Canada’s public health system covers the basics, but there are significant gaps. This page covers what provincial plans pay for, what they don’t, and how supplemental health insurance fills the gaps. It is part of the health, life and income protection guides. Health insurance pays specific medical bills; it does not replace income if you can’t work, which is the job of disability insurance, or pay a lump sum on a serious diagnosis, which is what critical illness insurance does. Dental coverage, including the federal Canadian Dental Care Plan, has its own page: dental insurance in Canada.
What Provincial Health Insurance Covers
Every province must cover medically necessary hospital and physician services, and some surgical-dental services, under the Canada Health Act.
| Service | Covered? | Notes |
|---|---|---|
| Doctor visits (GP and specialist) | ✅ Yes | Referral may be needed for specialist |
| Hospital stays | ✅ Yes | Ward room; a private or semi-private room costs extra |
| Surgery (medically necessary) | ✅ Yes | Including day surgery |
| Emergency room visits | ✅ Yes | No charge for treatment |
| Diagnostic tests (blood work, X-rays, CT, MRI) | ✅ Yes | When medically necessary |
| Maternity and newborn care | ✅ Yes | Hospital and physician care |
| Mental health (psychiatrist) | ✅ Yes | Psychiatrists are physicians |
| Cancer treatment in hospital | ✅ Yes | Hospital-administered |
| Ambulance services | ⚠️ Partial | Not fully covered; depends on the province and the circumstances |
What Provincial Health Insurance Does NOT Cover
These are not fully covered by provincial plans, although provinces extend some coverage to seniors, children and people receiving social assistance:
| Service | Covered? | Notes |
|---|---|---|
| Prescription drugs (outside hospital) | ❌ (mostly) | Public drug programs cover specific groups |
| Dental care | ❌ (mostly) | See the Canadian Dental Care Plan on the dental insurance page |
| Eye exams | ❌ (adults, mostly) | In Ontario, OHIP covers yearly eye exams for people 19 and under, exams every 18 months at 65 and older, and exams for adults 20 to 64 only with certain medical conditions |
| Glasses and contact lenses | ❌ | |
| Physiotherapy, massage, chiropractic | ❌ (mostly) | |
| Psychology and counselling | ❌ | |
| Private or semi-private hospital room | ❌ | You or a private plan pay the difference |
| Hearing aids, orthotics and medical devices | ❌ (mostly) | |
| Cosmetic surgery | ❌ | |
| Fertility treatments (IVF) | ⚠️ Some provinces | Ontario funds 1 IVF cycle per eligible patient under 43; fertility drugs are not included |
| Care outside Canada | ⚠️ Minimal | Provincial plans pay only small daily amounts abroad; see travel insurance |
Provincial Health Plans: Premiums, Waiting Periods and Drug Coverage
Each province runs its own plan (OHIP in Ontario, MSP in BC, AHCIP in Alberta, RAMQ in Quebec, and so on), and the rules differ:
- Premiums: Ontario collects the Ontario Health Premium, up to $900 a year depending on taxable income, through the income tax return.
- Waiting periods for new residents: Ontario has no waiting period. BC’s MSP wait is the rest of the month you become a resident plus two more months. In Alberta, people moving from another province are covered from the first day of the third month after they establish residency; people arriving from outside Canada may be covered from the date they establish residency if they apply within 3 months. Other provinces set their own rules, so check with the provincial plan before you move.
- Prescription drugs: public drug programs mainly cover seniors, children and people receiving social assistance. In Ontario, OHIP+ covers people aged 24 and under who have no private plan.
Supplemental Health Insurance: What It Covers
| Coverage Category | What’s Included | How plans usually limit it |
|---|---|---|
| Prescription drugs | Medications not covered by the provincial plan | A co-insurance percentage and a maximum |
| Paramedical / practitioners | Physiotherapy, massage, chiropractic, naturopath, acupuncture, osteopath | A per-visit or annual maximum per practitioner |
| Psychology / mental health | Psychologist, social worker, psychotherapist | An annual maximum |
| Vision | Eye exams, glasses, contact lenses | A maximum per benefit period |
| Dental | Cleanings, fillings, crowns (often a separate plan or add-on) | A co-insurance percentage, an annual maximum and sometimes a waiting period |
| Hospital | Semi-private or private room upgrade | Room differential |
| Medical equipment | Hearing aids, orthotics, braces, crutches, wheelchairs | A maximum per item or period |
| Travel medical | Emergency medical care while travelling | A per-trip or lifetime maximum |
| Ambulance | Ambulance costs the provincial plan doesn’t pay | Varies by plan |
Individual Health Insurance Plans
Individual plans are sold by several insurers, including Manulife (Flexcare) and the regional Blue Cross organizations, which sell personal plans for people who are self-employed, between jobs, retired or topping up group benefits. Two features are worth comparing:
- Underwriting: standard plans may ask medical questions, which can affect the plan you are offered. Guaranteed-acceptance plans skip the questions: Pacific Blue Cross, for example, sells one with no medical questions or exclusions and no waiting period on most benefits.
- Conversion from a group plan: some insurers sell a conversion plan with no medical questions if you apply soon after group coverage ends. Manitoba Blue Cross requires you to apply within 60 days.
Premiums depend on your age, where you live, who is covered and the level of coverage, so compare quotes on the same benefit schedule.
Employer Group Plans vs Individual Plans
| Factor | Employer Group Plan | Individual Plan |
|---|---|---|
| Premiums | The employer pays some or all | You pay |
| Coverage | Set by the employer’s plan | You choose from the insurer’s plan levels |
| Medical questions | Not usually for standard group benefits | May be required, unless you choose a guaranteed-acceptance or conversion plan |
| Portability | Usually ends when you leave the employer | Stays with you if you change jobs |
| Tax treatment | Employer premiums are not a taxable benefit federally (Quebec taxes them provincially) | Premiums qualify for the medical expense tax credit; self-employed people may be able to deduct them from business income |
Tax treatment of premiums
- Employer contributions to a plan that qualifies as a private health services plan aren't a taxable benefit federally.
- Quebec treats the employer's contributions as a taxable benefit for provincial tax (reported on the RL-1).
- Premiums you pay yourself count as eligible medical expenses.
- A self-employed person actively in the business who meets the Income Tax Act's conditions can deduct the premiums from business income instead.
Health Spending Account (HSA)
| Feature | Details |
|---|---|
| What it is | Employer-funded account for medical expenses |
| Tax treatment | Reimbursements are not a taxable benefit to the employee federally; Quebec taxes the employer’s contributions as a provincial benefit |
| What it covers | CRA-eligible medical expenses (dental, vision, prescriptions, paramedical, orthotics, etc.) |
| Annual amount | Set by the employer |
| Carry-forward | Set by the plan’s rules |
| Who offers it | Employers, instead of or alongside group insurance |
Coverage During a Provincial Waiting Period
If you move from another province, BC advises keeping your former provincial plan during the wait. If you arrive from outside Canada, BC advises arranging private health insurance before you arrive, and notes that most private insurance companies do not cover pre-existing conditions, including pregnancy. A workplace plan or a student plan can also cover some costs during the wait, depending on its terms.
When You Don’t Need Supplemental Insurance
| Situation | Why You May Skip It |
|---|---|
| Healthy with no prescriptions | Provincial plan covers doctor visits and hospital |
| Low income | Provincial programs may cover medications and other care |
| 24 or under in Ontario, with no private plan | OHIP+ covers many prescriptions |
| Senior with provincial drug coverage | Provinces extend drug coverage to seniors |
| Rarely use paramedical services | Paying out-of-pocket may be cheaper than premiums |
| CDCP covers your dental | Separate dental insurance may not be needed |
When Supplemental Insurance Matters Most
| Situation | Why |
|---|---|
| Take expensive prescription medications | Public drug programs mainly cover specific groups |
| Regular physiotherapy, massage, or chiropractic | Sessions are paid out of pocket without a plan |
| Need psychology/therapy sessions | Not covered by provincial plans |
| Family with children (dental, vision, orthotics) | Kids need dental, glasses, and regular care |
| Self-employed | No employer plan: you must cover everything yourself |
| Between jobs | Group coverage usually ends when you leave the job; group life coverage ends at the same time (employer group life insurance) |
| Travelling outside Canada | Provincial plans cover little abroad |
Related Resources
Sources
The figures and rules on this page come from these sources, last checked against them between September 24, 2026 and September 30, 2026. How we check facts.
- Canada Revenue Agency: Premiums and contributions to insurance plans
- Canada Revenue Agency: Lines 33099 and 33199 – Eligible medical expenses you can claim on your tax return
- Government of Alberta: Apply for health care coverage if you move to Alberta | Alberta.ca
- Government of British Columbia: Coverage wait period for the Medical Services Plan (MSP)
- Government of Ontario: What OHIP covers
- Government of Ontario: Get fertility treatments
- Government of Ontario: Health premium
- Government of Ontario: Learn about OHIP+
- Justice Laws (Canada): Income Tax Act
- Revenu Québec: Contributions to a group insurance plan including a private health services plan
- www2.mb.bluecross.ca: Blue Choice Conversion plan