Health insurance in Canada : Everything you need to know

Health insurance in Canada : Everything you need to know

Canada claims to have one of the most comprehensive health care systems in the world. Provides free access to emergency care and routine doctor’s visits to all citizens and permanent residents. However, the country’s universal healthcare system does not cover everything. There are still some services that are not free and for which Canadians must pay out-of-pocket, leading many to seek private or individual health insurance.

Health insurance in Canada
Health insurance in Canada

Insurance Business discusses public health care and health insurance in Canada in depth in this article. If you’re wondering or considering whether getting private health coverage is necessary or whether Medicare already provides enough protection, you’ve come to the right place. Here, in this article we will discuss how both types of coverage work, what they include and what is excluded from the policy. We also encourage insurance professionals to share this excerpt with their clients to help them find useful information about their health care. Read further in this article and share your knowledge about health insurance in Canada.

Learn About Health Care in Canada | Guide to Healthcare in Canada

How does Canada’s healthcare system work?

The country runs a publicly funded health care system under the Canada Health Act (CHA). The CHA (Canada Health Act) also sets out “five pillars” that all provincial and territorial health insurance in Canada must follow to receive the full federal cash contribution. Which is shown in this image below.

Health insurance in Canada
Health insurance in Canada

Healthcare in the country is primarily run and administered by all 13 provinces and territories, each of which has its own health insurance scheme. Each province and territory also receives funding from the federal government on a per capita basis.

According to, although benefits and how they are delivered vary, the basics remain the same – “universal coverage for medically necessary health care services provided on the basis of need rather than ability to pay.” Is performed.”

Health insurance in Canada
Health insurance in Canada

What does Canada’s national health insurance program cover?

Universal health insurance in Canada provides coverage for many of the essential healthcare and medical treatments and services. These include:

  • Diagnostics and examinations
  • Regular doctor and hospital visits
  • Standard accommodations in the hospital, including care, food, and prescriptions
  • Surgeries and treatments
  • Medically necessary dental surgeries
  • Eye examinations for those aged under 18 and over 65

What the national health insurance program covers varies between provinces and territories. You can check out the links in the table below to find out what healthcare covers where you live. The government website adds that provinces and territories are given “considerable leeway” on how to fund health insurance plans. These can be done through provincial and territorial revenues, payroll and sales taxes, and a combination of these.

Who is eligible for universal health insurance in Canada?

To be eligible to access Canada’s national health insurance program, one must be a resident of any province or territory. But who is considered a resident? According to the CHA, a resident is a “person lawfully entitled to be or to remain in Canada, who makes his home and is ordinarily present in the province.” The Act also specifically excludes tourists and visitors. What is excluded from National Health Insurance in Canada? Each province and territory has its own rules when it comes to what is covered by health insurance, so exclusions may vary. For the following services and treatments, depending on where you live, you may need to take out private health insurance to be covered.

  • Ambulance and EMT services
  • Dental care
  • Massage therapy
  • Medical equipment, such as crutches, leg braces, and wheelchairs
  • Outpatient prescription medications
  • Physiotherapy
  • Private hospital room stays
  • Prescription eyeglasses
  • Psychological services

How does private health insurance work in Canada?

With a long list of things typically excluded from Canadian health care, it’s not surprising that, when not required, nearly 70% of Canadians have health care insurance, according to the latest data from the Canadian Life and Health Insurance Association (CLHIA). Supplementary private health insurance purchased on the basis. According to CLHIA 90% of all private health insurance policies were obtained through group plans. That’s why it’s recommended that you check your employer’s benefit plans before purchasing additional health coverage to make sure you’re not paying for something you’re already covered for i.e. If you have taken any such insurance then you do not need to pay again.

Health insurance in Canada
Health insurance in Canada

How much does health insurance in Canada cost?

Private health insurance in Canada costs about $756 annually or about $63 per month, according to the latest figures gathered by the Canadian Institute for Health Information (CIHI). The institute’s research also revealed that the average Canadian pays out about $902 in out-of-pocket expenses each year, equivalent to around $75 monthly.  CIHI’s data, however, were taken before the coronavirus pandemic shook not just the country’s healthcare system but also that of the world, which means actual values may be significantly higher at present. The figures above are likewise mere estimates. Still, the best way to get an accurate quote is to contact an experienced health insurance professional.

The country is home to about 130 private health insurance providers, which serve more than 27 million Canadians, according to CLHIA’s most recent data. Here are some other notable numbers from CLHIA’s latest industry factbook, indicating a thriving private health insurance market.

Health insurance companies paid out around $30.4 billion in claims-

  • $13.4 billion were for prescription drugs
  • $9.5 billion were for dental coverage
  • $1.6 billion were for private hospital accommodations
  • $1.3 billion were for optical care
  • $1.1 billion were for massage therapy

These were the top five reasons for filing claims based on the research.

Is it worth getting health insurance in Canada?

Getting health care insurance for you and your family depends on your needs. While Canada’s universal health program provides coverage for many essential medical treatments and services, health care often extends beyond our provincial or territorial health plans. As CLHIA’s factbook reveals, prescription drugs and dental care are the two biggest reasons for filing claims as these are also the two largest healthcare expenses Canadians incur. So, if you’re taking regular medication or making frequent visits to the dentist, taking out private health insurance can prove beneficial.

Health insurance in Canada
Health insurance in Canada


Do Canadians get free health insurance?

For Canadian citizens, permanent residents, and other eligible persons who have enrolled in their province or territory’s version of Medicare, the answer is yes, healthcare is free…to a degree. Patients do not have to pay any fees to receive required medical care in a hospital or at a physician’s office.

Who is eligible for health insurance in Canada?

Who’s covered under the government health insurance plan in Canada? Only Canadian citizens and permanent residents are covered under the government health insurance plan. You must have a provincial health insurance card from the province or territory where you live.

Is it better to live in Canada or the US?

Additionally, Canada has better air quality, and its citizens tend to live longer lives. Canada has a high percentage of passport holders, offering convenient international travel. On the other hand, the USA may offer a more fast-paced lifestyle.

Is medicine free in Canada?

If you’re in a Canadian hospital (and you’re eligible for government healthcare) prescription drugs are provided at no cost to you, under the Canada Health Act. If you’re not in hospital, however, it’s up to your province or territory to establish prescription drug coverage.

Who pays for health insurance in Canada?

Learn about health care in Canada

Canada has a universal health care system funded through taxes. This means that any Canadian citizen or permanent resident can apply for public health insurance. Each province and territory has a different health plan that covers different services and products.

Is healthcare 100% free in Canada?

How is Public Healthcare in Canada Paid For? Public healthcare is free because patients are not required to pay any fees to receive medical attention at a healthcare facility. However, public health care in Canada is funded by a tax paid by Canadian citizens and permanent residents.

Which country has the best healthcare?

Healthcare System Performance Ranking

Key findings: “The top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care.

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