Canada’s healthcare system is regarded as one of the best in the world, providing all citizens and permanent residents free access to emergency care and regular doctor visits. However, there are still certain services that Medicare – the country’s universal health coverage – does not cover – including eye and dental care, outpatient prescription drugs, rehabilitation services, and private hospital rooms – which Canadians need to pay for.
So, it is not surprising that, although not required, nearly 70% of Canadians have taken out supplemental private health coverage, according to the latest figures from the Canadian Life and Health Insurance Association (CLHIA). Of these, 90% were purchased through group plans.
Overall, the nation’s health and life insurance providers paid out $30.4 billion in supplementary health benefits, $8.8 billion in disability claims, and $1.6 billion for accidental death and dismemberment, critical illness, and long-term care coverage last year, the association’s data also revealed. These numbers indicate a thriving private health insurance market in a country where the public health system already provides a good level of support for acute and accident care.
How does Canada’s healthcare system work?
Canada has a “decentralized, universal, publicly funded health system,” according to the Commonwealth Fund, a private nonprofit group that supports independent research on health care issues and provides grants aimed at improving the country’s health system.
“Health care is funded and administered primarily by the country’s 13 provinces and territories,” the organization explained. “Each has its own insurance plan, and each receives cash assistance from the federal government on a per-capita basis.”
The group added that while benefits and delivery approaches vary, all Canadian citizens and permanent residents receive “medically necessary hospital and physician services free at the point of use.”
However, not everything is covered by Medicare. According to the personal finance website moneyGenius, the public health system provides universal access to about 70% of a Canadian’s medical needs. The rest must be paid out of pocket or covered by supplemental private insurance.
What does Canada’s universal healthcare system cover?
The country’s public healthcare system covers many of the “basics.” These include:
- Doctor and hospital visits
- Diagnostics and examinations
- Surgeries and treatments
- Standard accommodations in the hospital (including care, food, and prescriptions)
- Medically necessary dental surgeries
- Eye examinations for Canadians aged under 18 or over 65
Each province and territory implement their own rules when it comes to health coverage, so the exclusions may vary. For the following items and services, private health insurance may be necessary to obtain cover, depending on where a person resides.
- Outpatient prescription medications
- Dental care
- Psychological services
- Massage therapy
- Private hospital room stays
- Ambulance and EMT services
- Prescription eyeglasses
- Medical equipment (including wheelchairs, crutches, and leg braces)
Long-term care insurance has long been lacking in the country, another thing to be aware of.
How much does private health insurance cost in Canada?
The latest available figures from the Canadian Institute for Health Information (CIHI) estimated the cost of private health insurance at $756 per year, which is equivalent to $63 monthly. The institute’s data also showed that the average Canadian paid out $902 in out-of-pocket health expenses, or slightly over $75 each month.
These numbers, however, were taken before COVID-19 shook not just Canada’s healthcare system but also that of the world’s, so the values might actually be higher at present. In addition, the figures above are mere estimates and the best way to get an accurate amount is to contact the health insurance companies directly.
moneyGenius rating: Undisclosed
Eligibility: Canadian citizen/age of majority
Features & benefits: Vision and dental coverage, prescription medication
Optional extras: Speech therapists, hearing aids, orthotics