Private Insurance: A Canadian's Perspective On Coverage

Canada has a decentralised, universal, publicly funded health system called Canadian Medicare. Canadian citizens and permanent residents have access to a single-payer, universal healthcare system. The federal government sets the guidelines and standards for the health insurance system, but the actual administration of the national insurance program is the responsibility of each province and territory.

Canadian Medicare provides coverage for approximately 70% of Canadians' healthcare needs, and the remaining 30% is paid for through the private sector. Private health insurance plans are more expensive but provide adequate and convenient service to clients. About 60% of Canadians are covered by private health insurance, most often as a benefit of employment.

Private health insurance in Canada: what does it cover?

Canada's healthcare system is unique. It is a decentralised, universal, publicly funded system called Canadian Medicare. Each of the 13 provinces and territories has its own health care plan, which is paid for through taxes. These plans cover basic medical care, but they usually do not pay for eye care or glasses, dental care, prescription medicines, or ambulance services.

Private health insurance often pays for things that government plans don't cover. The most common types of private insurance plans are extended health plans, which cover costs for prescription medications and prescription eyeglasses. About 60% of Canadians are covered by private health insurance, most often as a benefit of employment.

It is a good idea to buy private insurance while waiting for government coverage to begin. It is also highly recommended that Canadians purchase private health insurance before travelling outside their home province or territory to ensure coverage for unexpected medical expenses.

A number of services provided by hospitals and physicians are not considered medically necessary and are not insured by provincial and territorial health insurance plans. These include preferred hospital accommodation unless prescribed by a physician, private-duty nursing services, and the provision of telephones and televisions. Uninsured physician services for which patients may be charged include the provision of medical certificates and testimony in court.

Routine dental care is not covered under the government healthcare system in Canada. However, in 2022, the federal government announced the creation of a new Canada Dental Benefit to reimburse low- to middle-income parents for dental fees per child. In 2023, the government established the Canadian Dental Care Plan, which began a staggered enrolment rollout to pay for covered dental services for eligible residents.

How much does private health insurance cost in Canada?

The cost of private health insurance in Canada depends on several factors, including age, medical history, and the level of coverage required. While the Canadian government provides universal healthcare, it does not cover certain services, such as dental care, prescription drugs, and eyeglasses. As a result, many Canadians opt for supplementary private health insurance, which can be provided by their employer or purchased as an individual plan.

The cost of private health insurance varies based on the chosen provider and the desired level of coverage. For example, a basic plan for a 25-year-old single individual in Ontario seeking dental care and massage therapy coverage might cost around $350 per year. In contrast, a family of four in Manitoba seeking vision and prescription drug coverage might pay around $500 per year.

It is important to note that private health insurance premiums increase with age and can be influenced by pre-existing medical conditions. Additionally, the type of plan, deductible, and co-payments also impact the overall cost of private health insurance in Canada.

Pros and cons of private health insurance in Canada

Pros

• Comprehensive coverage: Private health insurance in Canada offers extensive medical services, elective treatments, and specialized care. This is particularly beneficial for individuals with specific health conditions or those in need of personalized medical attention.
• Faster access to care: Private health insurance can offer fast access to medical care, with reduced wait times for appointments and procedures. This allows individuals to receive prompt treatment, minimizing potential risks associated with delayed medical attention.
• Customized health insurance plans: Private health insurance allows individuals to customize their coverage to align with their unique requirements, providing a more flexible and tailored healthcare solution.

Cons

• Cost: The main limitation of private health insurance is the cost. While affordable private insurance options exist, private plans tend to be more expensive than public options, making them less affordable for certain individuals, especially those with lower incomes.
• Coverage limitations: Some private health insurance plans may impose limitations on pre-existing conditions or particular treatments. These coverage limitations can present difficulties for individuals with chronic health issues or those in need of specific medical procedures.
• Potential for profit-driven decisions: Private insurance companies prioritize profit, potentially resulting in decisions driven by financial interests rather than solely prioritizing patients' welfare.

Private health insurance for expats in Canada

Expats moving to Canada will find that the country has one of the best healthcare systems globally. Canada's healthcare is publicly funded and provided by private companies, and is similar to the UK's NHS. Canada's universal healthcare system is called Canadian Medicare, and it is available to all Canadian residents.

Private Health Insurance for Expats

Expats living in Canada will need health insurance. They can either:

• Enrol in the state-funded Canadian Medicare system
• Purchase private health insurance

Many expats prefer to purchase private health insurance to avoid potential obstacles with public health systems, such as language barriers and long waiting times.

Private Health Insurance Providers in Canada

• Cigna Global
• IMG Global Medical
• GeoBlue Xplorer
• International Citizens Insurance
• Insubuy

Cost of Private Health Insurance in Canada

The cost of private health insurance in Canada varies depending on several factors, such as the type of insurance, level of medical coverage, and duration of the policy. On average, private healthcare premiums for a household in Canada cost around C$4,000 per year, or C$333 per month.

Benefits of Private Health Insurance in Canada

Private health insurance in Canada offers several benefits, including:

• Shorter waiting times
• Access to a wider range of hospitals and doctors
• Coverage for services not included in Canadian Medicare, such as prescription medicine, ambulance services, dental care, eye care, and physiotherapy
• Option to be treated in another country

Private health insurance for students in Canada

Canada is known for its government-funded national healthcare system, which is meant to provide healthcare that is universally available to permanent residents. However, whether or not public health services are offered to international students is at the discretion of each province or territory.

Provinces and Territories that Offer Health Coverage to International Students:

• Newfoundland and Labrador
• Northwest Territories

Provinces and Territories that Do Not Offer Health Coverage to International Students:

• Manitoba
• Nova Scotia
• Ontario
• Quebec
• Saskatchewan
• Yukon

Private Health Insurance for International Students

In provinces or territories that do not offer health coverage to international students, students are generally required to purchase private health insurance. Educational institutions in these provinces or territories may offer health insurance packages, and some schools may require students to register for their health insurance packages unless they can prove they have acquired private health insurance from another source.

Services Covered by Private Health Insurance

Private health insurance typically covers services that are not covered or only partially covered by public health insurance, such as:

• Prescription drugs
• Dental services
• Eye care
• Medical devices
• Gender care
• Psychotherapy
• Physical therapy
• Private hospital rooms
• Ambulance services
• Prescription glasses

Choosing a Private Health Insurance Plan

When choosing a private health insurance plan, it is important to weigh your options and consider both school and country visa requirements. It is also advisable to purchase private health insurance before your trip to ensure that you are covered in all cases.

Frequently asked questions