Health Insurance in Canada
Canada’s universal healthcare system covers major things like surgery and hospitalization. It does not include a lot of other things, such as dentist visits and eyeglasses. If you do not have health and dental plans through your workplace, you will have to pay for these out-of-pocket.
To help you cover these expenses, you can buy health insurance. The type of plan you want will depend on your needs and those of your family. A health insurance plan should cover prescription medicine. Ensure to check how much of the cost of prescription an insurance company will cover. You also need to know if they will always cover “brand name” prescriptions or only generic ones.
Something else a health insurance plan can help with is dental issues. You should ask the insurance company what they cover (e.g. cleanings, root canals, fillings, etc.). Every health insurance provider is different. You also need to find out if they have a yearly cap. A cap is an amount you hit where the company will not pay any more during a calendar year.
A third item your health insurance plan should cover is eye exams and eyeglasses. Ask the company how often they will cover eye exams and new glasses, and how much of the cost they include.
Also, check what kind of therapies your insurance plan will cover, and for how much. A robust insurance policy will offer different coverage. Consider if you’ll need physiotherapy, a chiropractor, a private hospital, or a podiatrist during the year. Health insurance can also help with other medical costs. These costs can include things like oxygen, crutches, walkers, and wheelchairs.
Take some time to consider your needs before shopping for health insurance plans. You can then use an online calculator from a health insurance company to get a free quote. You can also find a health insurance broker to shop around for you.
Health Insurance Companies in Canada
There are many health insurance companies across Canada to choose from. There are also many coverage plans out there tailored to fit the different needs of families for illness insurance.
Below is an overview of some Canadian health insurance companies. Many of them provide a diverse selection of health insurance plans.
- Blue Cross Canada
- GreenShield Canada/ SureHealth
- Great-West Life Assurance Company
- Group Medical Services
- Sun Life Assurance Company Of Canada
- State Farm
- Scotia Life Health and Dental Insurance
- TD Insurance
- GMS Health Insurance
Health Insurance for the Self-employed
Now more than ever, Canadians are choosing to work for themselves. This trend is on the rise, and some examples of self-employment include:
- Starting your own business
- Contract-to-contract work with other companies
Being self-employed can offer increased independence, greater job satisfaction, and better work-life balance. One major thing missing from it is company health insurance plans. Being self-employed means being responsible for paying your own added health costs. This can add up fast, especially if you prefer extras, such as a private or semi-private hospital room.
As per a Statistics Canada report, a household spends over $2,251 each year on health and dental insurance. This includes eyewear, dental care, and prescription drugs.
There are health and dental insurance coverage plans that can help out self-employed Canadians. There are coverage options that focus on dental care, prescription drugs, or both. Some insurance plans offer extended health coverage. These include services like chiropractic care, massage therapists, vision, and more.
Plus, self-employed Canadians can take advantage of tax breaks when choosing insurance/health or illness insurance. Many can deduct insurance premiums from their business income. Talk to your tax specialist or accountant when filing your return.
Health Insurance – British Columbia
As stated before, public health insurance is available to all Canadian residents. With that said, public insurance coverage differs across the provinces. In BC, the Medical Services Plan (MSP) offers “medically-necessary” healthcare coverage. These include:
- Services offered by midwives and physicians
- Oral and dental surgery conducted in a hospital
- Medically required eye exams
- Some orthodontic services
- Diagnostic services (e.g. x-rays)
Services not covered by MSP include:
- Cosmetic surgery
- Routine dental care
- Eye examinations for those 19 to 64 years of age
- Hearing aids, eyeglasses, and added appliances or equipment
- Prescription drugs
- Acupuncture, massage therapy, chiropractic, naturopathy, non-surgical podiatry, and physical therapy services. MSP
- Screen tests and preventive services are not supported by evidence of “medical need.”
- Psychologists and counsellors
- Medical examinations, certificates, or tests for:
*Driving a motor vehicle
*Sports or recreational activities
Health Insurance – Ontario
Ontario Provincial Health Insurance Plan (OHIP) offers residents access to basic healthcare coverage. This plan covers:
- Services deemed “medically necessary” by a doctor
- Blood tests, x-rays, and added lab services, when requested by a doctor.
- Specific treatments are seen as “medically necessary.”
- Emergency oral or dental surgeries are administered in-hospital.
- Eye exams for those over 64 years of age or under 20
What the OHIP plan does not cover:
- Prescription eyewear
- Prescription drugs
- Registered therapists and specialists
- Routine dental care
- Emergency medical expenses when travelling abroad
Health Insurance – Alberta
Alberta Health Care Insurance Plan (AHCIP) offers insurance coverage for services deemed “medically” necessary. This includes some oral and dental services, too. A resident’s doctor deems what services are medically necessary.
Services included under AHCIP include:
- Any service “medically required” by a physician.
- “Medically required” diagnostic procedures. This includes radiological, laboratory, as well as added diagnostic services.
- Psychiatrist visits.
- Bariatric surgery for those eligible under the Weight Wise program. A letter from an Alberta physician is required.
- Mastectomy or breast augmentation for transgender surgery.
- Hospital, cancer, home care, mental health and addiction, physiotherapy, midwifery services, and more.
Medical services not covered in the plan:
- Cosmetic procedures, abdominoplasty (tummy tuck), and vasectomy reversal
- Health services offered by:
* A physician assistant or nurse practitioner
- Routine dental care and eye care services
- Prescription drugs
- Travel vaccines
- Assisted reproductive technologies
- Third-party health service requests. This includes medicals around sports, employment, driver’s tests, or insurance.
- Clinical psychologist services
- Diagnostic imaging referred by physiotherapists, chiropractors, and audiologists.
Health Insurance – Quebec
Régie de l’Assurance Maladie du Québec (RAMQ) is a public healthcare insurance plan for those without group employee benefits. Provincial residents gain access to “medically necessary” services. Examples of these include:
- Consultations and examinations with family physicians and specialists
- Prescription medication
Except for kids under 10, KAMQ does not cover dental insurance coverage. Added items with no coverage include:
- Routine vision and dental care, as well as eyeglasses
- Diagnostic services outside a hospital (e.g. lab tests, MRI, CT scans, and ultrasounds)
- Registered therapists and specialists (e.g. chiropractors, massage therapy, acupuncture, and physiotherapy)
The Bottom Line
Personal insurance is fast becoming the norm in Canada. Depending on the province, there are semi-private and private insurance options available. It really depends on your needs and budget. The real takeaway is the necessity to be covered for things like dental and eye care because treatment can become expensive. Most people find it easier to budget a manageable sum each month than to have to deal with nasty surprises.