Canada’s public health system covers the basics, but there are significant gaps. Here’s what’s covered, what isn’t, and how to fill those gaps with supplemental insurance.
What Provincial Health Insurance Covers
| Service | Covered? | Notes |
|---|---|---|
| Doctor visits (GP and specialist) | ✅ Yes | Referral may be needed for specialist |
| Hospital stays | ✅ Yes | Ward room only (shared room) |
| 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 ordered by a doctor |
| Maternity and newborn care | ✅ Yes | Hospital delivery, midwife care |
| Mental health (psychiatrist) | ✅ Yes | Psychiatrists are medical doctors |
| Immunizations (routine) | ✅ Yes | Varies by province — most childhood vaccines covered |
| Cancer treatment (chemo, radiation) | ✅ Yes | Hospital-administered |
| Ambulance services | ⚠️ Partial | $45–$850 depending on province; some charge a co-pay |
What Provincial Health Insurance Does NOT Cover
| Service | Covered? | Typical Cost (Out of Pocket) |
|---|---|---|
| Prescription drugs (outside hospital) | ❌ | $50–$500+/month depending on medication |
| Dental care | ❌ | $200–$600/year for basic; $1,000+ for major work |
| Eye exams (adults 20–64 in most provinces) | ❌ | $75–$150/exam |
| Glasses and contact lenses | ❌ | $200–$800/pair |
| Physiotherapy | ❌ (mostly) | $70–$120/session |
| Massage therapy | ❌ | $80–$130/session |
| Chiropractic | ❌ (mostly) | $50–$100/session |
| Psychology / therapy | ❌ | $150–$250/session |
| Private / semi-private hospital room | ❌ | $200–$400/night |
| Hearing aids | ❌ (mostly) | $1,000–$6,000/pair |
| Orthotics and medical devices | ❌ (mostly) | $300–$600/pair |
| Cosmetic surgery | ❌ | Varies widely |
| Fertility treatments (IVF) | ⚠️ Some provinces | $10,000–$15,000/cycle (Ontario covers 1 cycle) |
| Travel medical insurance | ❌ | Must purchase separately |
Provincial Health Plans at a Glance
| Province | Plan Name | Monthly Premium | Waiting Period (New Residents) | Drug Coverage |
|---|---|---|---|---|
| Ontario | OHIP | $0 | 3 months | OHIP+ (under 25), Trillium (low-income) |
| BC | MSP | $0 | None (eliminated 2020) | Fair PharmaCare (income-based) |
| Alberta | AHCIP | $0 | 3 months | Seniors, social assistance |
| Quebec | RAMQ | $0–$731/year (via tax) | 3 months | RAMQ mandatory drug plan |
| Manitoba | Manitoba Health | $0 | 3 months | Pharmacare (income-based) |
| Saskatchewan | Saskatchewan Health | $0 | 3 months | Drug Plan (seniors, low-income) |
| New Brunswick | Medicare | $0 | 3 months | Drug Plan (seniors, low-income) |
| Nova Scotia | MSI | $0 | 3 months | Pharmacare (income-based) |
| PEI | Health PEI | $0 | 3 months | Drug Programs (various) |
| Newfoundland | MCP | $0 | 3 months | NLPDP (income-based) |
Supplemental Health Insurance: What It Covers
| Coverage Category | What’s Included | Typical Annual Maximum |
|---|---|---|
| Prescription drugs | Medications not covered by provincial plan, including brand-name and generic | $5,000–$25,000 (or 80% co-pay) |
| Paramedical / practitioners | Physiotherapy, massage, chiropractic, naturopath, acupuncture, osteopath | $500–$1,000 per practitioner |
| Psychology / mental health | Psychologist, social worker, psychotherapist | $500–$2,000/year |
| Vision | Eye exams, glasses, contact lenses, laser surgery (some plans) | $200–$500 every 2 years |
| Dental | Cleanings, fillings, crowns, orthodontics (usually separate plan) | $750–$2,500/year |
| Hospital | Semi-private or private room upgrade | Unlimited (room differential) |
| Medical equipment | Hearing aids, orthotics, braces, crutches, wheelchairs | $500–$3,000 per item |
| Travel medical | Emergency medical while travelling outside province/country | $1M–$5M per trip |
| Ambulance | Ground and air ambulance co-pays | Full coverage of provincial gap |
Best Individual Health Insurance Plans in Canada
| Provider | Monthly Cost (Single, Age 30) | Prescription Coverage | Paramedical | Vision | Best For |
|---|---|---|---|---|---|
| Manulife Flexcare | $80–$200 | ✅ 80% up to $10K | ✅ $500–$1,000/practitioner | ✅ $200/2yr | Customizable tiers |
| Sun Life | $90–$220 | ✅ 80% up to $15K | ✅ $500–$1,000 | ✅ $200/2yr | Comprehensive coverage |
| Canada Life (GWL) | $85–$210 | ✅ 80% up to $10K | ✅ $500–$750 | ✅ $200/2yr | Broad provider network |
| Blue Cross | $70–$180 | ✅ 70–80% | ✅ $300–$750 | ✅ $150–$200/2yr | Provincial plans, budget-friendly |
| Green Shield | $80–$190 | ✅ 80% up to $10K | ✅ $500–$1,000 | ✅ $200/2yr | Digital experience |
| Desjardins | $75–$180 | ✅ 80% | ✅ $500–$750 | ✅ $200/2yr | Quebec residents |
| SSQ Insurance | $65–$150 | ✅ 70–80% | ✅ $300–$500 | ✅ $150/2yr | Budget option |
Costs increase significantly with age. A 50-year-old may pay 2–3x these rates.
Employer Group Plans vs Individual Plans
| Factor | Employer Group Plan | Individual Plan |
|---|---|---|
| Monthly cost to you | $0–$50 (employer subsidizes) | $80–$300 |
| Prescription coverage | 80–100%, high maximums | 70–80%, lower maximums |
| Paramedical limits | $500–$2,000/practitioner | $300–$1,000/practitioner |
| Medical underwriting | None (guaranteed issue) | May be required (health questions) |
| Pre-existing conditions | Covered from day one | May be excluded for 1–2 years |
| Portability | Lose it when you leave employer | You own it — keep it forever |
| Tax treatment | Employer premiums are a taxable benefit (except in Quebec) | Not tax-deductible (except self-employed) |
| Conversion option | Can convert to individual plan when leaving (within 31–60 days) | N/A |
Health Spending Account (HSA)
| Feature | Details |
|---|---|
| What it is | Employer-funded account for medical expenses |
| Tax treatment | Tax-free to employee, tax-deductible for employer |
| What it covers | Any CRA-eligible medical expense (dental, vision, prescriptions, paramedical, orthotics, etc.) |
| Annual amount | Set by employer (typically $500–$5,000/year) |
| Carry-forward | Some plans allow unused balance to carry forward 1 year |
| Who offers it | Small businesses instead of or alongside group insurance |
| Best for | Flexible coverage for employees with varying health needs |
Coverage During Provincial Waiting Period
| Option | Cost | Coverage | Duration |
|---|---|---|---|
| Private interim health plan (Blue Cross, Manulife) | $100–$300/month | Emergency medical, prescriptions, hospital | 1–3 months |
| Travel medical insurance | $3–$10/day | Emergency only (no prescriptions or paramedical) | 1–3 months |
| University/college student plan | Included in tuition | Extended health, dental, vision | Academic year |
| Employer group plan | $0 (starts on hire date) | Full extended health | May start before provincial coverage |
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 drug programs cover medications |
| Under 25 in Ontario | OHIP+ covers most prescriptions |
| Senior with provincial drug coverage | Most provinces have senior drug programs |
| Rarely use paramedical services | Paying out-of-pocket may be cheaper than premiums |
| CDCP covers your dental | No need for separate dental insurance |
When You Definitely Need Supplemental Insurance
| Situation | Why |
|---|---|
| Take expensive prescription medications | Provincial plans cover very few drugs for working-age adults |
| Regular physiotherapy, massage, or chiropractic | $70–$130/session adds up fast |
| Need psychology/therapy sessions | $150–$250/session, often needed weekly |
| 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 plan ends on last day of employment (or end of month) |
| Travelling outside Canada | Provincial plans cover little or nothing abroad |