Canada operates Medicare, a universal, publicly funded healthcare system administered separately by each of the 13 provinces and territories (e.g. OHIP in Ontario, MSP in British Columbia), covering medically necessary hospital and physician services for eligible residents at no direct cost. Here is what that actually means for an American or Briton living in Canada: what the public system gives you, what it does not, and where private cover fits.
Can you use the public system?
- Working for a local employer: Yes, once you complete residence registration
- Self-employed: Yes, once you complete residence registration
- Retired or not working: Only in limited cases
A US/UK expat becomes eligible for provincial health coverage only once they hold permanent residence or a qualifying long-term immigration status (e.g. in Ontario, a work permit for full-time work with an Ontario employer for at least 6 months); they must then actively register with the provincial plan (OHIP, MSP, etc.), providing proof of status and residency. There is no payroll contribution (Medicare is funded from general taxation; BC abolished MSP premiums in 2020), and there is no US or UK reciprocal healthcare agreement, so American and British nationals get no automatic entitlement and must qualify through immigration status like any other foreign national.
Waiting period: Varies significantly by province. Ontario abolished its former 3-month OHIP waiting period in 2026, so eligible applicants are covered from the date their application is approved. British Columbia still applies a wait equal to the remainder of the month residency is established plus two further full months (in practice, up to about 3 months) before MSP coverage begins. Confirm current rules with the specific province of residence.
If you are retiring here
A non-working retiree without permanent residence (for example a parent/grandparent on a Super Visa, or any long-stay visitor) is excluded entirely from provincial healthcare and must hold continuous private medical insurance (Super Visa applicants must show at least CAD 100,000 of coverage from an approved insurer for a minimum of one year). There is no employment-based route into Medicare for retirees and no US or UK reciprocal deal, so retirees only gain access once they obtain PR status, after which the province’s standard waiting period still applies.
What public cover will not give you
- Dental care is not covered by any provincial plan
- Outpatient prescription drugs are generally not covered outside hospital (separate provincial drug plans or private/employer coverage needed; rules vary by province)
- Vision care (eye exams, glasses) is largely excluded for working-age adults
- Private or semi-private hospital rooms are not covered
- Long wait times for non-urgent specialist consultations, diagnostics (MRI/CT) and elective surgery
- No coverage at all during the provincial waiting period before enrolment takes effect
- Ambulance services often incur a separate fee
So do you need private health insurance?
Not legally required for permanent residents once enrolled in a provincial plan, but de facto necessary to cover the waiting period and non-insured services (dental, vision, most drugs); for certain visa categories (e.g. the parent/grandparent Super Visa) private medical insurance of at least CAD 100,000 for a minimum of one year is a mandatory visa condition, since those visa holders are explicitly excluded from provincial healthcare.
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General information, not insurance, immigration or medical advice. Rules change and individual situations differ; check the official position before you commit. Researched from official sources, July 2026.