How to get health insurance in Canada
Canada has a universal health insurance program that covers basic medical expenses, but not everything. Private health insurance is used to cover expenses not covered by the government, such as prescription medications, dental care, vision care, and paramedical services. There are different types of private health insurance plans available, and they vary in coverage and cost. The cost of premiums depends on factors like age, health status, coverage extent, and the insurance provider.
You’ve probably heard that Canada has a free national health insurance program. And that’s true! We do have many healthcare costs that are publicly funded by taxpayers so that everyone gets the emergency care they need. However, this “free” health care doesn’t cover everything you might require to fully recover from an injury or illness. To cover those expenses, many Canadians use private health insurance.
In this article, we go over the different types of health insurance available in Canada, how to apply for it, and how to choose the best provider for you.
Universal health insurance
The “Medicare” system in Canada is a universal health system that is publicly funded through taxpayer dollars. It allows all Canadians to access essential medical care such as hospital visits and emergency surgery.
Provincial health insurance
Our universal healthcare system here in Canada is provincially administered. This means each province will have different rules to qualify for “free” universal healthcare. In order to access health coverage with the provincial plan, some provinces require you to be a permanent resident for at least three months, while others will require longer.
Private health care insurance
Many Canadians buy additional health insurance coverage through their employers or purchase private health insurance policies to cover these gaps in the public healthcare system. Private health insurance plans can vary in coverage and cost, depending on the provider, the specific policy, and your own health history (more on that below).
Travel health insurance
Emergency travel medical insurance covers unexpected medical events and treatment when you’re traveling. You can buy it when you’re traveling outside of Canada or if you’re a visitor to Canada. This is a form of private insurance, and those buying have many options for insurance providers.
Check out our travel insurance quoting tool to shop for the best travel insurance rates.
What is the difference between public and private health insurance in Canada?
Public health insurance in Canada covers basic and emergency medical services such as hospitalization, surgeries, and doctor’s visits. Private health insurance covers health care services and other medical expenses such as prescription medication, paramedical services (chiropractic services, physiotherapy, massage), and other medical equipment (CPAP machines, crutches, nebulizers, etc.).
In short, public health insurance takes care of the immediate care needed to treat injury and illness while private health insurance covers the cost that may be required to recover fully from that illness. For example, public health insurance will cover the cast for your broken leg, and private health insurance will provide physiotherapy coverage so you can walk and run normally again.
How does private health insurance work in Canada?
Private health insurance in Canada works alongside the publicly funded healthcare system to provide additional coverage for services not covered by the government. These health insurance plans can vary in terms of coverage and benefits. They require individuals to pay regular premiums, which can be monthly, quarterly, or annual payments. The cost of these premiums varies depending on factors such as age, health status, the extent of coverage, and the insurance provider (more on that below).
Individuals can get private health insurance through their employer benefits, they can purchase it on their own, or they can coordinate the two coverages. Each health insurance provider will have several tiers of coverage that can be coordinated with other plans.
🏥 What does health insurance cover?
Private health insurance covers the expenses that government healthcare does not.
|Extended health insurance can cover:
The coverage amounts and availability are all dependent on your insurance provider and what tier of coverage you select (more on that below).
Additionally, insurance companies have a price list of what they think is a “reasonable amount” for any service, equipment, or medication within your particular province. For example, under your prescription drug coverage, your plan may feel that name-brand medication like Ozempic is overpriced, and will only approve coverage for a generic alternative with the same ingredients.
🦷 Dental insurance
Canada has a universal dental care plan in place for uninsured families with an annual income of less than $90,000 and with children under 12 years old. This plan was introduced in 2022 and provides payments of up to $650 per child per year for families.
However, many families have extended dental care coverage through a private insurance provider. Many of these providers include dental coverage in their plans, usually up to 80% of the cost of dental services (although it depends on the plan).
|Private dental insurance can cover services such as:
What to know more about dental coverage? Read more about dental insurance here.
👁 Vision care insurance
Private plans usually provide reimbursement for vision care as well. Usually, the minimum coverage for vision care is one visit to an optometrist every 24 months and some money for corrective lenses.
|Some personal health insurance will include the following for eye care:
What to know more about eye care coverage? Read more about vision insurance here.
Types of extended health insurance plans
Every provider has different types of health insurance plans with varying coverage amounts and limits. Supplemental health care is usually put into a tiered system, with each tier increasing its coverage at higher costs. The plans are usually separated into basic, standard, and enhanced tiers.
Coverage tiers and costs may look like*…
|Basic health plan||Prescription drugs – 60% up to $750
Dental – 60% up to $500
Vision – No coverage
Paramedical Expenses – $25 per visit up to $250 ($35 for psychologist/social workers)
Travel – No coverage
|Standard health plan||Prescription drugs – 70% up to $7,000
Dental – 70% up to $750 (preventative only)
Vision – $250 every 2 years, $50 per eye exam
Paramedical Expenses – 100% up to $300 per practitioner (up to $1000 for psychologists/social workers)
Travel – $5 million in emergency health coverage for the first 60 days
|Enhanced health plan||Prescription drugs – 80% up to $5,000
Dental – 80% preventative care up to $750, 50% restorative care up to $500, 60% up to $1,500 for orthodontic
Vision – $300 every 2 years, $50 per eye exam
Paramedical Expenses – 100% up to $400 per practitioner (up to $1500 for psychologists/social workers)
Travel – $5 million in emergency health coverage for the first 60 days
*Quote for a 35-year-old person in Ontario with no pre-existing health conditions.
Every plan will have a deductible amount, a waiting period before you can claim coverage, and its own process for claims. Some health insurance providers direct bill, while others will require you to pay for your medical expenses upfront and will reimburse you after you submit the receipts for your medical bills.
What kind of health insurance is available in Canada?
As mentioned above, while basic healthcare services are publicly funded, there are certain healthcare expenses that are not covered by the government. This includes prescription medications (except in some specific cases, such as for seniors or low-income individuals), dental care, vision care, and paramedical services (e.g., physiotherapy, chiropractic services). These services are typically covered through private health insurance plans.
Medically underwritten health insurance
Standard health insurance is medically underwritten. This means that during the application process, the insurance company will ask you about your health and lifestyle and use your answers to determine your eligibility and price for your insurance. For medically-underwritten policies, insurers may exclude any pre-existing conditions. But you still have options for health insurance if you have a health issue.
Guaranteed acceptance health insurance
Guaranteed acceptance health insurance is a no (or few)-questions-asked kind of policy. There is no medical questions, medical underwriitng, and generally pre-existing conditions are covered.
You can get guaranteed acceptance policies if you’re transitioning from a work benefits policy to your own policy, as long as it’s within 60-90 days of your work benefits ending.
Most companies will have basic, standard, and enhanced options for medically underwritten and usually basic or standard options for guaranteed acceptance.
|Medically underwritten health insurance||Guaranteed acceptance health insurance|
How to choose a health insurance plan
In order to choose a health insurance plan, you have to figure out your insurance needs. To find out your healthcare needs you can ask yourself:
- Do I have health insurance coverage through my employer?
- Do I have health insurance coverage through my spouse’s employer?
- Do I have dependents that will require more coverage?
- How much can I afford to spend on health insurance each month?
The answers to these questions will help you determine which plan is the best for you and your family.
Still having trouble figuring out which plan is best for you? Here is a list of plan types and the scenarios in which they might be right for your insurance needs.
You might choose a…
|Basic health plan…|
|Standard health plan…|
|Enhanced health plan…|
|Guaranteed acceptance health plan…|
How much does private health insurance cost in Canada?
The monthly cost of medical coverage depends on your health as well as the plan you select.
|To determine your health insurance premiums, the insurance company will want to know:
If you are in poor health, it may be difficult to get standard health insurance coverage, but there are other options for you. Some health and dental insurance providers, like Manulife and GreenShield, offer a “guaranteed” healthcare coverage plan. However, these plans are likely to be much more expensive than standard plans.
Who is the best health insurance provider in Canada?
There is no single “best” health insurance provider because everyone’s coverage needs are different. Here are the health providers that we’ve partnered with to offer the best health insurance in Canada.
Manulife offers health and dental insurance through its CoverMe Flexcare product. These plans are great for those looking for add-ons and flexible coverage. For example, they have products that are dental-only, vision-only, or even just drug costs after you front the first $10,000.
Sunlife offers personal health insurance as one of its flagship products. They offer plans in the classic three-tier system—basic, standard, and enhanced with ascending coverage levels depending on your needs and budget.
SureHealth offers several levels of plans including three types of plans with guaranteed acceptance coverage—coverage for those who have existing health conditions or would otherwise not qualify for standard health insurance.
Desjardins offers health and dental insurance through their SOLO healthcare product. This product has two tiers, basic and enhanced, with vision care included in both and ascending coverage options for prescription medication and dental depending on your coverage needs.
GMS also offers guaranteed acceptance health insurance in addition to three standard plans (OmniPlan, ExtendaPlan, and BasicPlan). Their products have no waiting periods and coordinate with their LifeWorks program, a digital wellness platform to promote physical and mental well-being.
Read our review of the Best Health Insurance in Canada.
Is medical insurance worth it in Canada?
Yes, medical insurance is worth it in Canada, even if you have access to public health insurance. Your private health insurance covers the medical expenses that come up when you recover. This can include prescription medication, crutches, physiotherapy, and more.
Just imagine paying this bill without private health insurance…
In addition, personal health insurance covers more than just emergency recovery care. It can help with other health maintenance costs such as:
- Therapy (psychological and counseling services)
- Massage services
- Chiropractic services
- Vision care
- Dental care
- And more
All of these health services are an essential part of living well, and it’s important to keep up with them.
|– The cost of your health is priceless. –|
How do you file a medical claim?
Some private health plans have direct bills, meaning that the service provider (doctor, dentist, practitioner, etc.) sends the bill directly to the health insurer for you. Other private health insurance coverage requires you to submit the receipt for your health expenses after the fact, and they will reimburse you.
For example, if your doctor prescribes you prescription drugs, the conversation at the pharmacy may go one of two ways when you go to pick up the medication and present your health insurance card.
|The pharmacist sends the bill directly to your health insurance company. They pay the agreed-upon amount (say 80%) and you are responsible for paying the other 20% at the till.|
|The pharmacist says that the company doesn’t allow direct billing. You must pay the full price at the till and save your prescription receipt (different from the till/debit receipt—this is usually a slip of paper that comes in the bag with your medication). You then send that receipt to your insurance company either by mail or online, using an online claims filing process. They will then send you back the agreed-upon coverage amount for that medication.|
Read more about how to file a health insurance claim.
Looking for a health insurance quote?
If you’re looking for a great price on personal health and dental insurance, PolicyAdvisor can help! We have a team of licensed insurance experts to help you go through health plans from Canada’s best insurance providers. Book a quick call with one of our advisors today and we can determine your health insurance needs.
Frequently Asked Questions
What if you’re leaving your job with benefits?
If you have a job with benefits and you’re leaving that job, you will get guaranteed acceptance with most insurance providers when you leave. This means when you transition to your new plan, you don’t have to go through any medical questionnaires—your new individual policy is guaranteed to be accepted. However, you must apply for the new coverage within the first 60 – 90 days of your employer benefits ending.
Isn’t health insurance in Canada free?
Some parts of healthcare are free in Canada. Universal healthcare in Canada is administered by the provincial government and is funded by taxpayer dollars. Publicly funded health insurance covers basic medical expenses like seeing a doctor, surgery, non-private hospitalizations, etc. It does not cover prescription medication, paramedical expenses, vision care, dental care, or medical equipment that may be needed to recover from injury or illness. Private insurance can cover these expenses and more.
How much is health insurance per month in Canada?
The average 35-year-old Canadian can expect to pay $80-$100 per month for private health insurance. However, your price is determined by your individual age, location, and health history. To get the best rate, it’s important to shop around.
Is private health insurance tax deductible in Canada?
In some cases, private health insurance can be tax deductible. For example, if you are self-employed or a business owner, it may be written off as a business expense. Individuals may be able to include premiums as part of their medical expenses when calculating tax credits as well.
How much do employees pay for benefits in Canada?
Some employers will cover all of your health insurance costs, while others will only pay a portion and expect you to pay the rest to participate in the group plan. Group and employer plans have a discounted rate because the employer gets a group deal. So you can expect to pay less than if you bought your own plan.
However, with employer plans, you usually have little to no say about what plan you’ll get. In order to get the coverage you and your family actually need, you may consider an additional private health insurance plan.
What if I’m covered under my spouse’s plan?
That’s great! We’re glad that you have some sort of health insurance coverage to keep your financial wellness in check while you rest and recover. However, employer benefits may not have the most comprehensive plan. You may consider buying your own individual plan to supplement your spouse’s employer’s plan to fit all your family’s needs. You can use both plans to get close to 100% coverage for your medical costs by coordinating your benefits.
Connect with a licensed insurance advisor
Still unsure which plan would be best for you? Schedule a call with one of our expert insurance advisors for one-on-one advice. The conversation has no obligations to buy—let’s just start with a conversation about your insurance needs. Our health and dental insurance agents will ask you a few questions, then shop with Canada’s best insurance companies to get you the best price on health insurance.
- Canada has public health care that covers basic health emergencies, but not all services are included
- Private insurance can cover medications, dental care, vision care, travel medical, medical equipment, and more
- You can have more than one health insurance plan and coordinate the benefits for 100% coverage