies
Check if eligible for provincial drug programs
Keep all prescription receipts for tax time

For dental:

Get cleanings every 6-12 months (preventive cheaper than reactive)
Check CDCP eligibility if uninsured
Consider dental schools for major work
Keep dental receipts for tax claims

For mental health:

Check if employer offers EAP (free counseling)
Look for sliding-scale therapists
Ask about virtual therapy options (often cheaper)
Keep therapy receipts for tax deductions

File Your Personal Taxes in Canada - Claiming medical expense deductions
Immigrate to Canada - Health coverage for newcomers and waiting periods
Retirement Investing in Canada - Planning for healthcare costs in retirement
Buy Your First Home in Canada - Health Spending Accounts and tax planning

Corrections Policy

Refdesk.ca is committed to accuracy. Health insurance information on this page is verified against official Health Canada, provincial health ministry, and insurance industry sources. Content is updated quarterly to reflect policy changes and program updates. If you find an error, outdated information, or broken links, please report it to [email protected] with the subject line "Health Insurance Topic - Correction Request." We review all submissions within 48 hours and update content as needed, posting a dated correction notice for significant errors. This guide was last reviewed on January 20, 2025.