Health insurance in
State Health Insurance
How does the state health insurance system work?
The Canadian state system, commonly referred to overall as Medicare, is split across the different provinces and territories. Your health insurance will therefore be geographically dictated, both in terms of cost and in terms of the treatments covered. Your employer is likely to sign you up for a particular group policy, which is compulsory, so your choice of health insurance will probably not be very extensive.
For example, if you are going to be living and working in Alberta, you will be registered with the Alberta Health Care Insurance Plan (AHCIP). If resident in Manitoba, you will be eligible for Manitoba Health, Seniors and Active Living.
Doctors themselves are self-employed and invoice their provincial authority to cover their costs. If you are registered with the local insurance scheme, your healthcare will be free at the point of delivery for any treatments covered under your plan, but you may have to pay out-of-pocket costs for other medical care.
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Who is eligible for state healthcare?
Everyone who has residency, who is registered with their provincial provider, and who is making health insurance contributions, will be eligible for state healthcare in Canada. The requirement for this is that you are in the country for up to 183 days per year. Some provinces require that you are in Canada for an initial 153 consecutive days out of the 183 in order to be eligible for state insurance.
How do you apply to join the state health insurance system?
All provinces have slightly different registration requirements, so it is important that you check before arrival to find out what you will need to take with you in order to register. You will usually need your passport, residency and immigration documents, work permit, and a completed application form relevant to your region.
There can be a three-month waiting period in some regions before you are issued with your health insurance card, so you may need private cover during this period. Some provinces will sign you up immediately.
In order to register with a doctor, you can consult the local phone directory or search online, or contact a community health centre (a Centre local de services communautaires in Quebec) in your area. There are walk-in clinics available; an online system called Medimap can assist you in locating these.
If you have had to undergo a medical examination before arriving in Canada, you may have been told that you need to report to the “public health authorities,” a process known as “medical surveillance.”
If this was the case, you must contact the public health authority in the province or territory where you live within 30 days of your arrival. If you do not report to the public health authority, you may not be granted residency until the issue has been resolved. After you have your assessment, however, no future changes to your health will affect your immigration status.
Note that you may have no choice other than signing up with a provider chosen by your employer, with no opt-out clause, and this may not prove to be the cheapest option.
What is covered by the state health insurance system?
Although this may differ from region to region, most public health insurance plans cover:
- GP visits
- some dental care
- some prescription costs
Medical coverage in any Canadian province will give you access to basic health services in any other province across Canada, but note that costs may vary: you may have to pay for patient transport, for example, and some medications and emergency dental treatments may not be covered between provinces. If you are travelling within Canada, therefore, it is advisable to check what is covered before you go.
If you are pregnant, you will be covered by most of the public schemes as long as you have registered and have been making contributions into the system. British Columbia, Ontario and Quebec will cover you for midwife care; other provinces may not. Quebec also offers publically funded fertility treatment.
The Canadian medical system will offer ante-natal and post-natal care and advice in some provinces, as well as assisting you through labour itself. If you are working, you may be able to take paid leave from your employer under Employment Insurance. As before, however, check to see whether your regional coverage will cover pregnancy and maternity care.
With regard to prescriptions, all necessary medication given by Canadian hospitals is free of charge. Canada has a prescribed drugs list, so you can check to see whether your prescription medication is legal in the country.
However, medication prescribed by your GP may not be covered, or only be partly covered, under individual state schemes. Overall, more than 60% of prescriptions in Canada are paid for out-of-pocket: a high percentage compared to a lot of other countries. Many Canadian citizens believe that pharmaceuticals should be covered by the state and this is a major political issue. Although few Canadians are uninsured, in practice a higher number are estimated to be underinsured and cannot in fact get the medication that they need.
You may, however, be able to get insurance coverage that pays part of the cost of prescription medicines. In order to find out whether you are entitled to this, you can apply to:
- provincial and territorial governments
- publically funded drug programs
- employers who have private insurance plans for their employees
Senior citizens, children and patients on social assistance may be able to apply for extended health services through a PharmaCare program. Again, coverage for prescriptions varies from province to province and you may have coverage from your employer that applies to some medication.
Long-term care is not covered and neither is home care. If you think you may require these services, you will need to take out a private policy.
Some provincial policies also have provision for mental health and addiction cover, including:
You can also get help if you or someone you know has:
- a psychiatric disorder
- an addiction
- any other mental health problem
Are retirees covered by state medical insurance?
You will be covered by provincial medical insurance as long as you have residency. Some retirees split their time between Canada and their home nation: this will not prevent you from applying for residency, but you must comply with the residency regulations if you are to be eligible for state health cover.
Are students covered by state medical insurance?
International students will be covered for healthcare in some provinces but not others, so it is advisable to check with your university and college to find out whether you will be covered under the state scheme, or whether you will have to take out private health insurance. You can purchase a number of policies specifically designed for international students.
Will your family be covered by your insurance?
Your dependents can be covered by your insurance but it will depend on the policy in question. There are opt-out exceptions for spousal and common-law coverage. If your spouse pays less from their salary for their health insurance, with access to a wider range of services and lower deductibles, you can opt out of your own company’s plan and sign up with your spouse’s employer’s plan instead. It is worth doing the maths with regard to this issue, as the costs of plans can vary considerably and it could save you money in the long run.
Is dental treatment covered by state health insurance?
Some dental treatment is covered under some provincial insurance policies, usually when deemed medically necessary, but you can get supplementary insurance to cover your dental care.
What are the contribution rates for state health insurance?
It has been estimated that an “average” Canadian family, consisting of two adults and two children, earning about $127,000, will pay about $12,000 a year for public health care. This is high when considered in global terms, but other evaluations suggest that costs are lower and estimate that an individual will, on average, pay around $5,789 per annum in public health costs. However, the consensus is that earners in a higher income bracket will in effect be subsidizing healthcare for those who are not earning as much.
Check with your employer, if they have signed you up to a plan, in order to see what exactly you are paying for and whether there are any deductibles in the system that you do not need. Dental policies, for instance, can almost double your costs.
Some expats report that they have ended up paying substantial amounts from their salaries for health insurance while their employers’ contributions have remained low; for example, over $300 per month with an employer’s contribution of $20. In this case, it may be cheaper to take out private health cover.
Private Health Insurance
Why buy private health insurance?
Canadians are proud of their national healthcare system, but the main complaint is that they often experience long waiting times. There are also treatments which the provincial system does not cover. For a wider choice of treatment and speed of access, therefore, you may wish to consider taking out private cover.
Private health insurance will also top up your state coverage and fill in any gaps while you wait for your health insurance card to arrive and want to avoid expensive out-of-pocket costs: non-resident visitors can pay up to $5,000 per day in a hospital and double that amount for a stay in an ICU. Around ⅔ of Canadians take out private cover.
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What is covered by private health insurance?
Private insurance will speed up your access to treatment and give you a wider choice, and it will also offer provision for services not available under provincial plans, such as:
- advanced dental treatment
- cosmetic surgery
- gender reassignment surgery
- prescription drugs
- medical supplies
- hearing aids
- semi-private or private rooms in hospital
- chiropractic and registered massage therapy
- disability income if you develop a serious health condition and can no longer work
- critical illness coverage for illnesses such as cancer
- mental health support services and counselling
- speech therapy services
Check what your specific provincial policy offers you and whether there are any treatment gaps in your region that you may encounter, which private cover may be able to fill.
How much does private health insurance cost?
Private health insurance in Canada varies depending on your individual circumstances and the type of policy that you require. Average quoted costs from some local providers range between $157 per month for a family, $47 for a single male, and $80 for a single female. Costs from larger providers may cost more, but may also give you more extensive coverage.
Which companies offer private health insurance?
The big international providers cover Canada such as:
- Blue Cross
- Cigna Global
- Sun Life Assurance
There are also a large number of local providers, some of which provide tailored coverage if, for example, you are a US citizen spending time in Canada who would like coverage for both nations. Blue Cross, for example, is organized across Canada’s provinces.
Glossary of health insurance terms
Centre local de services communautaires - Community Health Centre (Quebec)