Health Insurance and Healthcare in Canada Explained

How Healthcare Works in Canada

Canada’s free and public healthcare system is very generous when it comes to its own citizens and permanent residents. But when it comes to expats, it is not fully free. Non-residents will be expected to cover some costs on their own.

Expats looking into making Canada their permanent home, can apply for a medicare card as soon as they register as residents. The card will take on average 3 months to be issued. That is also the timeframe when your public healthcare plan should kick in. In the meantime, you should supplement with private healthcare. Learn more about getting private health insurance below.

Canadian Healthcare System Explained

So how does healthcare work in Canada? Healthcare in Canada is paid for by taxpayers, and the system works reasonably well. Canada’s healthcare system ranks high on an international scale with the main problem and complaint being wait times. On average, times to see a doctor or specialist is longer than in other countries. Read more about average wait times, and the pros and cons, below.

If you are an expat that plans on applying for permanent residency, the following sub-section gives an overview of what you can expect once you become eligible for the Canadian public healthcare system.

What Does the Public Healthcare Cover?

Most basic healthcare and medical services are covered under the public healthcare system known as Medicare in Canada. While each plan is different from province to province and territory, every province and territory offers emergency medical services even if you do not have a government health card.

Public Healthcare in Alberta 

Albertans are covered under the Alberta Health Care Insurance Plan (AHCIP). It covers medically necessary doctors’ services; some dental and oral surgical health services; psychiatrist visits; medically necessary diagnostic services including laboratory and radiological procedures; oral and maxillofacial surgery services; bariatric surgery; nursing services; hospital stays and meals; medications administered during hospital stays; use of the operating and care room, radiotherapy, physiotherapy, and anesthetic facilities; inter-facility transfer by ambulance; and routine surgical equipment and supplies.

Public Healthcare in British Columbia

Canadians in British Columbia are covered under the Medical Services Plan (MSP). Under this provincial plan, patients are covered for midwives’ and doctors’ services, dental and oral surgery performed in a hospital, medically necessary eye examinations, some orthodontic services, and diagnostic services including X-rays.

Public Healthcare in Manitoba

The provincial health plan in this province is known as Manitoba Health. It covers medically necessary doctors’ services; surgery and anesthesia; X-ray and laboratory services ordered by a doctor and performed in an approved facility; routine eye exams every two years for residents under 19 or over 64; eye exams considered medically necessary; seven chiropractor visits per year; specific dental procedures; eyeglasses for seniors; standard hospital stays and meals; nursing services; medication administered in hospital; operating room, anesthetics, and surgical supplies; occupational therapy, physiotherapy, and speech therapy; dietic counseling; and personal home care.

Public Healthcare in New Brunswick

Canadians are covered under Medicare in this province. Medicare covers doctors’ and hospital services; specific surgical dental procedures if it is medically necessary; standard hospital stays and meals; nursing service; drugs administered during hospital stay; operating, delivery room, and anesthetic facilities; necessary laboratory and X-ray services; therapies including physiotherapy, occupational and speech therapy, audiology, and radiotherapy; routine surgical supplies.

Public Healthcare in Newfoundland and Labrador

Canadians living in Newfoundland and Labrador are covered under the Medical Care Plan (MCP), and it includes visits to the doctor’s office or hospital; surgical, diagnostic, and therapeutic procedures, including anesthesia; pre- and post-operative care; maternity care; radiology interpretive services; and specific surgical-dental procedures which are medically necessary.

Public Healthcare in Northwest Territories

The Northwest Territories Health Care Plan covers medically necessary surgery; obstetrical care; eye exams, treatment, and procedures; dental services if related to jaw injuries or disease; standard hospital stays and meals; nursing services; diagnostic services including X-rays and laboratory work, medication administered in a hospital; radiotherapy treatment, occupational therapy, and physiotherapy; detoxification services; use of operating room, anesthetics, and medical equipment.

Public Healthcare in Nova Scotia

In this province, Canadians are covered under the Medical Services Insurance (MSI). It includes doctors’ services, some dental and optometric services, doctor referred specialist visits, and certain hospital in-patient and out-patient services.

Public Healthcare in Nunavut

Residents in Nunavut are covered under the Nunavut Health Care Plan, and it covers doctors’ services; surgery when necessary; obstetrical care; eye exams, treatments, and procedures; standard Intensive Care Unit; nursing services; laboratory, X-ray, and diagnostic procedure; medicine administered in a hospital; use of operating room, case room, anesthetic facilities, and necessary equipment and supplies; radiotherapy treatment, occupational therapy, and physiotherapy.

Public Healthcare in Ontario

Residents of Ontario are covered under the Ontario Health Insurance Plan (OHIP). It includes appointments with family doctors, visits to walk-in clinics and other healthcare providers, medical tests, and surgeries.

Public Healthcare in Prince Edward Island

In Prince Edward Island, residents are covered for doctor and in-hospital services, home care, palliative care, long-term care, addiction services, mental health services, drug programs through PEI Pharmacare, and primary care services (dental public health services, chronic disease prevention and management, public health nursing, diabetes program, community nutrition, cancer screening programs, speech-language pathology services, etc.).

Public Healthcare in Québec 

Services covered by the Régie de l’assurance maladie du Québec (RAMQ) in Québec include surgeries, anesthetic agents, cortisone, medical exams, ophthalmic drops, diagnostic mammography, urine and blood glucose tests, and vasectomies.

Public Healthcare in Saskatchewan

Residents of Saskatchewan are covered for doctors’ services; physiotherapy and occupational therapy; immunization services; sexually transmitted infections (STI) treatment; HIV testing; treatment for drug and alcohol abuse; mental health services; problem gambling services; certain dental, optical, podiatry services, prescription drugs, and medical supplies and appliances; and screening mammography for women between the ages of 50 and 69.

Public Healthcare in Yukon

In Yukon, residents are covered for doctors’ services; care during pregnancy; specific dental-surgical procedures performed in an approved hospital; standard hospital stay and meals; nursing services; laboratory, radiological, and diagnostic procedures; medicine administered in a hospital; use of operating room, care room, and anesthetic facilities including supplies and equipment; radiotherapy and physiotherapy services.

Canadian Healthcare Costs

Canada spends a lot on its healthcare and is among the top spenders in the Organization for Economic Co-operation and Development (OECD). More than 11% of Canada’s Gross Domestic Product (GDP) is spent on healthcare – that is an average of more than 6,000 CAD (4,515 USD) per Canadian. The cost of public healthcare continues to increase each year, having already grown an incredible 70% for Canadian families over a period of two decades.

Why is Canadian Healthcare So Expensive?

Some find it difficult to use the term “free” when describing Canada’s healthcare system because it is not actually free: taxpayers pay a lot for universal healthcare, as outlined above. In fact, Canada’s healthcare is one of the most expensive systems in the world. This is the price they pay for “free” universal healthcare for all and their system.

Canadian Healthcare Facts

While this section so far has touched on a few of Canada’s healthcare system pros and cons, here is a recap of all of the positives and negatives when it comes to the Canadian system.

Pros

• Universal healthcare– Canada’s free healthcare system strives to provide equal services for all so long as they are a Canadian citizen or permanent resident. Pensioners also receive healthcare in this country.
• Quality healthcare – Canada is consistently ranked as one of the countries with the best healthcare system in the world due to its care and quality.
• Educational programs – These programs are for seniors and they teach the general public how to prevent injuries and inform them about health risks. They are funded by the government. This helps Canadians stay aware and healthy and ultimately reduces healthcare costs.

Cons

• Unequal– As much as the Canadian healthcare system works towards providing equal and quality service for all, there has been evidence that minority groups such as the LQBTQ community and refugees receive less than satisfactory healthcare service, especially those in poverty.
• Wait times– Wait times to see a doctor and specialist in Canada are longer than the average wait times in other developed countries. Read more about average wait times to see a doctor below.
• Limited coverage – There is limited coverage on things like mental and oral health, some forms of therapy, assistive devices, and sex reassignment surgery.
• Expensive– Canada is one of the top-spending OECD countries when it comes to healthcare, spending well-above the OECD average. It is Canadian taxpayers who pay for this with the average person spending more than 6,000 CAD (4,515 USD) a year.
• Accessibility in rural areas – Because Canada is such a large country, funding goes to central cities. Other parts of Canada, however, do not get sufficient resources, forcing people from rural areas to have to travel to get adequate healthcare.

An Overview of Private Health Insurance

If you are wondering how health insurance works in Canada, this section will explain all you need to know.

Do You Need Healthcare in Canada?

Since there is free, universal healthcare for all in the Great White North, do you need health insurance in Canada? Yes, and most Canadians do have it. In fact, 25 million Canadians are insured by supplementary medical insurance. This is because the public healthcare system does not cover everything (e.g., for example, prescription drugs and medication). In 2017 alone, 11.3 billion CAD (approximately 8.5 billion USD) was spent on prescription drugs through private health insurance benefits.

While the drug plan in Canada is affordable, many Canadians have private health insurance (mostly through their employer) that covers a high percentage of medicine (e.g., birth control). Other examples of health insurance coverage include things like disability income, critical illness coverage, mental health counseling, travel insurance, the cost to have your body returned home if you die, prosthetic devices, home care and long-term care, optical care, speech therapy, registered massage therapy, physiotherapy, hearing aids, chiropractic, semi-private or private hospital rooms, and dental care.

If not via their employer, Canadians can also buy private health insurance through private insurance companies. There are more than 80 health insurers in Canada and various types of health insurance plans, so the options for residents are plentiful. You will need to research different companies and find which one meets your desired level of coverage, budget, and benefits.

An important thing to note when it comes to private and public health insurance in Canada is that residents are allowed to purchase supplementary insurance to cover services that are not covered by the public system. However, they cannot buy private insurance for basic medical services that are already offered to Canadians via the public healthcare system.

How Much Is Health Insurance?

The average Canadian family spends 4,000 CAD (3,010 USD) on private health insurance premiums, but prices for plans vary depending on the level of coverage and quality.

Here is the average cost of health insurance in Canada per month:

Benefits of Private Health Insurance

If you are on the fence about getting private health insurance, here are a few factors to consider:

• If you are self-employed, you may be able to deduct private health insurance premiums from your business income taxes.
• With so many different insurance companies in Canada, there are lots of flexible plans to choose from that suit you and your family.
• Because the public healthcare system covers different services depending on which province you are in, private health insurers adjust to this and offer coverage that is tailored to each province and territory.
• Payment is simple and most companies offer flexible payment options.

How to Get Health Insurance in Canada

Until an expat becomes eligible for the public healthcare system, it is strongly recommended that they get travel medical insurance or an annual international medical plan before coming to Canada. A non-resident in Canada can pay upwards to 5,000 CAD (3,761 USD) per day if they require a hospital stay. This amount can double for intensive care. It is best that expats ensure they have some sort of coverage in case of an emergency.

Once an expat is qualified for the public healthcare system and is looking to top up their coverage with additional private insurance, getting in contact with the insurance company of your choice is simple (usually by telephone or online). They will help you with the process, breakdown costs for you, and answer any questions or doubts you may have before signing up.

If you are getting health insurance via your employer, your company’s Human Resources Department should be able to help you with this process, and typically take care of the enrollment process for you. They should also be able to help in answering any questions with regards to your private health insurance benefits and coverage.

Best Health Insurers in Canada

Here is a look at some of the leading companies offering private health insurance:

• Manulife – Examples of insurance plans are Flexcare Health and Dental, and FollowMe.
• Sunlife Financial – Their extended healthcare insurance is available for entire families. Dental healthcare is included.
• Great-West Life – Focuses on two healthcare packages for families or individuals and categories include Core, Core Plus, and Core Elite.
• Ontario Blue Cross – In Ontario, this insurance provider offers many different plans including Basic Blue Choice and Basic Plus.
• GMS Health Insurance – Plans include the Omni Plan, the ExtendaPlan, and a Basic Plan.
• ScotiaLife Health and Dental Insurance – Accepts individuals and families; however not the best for those with preexisting conditions as they tend to be quite strict.
• Desjardins Insurance – Offers affordable and customizable health insurance.
• CAA – Known mostly for auto insurance, this provider does have a healthcare branch via Manulife.
• Green Shield Canada – Two individual plans include Zone (for those who are new to private healthcare) and Link (best for people leaving a private healthcare plan and are retiring, for example, and want private coverage to continue).
• TD Insurance – TD offers critical care and critical accident insurance.
• Ivari – Also focuses on critical care insurance; only applicable for those with a critical illness.

Private Health Insurance and the Canadian Economy

Health insurers play an essential role in the Canadian economy and stabilizing financial markets. Benefit payments to Canadians help keep the cost of government support programs and spending down. They also employ a large number of workers and pay their fair share in tax contributions – in 2017, this was 7.7 billion CAD (approximately 5.8 billion USD)!

How to Find a Doctor or Dentist

At some point during your expat adventure abroad, you might need to figure out how to find a doctor and dentist in Canada. This sub-section includes information on how to find a family doctor, how to find a dentist, how to find specialists, and much more.

How to Find a Family Doctor

Family doctors in Canada are also known as general practitioners (GP). Be warned that there is actually a shortage of doctors in some parts of Canada, so finding a doctor might take some time. The earlier you can get started on your search, the better.

Here are some ways you can find a GP:

• Get a recommendation from friends, colleagues, and other expats.
• Do your search in July. Many family physicians graduate at this time so a whole new crop will be accepting new patients.
• Use useful online tools such as Health Care Connect or Doctor Search (if in Ontario).

Each province will have its own online tool to help you find recommended doctors in your area. If you are wondering how to find specialists in Canada, once you have a family doctor, they will be able to refer you to one.

How to Find a Dentist

Unlike doctors in Canada, finding a dentist is pretty easy. The best way to search is by going online or getting a recommendation from colleagues, friends, or other expats.

Average Wait Time to See a Doctor in Canada

Compared to other developed countries, Canadians wait longer to see a doctor. It is one of the biggest complaints you will hear from Canadian residents. There are even apps and online sites for walk-in clinics that allow you to look up the average wait times of facilities near you.

A 2018 report showed that the average wait time to see a specialist in Canada was 19.8 weeks. Saskatchewan was the province with the shortest wait time (15.4 weeks) while New Brunswick reported waiting 45.1 weeks – the longest in the country. Wait times also depend on the kind of specialist you want to see or procedure you need. For example, for orthopedic surgery, the average wait time is 39 weeks. For medical oncology, it is 3.8 weeks.

When it comes to seeing a doctor, in 2017 it was reported that 43% of Canadians were able to get an appointment with a doctor the day of or the next day. Twenty percent said that they waited at least a week.

If a Doctor is Unavailable

When a doctor is not available, Canadians opt for going to the emergency room where the average wait time is about four hours. Part of the reason for the long wait in emergency rooms across Canada is a lack of physicians. It has also been suggested that patients without a family doctor who opt for emergency room care also slow down the process.

Giving Birth in Canada

Giving birth in Canada for non-residents has its advantages and disadvantages. For the parents, the downside is the cost. For the child, the advantage is Canadian citizenship. Read on to learn more.

Cost of Having a Baby in Canada

While giving birth in Canada for citizenship is a major plus, there is also a downside of having a baby in Canada as a foreigner: cost. If you are giving birth in Canada as a permanent resident or are a citizen, you are completely covered through Canada’s universal healthcare system. Your delivery will be free unless you opt for a private room, which could be a couple of hundred dollars unless it is covered by some sort of supplemental insurance you may have. The average stay for a new mom after delivery is two to three days. If she had a C-section, the stay increases to four days.

If you are giving birth in Canada without health insurance and without permanent resident status, be prepared to pay out of pocket. A regular delivery can be anywhere between 5,000 CAD (3,759 USD) to 8,000 CAD (6,015 USD). If you require a C-section, it can cost between 10,000 (7,521 USD) and 12,000 CAD (9,025 USD).

The following is a breakdown of some other baby-related costs if you plan on giving birth in Canada as a non-resident with no international insurance:

Documents Needed for Giving Birth in Canada

Some things you will want to make sure to bring along with you to the hospital, especially if you are giving birth as a foreigner, are:

• Birth plan
• Medical records
• Healthcare and insurance cards
• Passports and visas
• Social insurance number (if applicable)

Once you have your baby, you will have to register your baby in Canada. Each province and territory has its own process for how and by when to register your child, so it is best to check with your local authorities for information on this. Nurses and staff at the hospital that assisted during your delivery might be able to help you with this as well.

The Benefit of Giving Birth in Canada

Just like in the US, one of the main benefits of giving birth in Canada is that your child will automatically be granted Canadian citizenship – even if you are not Canadian. The child will have the right to live in Canada or travel to Canada whenever without a visa. They will be entitled to receive free education and enjoy all of Canada’s other social benefits.

Giving birth in Canada for citizenship is very popular and known as “birth tourism,” which is not considered illegal. In many other places around the world, birth tourism has been banned.

Keep in mind that having a child who is Canadian will not affect or have any impact on a foreign parent receiving permanent residency or citizenship. Non-resident parents of a Canadian child receive no particular advantage during their immigration process, and parental sponsorship has become increasingly restrictive.

If you have no permanent residency, most likely you will have to return to your home country with your child.