Understanding Medicare and Private Coverage Options
Canada is famous for its breathtaking landscapes, world-class hockey, and rich cultural heritage. It is also known for its publicly funded healthcare system, Medicare, which provides basic medical services at no direct cost to citizens and eligible long-term residents.
However, healthcare coverage is not automatic for foreigners in Canada, and most medical services have high out-of-pocket costs unless the individual is enrolled in a provincial or territorial health plan.
As a result, having international health insurance in Canada is essential for avoiding unexpected medical expenses and ensuring proper care. In this article, we'll explain how private health insurance works in Canada, explore your coverage options, and help you find the right protection for yourself and your family.
Canada is famous for its breathtaking landscapes, world-class hockey, and rich cultural heritage. It is also known for its publicly funded healthcare system, Medicare, which provides basic medical services at no direct cost to citizens and eligible long-term residents.
However, healthcare coverage is not automatic for foreigners in Canada, and most medical services have high out-of-pocket costs unless the individual is enrolled in a provincial or territorial health plan.
As a result, having international health insurance in Canada is essential for avoiding unexpected medical expenses and ensuring proper care. In this article, we'll explain how private health insurance works in Canada, explore your coverage options, and help you find the right protection for yourself and your family.
Healthcare Coverage in Canada
Canada’s healthcare system is a hybrid model that blends public and private services. The government provides universal coverage for essential medical services through a publicly funded system. This ensures that all Canadian citizens and permanent residents can access necessary care without direct charges.
In addition to public coverage, many Canadians rely on private insurance plans to cover services not included in the public plan, such as dental, vision, and prescription drugs. This is often provided by their employers.
However, accessing Medicare can be challenging for foreigners. Eligibility for a provincial health card depends on various factors, including immigration status. For this reason, many opt to carry private international health insurance to ensure access to care.
Even after gaining access to Medicare, additional coverage may be necessary to avoid high out-of-pocket costs for services not covered by the public system.
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Public Health System (Canada Medicare)
The federal government subsidizes Canada’s Medicare system, but each province and territory manages its own healthcare plan.
These public plans ensure that all Canadian citizens, permanent residents, and some temporary residents have access to essential medical services, including hospital care, doctor visits, and other necessary treatments.
While the government covers the cost of public healthcare, services are provided through both public and private facilities. Having Medicare coverage does not restrict individuals to public hospitals or clinics.
However, there is little distinction between public and private care when it comes to essential services. By law, any medical service covered by Medicare must meet the same standards, ensuring consistency in the quality of care across the country.
Read more about accessing public healthcare in Canada in our detailed article on the healthcare system in Canada.
Private Health Insurance in Canada
Private health insurance in Canada is essential for those seeking broader coverage or faster access to care beyond what the public system offers.
This is especially important for individuals and families who need additional services such as prescription drugs, dental and vision care, mental healthcare, and complementary therapies like chiropractic care, which are often not fully covered by Medicare.
Around 60% of Canadian residents carry private plans to supplement their public coverage. For those without the right visa status to access Medicare or those who must wait for provincial coverage, private health insurance is crucial to ensure access to necessary healthcare.
Even for those eligible for Medicare, private plans offer several benefits, including coverage for services not included in the public system, faster access to care, and reduced wait times.
Moreover, if you frequently travel between Canada and other countries, global health insurance ensures that your medical coverage remains consistent, high-quality, and affordable, no matter where you go. This peace of mind allows you to focus on your health needs both within Canada and abroad.
How to Get Private Health Insurance in Canada as an Expat
If you're an expat living in Canada, securing private health insurance is relatively easy. However, understanding your options and following the necessary steps will help you select the best plan for your needs.
You can obtain coverage through your employer, directly from private insurance providers, or through insurance marketplaces. Your eligibility for provincial healthcare (such as Medicare) will also influence the level of coverage you need.
To help guide you through this process, here’s a step-by-step guide to obtaining health insurance as an expat in Canada.
Step 1: Determine Your Eligibility for Provincial Healthcare
Before purchasing private health insurance, it’s important to determine whether you’re eligible for Canada’s public healthcare system, known as Medicare.
As a permanent resident, work permit holder, or spouse of a Canadian citizen or permanent resident, you may qualify for provincial or territorial healthcare coverage.
Since eligibility criteria can vary by province, it's essential to check with the relevant provincial health authority to find out if you're eligible for coverage and when it will begin.
Step 2: Decide What Coverage You Need
Your need for private coverage depends on whether you have access to Medicare. If you’re eligible for Medicare, you'll primarily need private insurance to cover services that aren’t included, such as prescription drugs, dental, and vision care.
If you’re not eligible for Medicare, you’ll need a more comprehensive private plan to cover all your healthcare needs. It’s a good idea to purchase your private policy before moving to Canada to ensure you won’t experience any gaps in coverage.
Step 3: Check With Your Employer
If you're in Canada for work, your employer may provide health coverage in addition to Medicare. If you're working for a division of a company based in your home country, they may offer group insurance tailored for international employees.
Check with your employer to understand what health benefits you'll have before you move to Canada. It's important to confirm the specifics of the coverage, including any waiting periods, exclusions, and whether the plan covers services not included in Medicare, such as dental, vision, or prescription drugs.
Step 4: Research Canadian Providers
If your employer doesn’t provide insurance or you need additional coverage, you can purchase private insurance directly from Canadian providers.
Canadian health insurance providers typically offer supplementary plans to cover services like prescription drugs, dental, vision, and specialized care not included in Medicare.
However, if you're looking for more comprehensive coverage – especially if you plan to travel or require more flexible international protection – a global health insurance plan may be a better option.
Step 5: Consider International Insurance
If you're not covered by Medicare, or if you need a health plan that covers you both in Canada and internationally, consider an international health insurance plan.
These plans provide comprehensive coverage, including emergency care, hospitalization, outpatient services, and preventive care, no matter where you are.
International insurance plans can also be tailored to your specific needs, whether you’re traveling frequently, living in Canada long-term, or seeking coverage for family members.
They also offer more flexibility in choosing healthcare providers, with access to a broader network of doctors and hospitals worldwide.
Are you moving to Canada and need insurance?
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How To Choose an Insurance Provider
Choosing the right health insurance provider is essential for ensuring you have the coverage you need as an expat.
There are several factors you should consider to make sure you find the best plan for your needs.
Evaluate Your Coverage Needs
Start by assessing the type of coverage you need. If you are eligible for Medicare, you’ll likely only need private insurance to cover services not included in the public healthcare system, such as dental, vision, and prescription drugs.
If you’re not eligible for Medicare, you’ll require a more comprehensive health insurance plan to cover all your medical needs.
Insider Tip: If you’re the spouse or common-law partner of someone working in Canada on a work permit but you’re visiting, you won’t be eligible for a provincial health card. However, if your partner has provincial healthcare and private insurance through their employer, you may be able to get additional coverage through their plan.
This supplemental coverage typically helps with services like prescription drugs, dental care, and physiotherapy not covered by provincial healthcare. However, since you won’t have full provincial coverage, you’ll still need global health insurance to cover essential medical expenses, particularly for emergencies or services not included in the private plan.
Consider Your Specific Healthcare Requirements
Think about your personal healthcare needs and the services you require. For example, if you have chronic conditions or require specialized treatments, ensure your chosen plan covers these.
If you travel frequently, look for a policy that provides coverage both in Canada and abroad. If you have dependents, consider whether the plan includes family coverage and what services are provided.
Compare Premium Costs
Insurance premiums can vary widely depending on the provider and the level of coverage. While affordability is important, be sure to check what’s included in the premium.
Lower-cost plans may have higher out-of-pocket expenses or limited coverage, which could ultimately end up being more expensive in the long run. The key is to balance affordability with the coverage you truly need.
Read More: Compare Global Health Insurance Plans
Check Reputation and Customer Service
Before choosing a provider, research the company’s reputation. Look for providers with a strong history of customer satisfaction, easy claim processes, and responsive customer service. A good insurance company will make it easy to contact them and handle claims efficiently.
Work With an Insurance Broker
Navigating the Canadian insurance market can be overwhelming, especially if you're unfamiliar with the various plans and providers.
An insurance broker can simplify the process by helping you compare options and ensuring you get the coverage best suited to your needs. Brokers can explain policy details, highlight exclusions, and guide you to the most cost-effective choices.
Our licensed brokers can help you find an international policy tailored to your needs, making the entire process easier and ensuring you get the right coverage.
How Much is Private Health Insurance in Canada?
Private health insurance in Canada is typically affordable, as the public healthcare system (Medicare) covers most essential healthcare services.
However, private insurance is necessary for services not included in Medicare, such as prescription drugs, dental care, vision, and certain paramedical services.
The cost of private insurance can vary depending on several factors, including:
- Age
- Number of family members
- Health status
- Level of coverage
- Additional coverage options
A Breakdown of Canadian Private Health Insurance Costs
Canadian private health insurance typically includes the following costs:
- Premiums: The monthly or yearly payment for the policy:
- A 35-year-old single male typically pays around $61.32 CAD per month (approximately $41 USD).
- A couple (both aged 28) can expect to pay about $110.38 CAD ($74 USD) per month.
- A family of four may pay around $175.89 CAD ($117 USD) per month.
- Deductibles: This is the amount you must pay before your insurance starts covering expenses. Depending on the plan, deductibles typically range from $100 CAD to $500 CAD annually.
- Co-pays: The fixed amount you pay per service, which typically ranges from $5 to $30 CAD (e.g., doctor visits, prescriptions).
- Percentage of Service: This is the portion of the healthcare service cost that you are responsible for paying, which generally ranges from 5% to 30%, depending on your plan.
- Expenses Above Plan Limits: If you exceed your plan's yearly limit for a specific type of care, you'll need to cover the excess out of pocket.
The actual cost of private health insurance will depend on the plan you select, your specific health needs, and your family situation. It's important to carefully review the coverage and costs to ensure it meets your needs.
Are you moving to Canada and need insurance?
Get a FREE international health insurance quote to learn which steps to take next.
The Best Health Insurance Plans for Foreigners in Canada
Comprehensive health insurance is essential for foreigners planning to move to Canada. An international medical plan is the best option for most expats, especially in the initial stages.
While Canada’s Medicare system with additional private coverage is a solid option, it's unavailable to most foreigners and doesn't kick in immediately for newcomers.
A global health insurance plan will provide coverage tailored to your specific needs, whether you're a temporary resident, student, or international employee.
Read More: International Health Insurance
The Best Health Plans for Non-Canadian Citizens
If you're moving to Canada from abroad, IMG Global Medical offers comprehensive coverage at an affordable price.
The plan is fully customizable, allowing you to select the types and levels of coverage that best suit your needs. Moreover, it’s accepted worldwide, so you’ll remain covered even when traveling back to your home country or abroad.
IMG Global Medical Plan
- Four plan options and additional optional coverages
- Choice of the coverage area to reflect your geographical area of need
- Freedom to choose your health care provider wherever you are in the world
Cigna Global Insurance Plan
- The flexibility to tailor a plan to suit your individual needs
- Access to Cigna Global’s trusted network of hospitals and doctors
- The convenience and confidence of 24/7/365 customer service
The Best Health Insurance for U.S. Citizens
If you are moving to Canada from the United States, it’s essential to have a health plan that allows you to access doctors and hospitals without facing high medical bills.
The GeoBlue Xplorer plan is an excellent option for U.S. citizens living in Canada. Depending on the level of coverage you choose, you can receive comprehensive health insurance in Canada, the U.S., and many other countries worldwide.
Xplorer Worldwide Medical Plan
- Premium Benefits, Coverage and Service
- Define your deductible and prescription benefits
- For Foreigners in the US or US citizens abroad
The Essential plan offers a more affordable option by excluding U.S. coverage if you don't plan to return there frequently.
Read More: Health Insurance For U.S. Citizens Abroad
Medical Plans for Students at Canadian Colleges and Universities
International students in Canada are required to have health insurance during their studies.
Some provinces and territories, including Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, and Saskatchewan, provide health insurance plans specifically for international students. However, Ontario, Quebec, Prince Edward Island, and Yukon do not.
In these cases, some universities offer their own health insurance plans, which you may be required to enroll in. If you're required to find private insurance on your own, here are two excellent options:
StudentSecure Insurance from WorldTrips provides coverage in over 130 countries, including Canada. It offers four plan tiers, allowing you to choose the coverage that best suits your needs and budget. The plan also covers various sports activities, including intercollegiate and interscholastic sports.
StudentSecure Insurance
- Provides Medical, Dental, and Evacuation Benefits
- Keep your coverage when your studies last multiple years
- Medical providers are available in over 130 countries worldwide
GeoBlue Navigator offers comprehensive health insurance plans for U.S. students studying in Canada, including coverage for medical needs in the U.S.
GeoBlue Student Medical Coverage
- Worldwide medical coverage built for students and faculty in the U.S. and abroad.
- Select from a range of deductibles and rates.
- Choose providers either in or out of our elite network.
Group Medical Insurance for International Employees in Canada
For employers with international employees in Canada, offering a solid benefits package is essential for their peace of mind and well-being. A group health insurance plan should be a top priority.
While Canadian employees will have access to provincial or territorial health insurance, international employees may require or prefer a global health plan that provides coverage in Canada and their home country.
A group international health plan is a great solution if you have two or more international employees living in Canada. These plans can be customized to meet your employees' specific needs and fit within your budget.
Our licensed agents are available to help you design the appropriate coverage to protect your employees while they are working outside of their home country.
Read our article on International Global Health Insurance Plans to learn more about your options, as well as other employee benefits like group international life insurance, group travel insurance, disability insurance, and comprehensive global employee coverage.
Global Benefits for Organizations
- Offering group plans for international health, life and travel
- Request a quote from the leading insurers around the globe
- A licensed agent will provide quotes and expert advice
How to Find a Family Physician or GP in Canada
Canada currently faces a shortage of family physicians, and many Canadians experience long wait times – sometimes more than six months – before finding a primary care doctor.
However, with private health insurance, you can often receive the care you need, even without a family doctor. Walk-in clinics are available to help with illness, injury, or other health concerns that arise.
Without a provincial or territorial health card, you cannot register for a family doctor through services like Nova Scotia's Need a Family Practice registry.
Ontario has a high demand for family doctors, leading to long waitlists, though efforts are being made to recruit more doctors into the province. Meanwhile, in provinces like British Columbia, you can access fully private clinics but must pay out of pocket for services.
Canada’s government website recommends using their community health center directory to help find a doctor. However, if you're a foreigner without a health card, your best option is to seek treatment as needed at reputable hospitals and clinics nearby.
By providing your private insurance information, your bills should be covered. Once you obtain a provincial or territorial health card, you can register for a family physician and begin receiving more coordinated care.
Read More: How to Find a Doctor Abroad
How to Access Hospital Care in Canada
Before visiting a hospital in Canada, check with your insurance provider to confirm which hospitals near you are covered.
The government typically pays for hospital services in Canada. However, private insurance may cover extras like private rooms or additional services. If you don’t have a provincial health card, ensure the hospital you plan to visit will accept your private insurance plan.
When shopping for an international medical plan, it’s a good idea to inquire about the hospitals in the area where you will be living. Find out what plans they tend to accept and how much you'll likely pay out of pocket for various services. If you don't have coverage, you may be left with hefty medical bills.
Read More: Hospitals in Canada
Protect Your Health and Well-Being in Canada
Securing the right health insurance is essential for foreigners in Canada. It ensures that you can access the care you need without facing the burden of unexpected medical expenses.
Whether you're waiting for provincial coverage, need services not covered by basic plans, or need global coverage for travel, the right insurance provides invaluable peace of mind.
However, with so many options available, navigating the process can feel overwhelming. This is where a licensed insurance broker becomes a vital resource. By working with a broker, you can confidently explore your options and find the coverage that perfectly aligns with your needs and those of your family.
Don't leave your health to chance – take the necessary steps now to secure the protection you deserve, no matter where life takes you.
Find the Best International Medical Insurance
- Compare multiple quotes and coverage options
- Work with an insurance expert at no additional cost
- Find the best plan for your needs and budget
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Author: Kamela Hutzley is a Senior Editor at International Citizens Insurance. She is a native New Jerseyite who recently emigrated to Halifax, Nova Scotia. In late 2022, she spent a month each in Ottawa, Montreal, and Quebec City, before deciding on Atlantic Canada for the long haul. She’s traveled to Hawai’i, Jamaica, France, Spain, the UK, Ireland, Greece, Switzerland, Germany and the Netherlands. Kamela writes about International Life Insurance, Travel insurance, and Health topics as well as advice for expats and travelers.