How does health insurance in Canada work?

There are 3 types of healthcare coverage in Canada: 

• Universal healthcare (provincial/territorial): This healthcare is funded by taxpayers. Most basic healthcare and medical services are covered, however there are some differences from province to province and territory.

  For most services you must provide a provincial/territorial health card. 

• Workplace benefits: Workplace benefits are provided by many employers or associations to help employees cover the cost of things provincial/territorial health care plans may not pay for, including certain prescription drugs, dental, hospital, vision, paramedical and ambulance services.

  Because costs are shared with a group, they’re often more affordable than a personal health and dental plan. 

  Many workplace benefit plans allow you to customize your coverage to your needs.

• Personal health and dental insurance: This insurance is most often used by people who are retired, who are self-employed or not eligible for group benefits, or who are losing their previous group benefits coverage.

  It’s similar to group benefits because it helps pay for things provincial/territorial health care plans may not cover. 

  There are plans that suit your needs and budget. Coverage is guaranteed for some plans and you can even qualify with pre-existing medical conditions.

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What does health insurance typically cover?

• Universal health care (provincial/territorial)

  • Family doctor visits, emergency room visits, outpatient clinic appointments

  • Inpatient care/surgery

  • Medicines you receive as part of your inpatient care

  • Diagnostic tests, bloodwork, scans, genetic testing

  • Radiation therapy

  • Medicines infused or injected in an outpatient clinic (e.g., chemotherapy, hydration)

  • Cancer support services offered in hospitals (e.g., dietician, counselling, physiotherapy)

  • Mental health services through a cancer centre

  • Prescription drugs
     

• Workplace benefits

  • Prescription drugs1

  • Dental care

  • Vision care and prescription eyewear

  • Paramedical services such as physiotherapy and chiropractic

  • Ambulance services
     

• Personal health and dental insurance

  • Prescription drugs1

  • Dental care

  • Vision care and prescription eyewear

  • Paramedical services such as physiotherapy, massage and chiropractic

  • Ambulance services

  • Medical supplies

  • Hearing aids

  • In-home nursing and health aide care

  • Emergency travel medical

  • Major dental care

  • Accidental death and dismemberment

  • Hospital accommodation and cash
     

Is personal health insurance necessary in Canada?

This depends on how much you and your family currently spend on various types of healthcare and how concerned you are about the risk of potential future healthcare expenses. If you spend a lot on healthcare that’s not covered by a provincial/territorial plan, or you have health concerns which may lead to expenses down the road, personal health insurance may be worth it.