Guide: Medical Insurance in Canada

Guide: Medical Insurance in Canada

Canada's universal healthcare system is very friendly to Canadian citizens and permanent residents. When you have pu

Canada's universal healthcare system is very friendly to Canadian citizens and permanent residents. When you have public Medical insurance in Canada, you will not pay out of pocket for most of the healthcare services. Why? The universal healthcare system is funded through taxes. However, you must have a healthcare insurance card every time you want medical services.

Every territory and province has its own specialized medical insurance plan. But all of them offer free emergency health services.  Still, there are government restrictions on these services, especially for non-residents.

​​

Insurance Covers Are Protected Under Canada Health Act 

The universal healthcare system is under Canada Health Act. And all healthcare services must align with its policies. While this is meant to protect citizens' interests, these healthcare facilities are run by municipalities, trusts, and voluntary organizations. Here are the terms and conditions of the Canada Health Act;

  • All services offered under public insurance plans should not be profitable–all healthcare facilities are accountable to their respective provinces and territories' regulations.
  • Any person with a Health Card must get equal services––no discrimination or neglect to any person.
  • Healthcare facilities must be reasonably funded to accommodate everyone.

What Does Your Medical Insurance Policy Cover?

The policy covers you, your spouse, and your children (below 19 years). But children aged 19 years and above may be eligible for your coverage if they are disabled or in school.

How long does a resident typically wait to get public Medical Insurance in Canada?

Waiting time depends on your province or territory. In some places, you'll have to wait for up to three months before you're eligible for government health insurance. If you want to be sure how long it should take, contact the ministry of health in your area. 

Is a Health Card a Compulsory Requirement?

To benefit from public Medical insurance in Canada, you must have a valid government health card. These cards help you to access public health care services from your province or territory. The card must be presented to the healthcare provider every time you visit a medical facility.

Provinces and territories offering Medical insurance in Canada. Each province or territory has its own insurance plan designed to cater to that region's population. 

Note carefully; You should consult a public healthcare provider in your province or territory to get the whole list of services offered in your area.  Here are some of the covered  medical services provided in public healthcare facilities: 

✔      Diagnostic services.

✔      Laboratory services.

✔      Nursing services.

✔      Psychiatrist visits.

✔      Surgeries.

✔      Radiotherapy.

✔      Dietary counselling.

✔      Occupational and speech therapy.

✔      Immunization services.

Extra Private Health Insurance Cover That You May Want

Public Medical Insurance in Canada offers coverage for basic health care services. That means that you'll require private insurance to cover what the government does not fully cover. So the universal policy generally doesn't cover the following: 

  • Ambulance services––In many scenarios, you'll have to pay a small token for the ambulance services. For example, you have to pay $45 if you live in Ontario. If the healthcare provider indicates that the trip is not medically necessary, you'll have to incur huge costs, which can go for up to $250.
  • Medications–– A public healthcare provider will give you a prescription after treatment. But you'll need to refill at a community pharmacy. Options for this are; to pay out of pocket, coverage from an employer plan, or enroll in a drug plan available in your province. 
  • Physiotherapy––these services are fully funded for certain people. Children and older adults of 65 years and above. So for these services, you need to find an alternative; cash or private insurance cover. 
  • Vision care –– In most scenarios, routine eye examinations and eyeglasses are not covered by provincial health insurance plans and patients must pay for services out of pocket. Depending on your province or territory, there may be programs that cover these services for specific groups e.g. diabetics, seniors, or children . 
  • Dental care––  Apart from emergency treatment, other services are not covered. The only exception is for some people that come from low-income families. So the option for these services is to pay for yourself or take a dental policy from your private insurance.

The Cost of Healthcare Insurance in Canada

An average family in Canada spends roughly $4,000 on a private health insurance plan. But these expenses vary with the quality of services and the level of coverage. If you work in an organization, you might get extra coverage for the uncovered healthcare services.

Medical Insurance Coverage for Refugee Claimants and Protected Persons 

The Interim Federal Health Program (IFHPH), in the most reasonable occurrences, provide temporary insurance coverage for; 

  • Refugee claimants.
  • Protected persons.

Suppose you're in this category; IFHPH will pay for you until you're eligible for this coverage in your respective province or territory. That is until you get Canadian Citizenship so that you can apply for the coverage. In other scenarios, if you don't have to stay in the country for long, the organization may pay for you until you can fund a private healthcare policy.

Travel Medical Care Insurance

If you intend to travel outside the country, you should purchase a healthcare plan to cover you while you're in a foreign country. Consult your travel company to get more information. 

What About Traveling Within the Country?

Canadian provinces and territories have agreements that help you access healthcare services when travelling to another province or territory. In Quebec, this agreement applies to hospital fees only, hence you should check these limitations before travelling. 

What You Should Know About Canadian Healthcare Insurance?

Public Medical Insurance in Canada has a positive and negative impact on the people. Here are the pros and cons of Canadian public insurance.

Pros

●        Universal healthcare––the universal medical coverage provides citizens and permanent residents with quality services.

●        Educational programs ––through healthcare programs funded by the Canadian government, people are educated on health protocols. The move helps Canadians avoid health risks which help to reduce healthcare costs.

●        Quality healthcare – Canada is a country with one of the highest quality healthcare services.

Cons

●        Extended waiting times––due to the free aspect of healthcare services, many patients go in large numbers, which sometimes increases the waiting time in the hospitals.

●         Limited coverage – although the government covers many healthcare services, the ones that are not covered are expensive to many.  Due to that, citizens have to acquire policies from private insurance to compensate for services that are not covered.

●        Expensive– the Canadian pays indirectly through taxes and spends a lot of money. An average Canadian taxpayer spends $6,000.

Conclusion 

Canada's universal healthcare system offers universal health care services. These services are inclusive for Canadian citizens and permanent residents. However, the government doesn't fund all services. Some of the healthcare services that are not fully covered include prescription and dental services. You have to pay out of pocket or acquire private coverage in this scenario.

 If you're a refugee, IFHPH may pay for you until you're eligible for government coverage or are able to purchase one. As a low-income citizen, you may get additional help from the government to cover the medical services.

Provinces or territories have a mutual agreement on covering patients visiting another province. But, you must check the limitations to avoid inconveniences. 

This article offers general information only and is not intended as medical or other professional advice. A healthcare provider should be consulted regarding your specific situation. While the information presented is believed to be factual and current, its accuracy is not guaranteed, and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the authors as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products, or services is expressly given or implied by Mednow or its affiliates.

Get Started

We recommend

Can a pharmacist prescribe? | Ask a Pharmacist

Got a question for Mednow pharmacists? Ask in the comments and we'll get you an answer!

What is Lifestyle Medicine?

Lifestyle medicine addresses the six pillars of health that, when working together, support total health.

Why Mednow doesn’t sell frozen pizza

Nothing at all against pizza. We like pizza. It’s just that we’re a pharmacy so we focus on pharmacy things.