Insights & advice
Health insurance 101: How does health insurance work in Canada?
Jan. 2022 – 15 min read
Key takeaways
Universal provincial/territorial healthcare covers most basic healthcare and medical services.
Workplace benefits help employees cover the cost of things provincial/territorial health care plans may not pay for.
Personal health insurance helps people who don’t have group benefits coverage cover the cost of things provincial/territorial health care plans may not pay for.
You can apply for personal insurance online in less than 15 minutes
What is health insurance?
Health insurance can help you pay less for medical care. You pay a fee (also known as a premium) for coverage, usually monthly.
Some health insurance plans have a deductible (the amount you pay out of pocket before your health insurance coverage takes effect).
Some health insurance pays 100% of costs after deductible, others pay a percentage (coinsurance).
Health insurance coverage may also come with additional no-cost programs and services, like virtual health care for example.
How does health insurance in Canada work?
There are 3 types of healthcare coverage in Canada:
Universal healthcare (provincial/territorial): This healthcare is funded by taxpayers. Most basic healthcare and medical services are covered, however there are some differences from province to province and territory.
For most services you must provide a provincial/territorial health card.
Workplace benefits: Workplace benefits are provided by many employers or associations to help employees cover the cost of things provincial/territorial health care plans may not pay for, including certain prescription drugs, dental, hospital, vision, paramedical and ambulance services.
Because costs are shared with a group, they’re often more affordable than a personal health and dental plan.
Many workplace benefit plans allow you to customize your coverage to your needs.
Personal health and dental insurance: This insurance is most often used by people who are retired, who are self-employed or not eligible for group benefits, or who are losing their previous group benefits coverage.
It’s similar to group benefits because it helps pay for things provincial/territorial health care plans may not cover.
There are plans that suit your needs and budget. Coverage is guaranteed for some plans and you can even qualify with pre-existing medical conditions.
What does health insurance typically cover?
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Universal health care (provincial/territorial)
- Family doctor visits, emergency room visits, outpatient clinic appointments
- Inpatient care/surgery
- Medicines you receive as part of your inpatient care
- Diagnostic tests, bloodwork, scans, genetic testing
- Radiation therapy
- Medicines infused or injected in an outpatient clinic (e.g., chemotherapy, hydration)
- Cancer support services offered in hospitals (e.g., dietician, counselling, physiotherapy)
- Mental health services through a cancer centre
- Prescription drugs
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Workplace benefits
- Prescription drugs1
- Dental care
- Vision care and prescription eyewear
- Paramedical services such as physiotherapy and chiropractic
- Ambulance services
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Personal health and dental insurance
- Prescription drugs1
- Dental care
- Vision care and prescription eyewear
- Paramedical services such as physiotherapy, massage and chiropractic
- Ambulance services
- Medical supplies
- Hearing aids
- In-home nursing and health aide care
- Emergency travel medical
- Major dental care
- Accidental death and dismemberment
- Hospital accommodation and cash
Is personal health insurance necessary in Canada?
This depends on how much you and your family currently spend on various types of healthcare and how concerned you are about the risk of potential future healthcare expenses.
If you spend a lot on healthcare that’s not covered by a provincial/territorial plan, or you have health concerns which may lead to expenses down the road, personal health insurance may be worth it.
How to get personal insurance
There are great options available whether you’re retired or losing coverage, or self-employed or don’t qualify for benefits with your employer.
What’s next?
Now that you understand more about how health insurance works in Canada, you may want to:
Check your provincial/territorial coverage
Check your group benefits coverage (if applicable)
Talk with an advisor about your need for personal health insurance
Ready to get health and dental coverage?
If you’d like to explore plans and see how much they could cost you, get a quote.
- Footnote 1
- 1 If you are a Quebec resident, personal health insurance can provide supplemental coverage to the prescription drug coverage provided under the Régie de l’assurance maladie du Québec (RAMQ) basic prescription drug insurance plan. Personal health insurance doesn’t remove your obligation to have drug coverage through the RAMQ drug public plan, through your employer or an association you are a member of or through the employer of your spouse.
