Health Insurance in Canada 2026: Public Plans and Private Cover

Canadian provincial health card beside a stethoscope and a private insurance benefits booklet on a desk

Last reviewed: October 1, 2026

Short answer: Canada does not have one national health plan. Each province and territory runs its own public plan (OHIP in Ontario, MSP in British Columbia, AHCIP in Alberta, RAMQ in Quebec and so on), and the federal Canada Health Act sets the conditions those plans must meet. If you are an eligible resident with a health card, medically necessary hospital and doctor services are paid for through taxes, with no bill at the point of care.

Public plans leave large gaps: most prescription drugs taken outside hospital, dental care, vision care, physiotherapy, ambulance fees and almost all care outside Canada. Most people fill those gaps with an employer group plan, an individual plan or a targeted public programme. Newcomers may wait up to three months for coverage in some provinces, international students are covered in some provinces and not in others, and visitors are not covered at all, so private insurance matters most in your first months in Canada and whenever you travel.

This guide explains how provincial plans work, who qualifies and when, what is left out, and how to choose private or supplemental coverage without overpaying. It draws on Health Canada, Immigration, Refugees and Citizenship Canada (IRCC), the Canada Revenue Agency (CRA), provincial health ministries, the Financial Consumer Agency of Canada (FCAC), the Canadian Life and Health Insurance Association (CLHIA), Assuris and other official bodies. We do not recommend any insurer or product, and we do not show real premiums.

This article is general information, not financial, insurance or medical advice. Rules differ by province and territory and change often, so confirm details with your provincial health ministry and your insurer.

In this guide

How medicare works in Canada
What public plans do not cover
Eligibility and newcomer waiting periods by province
How to apply for a health card
International students
Temporary workers
Visitors and the super visa insurance requirement
Refugees, asylum claimants and the IFHP
Moving between provinces
Out-of-country coverage and travel insurance
Private and supplemental health insurance
Related products compared
Coordination of benefits
Deductibles, co-insurance and maximums, with a worked example
What affects your premium
Tax notes
How to choose a plan, step by step
Pre-existing conditions and stability clauses
Claims, appeals and complaints
Assuris protection and licensed advisors
Scams and red flags
Common mistakes
Checklist
FAQ
Bottom line
Sources

How medicare works in Canada

Medicare is the informal name for Canada's publicly funded health care system: thirteen provincial and territorial insurance plans that pay for medically necessary hospital and physician services for eligible residents. It is funded through taxes, not through premiums charged at the hospital door.

Who does what

Health Canada describes the split of roles plainly. Provinces and territories deliver health care services and regulate providers such as doctors and nurses. The federal government sets national standards through the Canada Health Act, helps fund the system, and looks after certain groups directly. Those groups include veterans, refugee claimants, people in federal penitentiaries, members of the Canadian Forces, and First Nations people on reserve and Inuit.

The five Canada Health Act standards

To receive full federal health funding, each provincial plan must meet five criteria set out in the Act.

Criterion	What it means in practice
Public administration	The plan is run on a non-profit basis by a public authority.
Comprehensiveness	The plan covers medically necessary hospital, physician and certain surgical-dental services.
Universality	All insured residents are entitled to insured services on uniform terms and conditions.
Portability	Coverage follows you when you travel or move within Canada, with limited coverage abroad. A waiting period for new residents cannot exceed three months.
Accessibility	Residents get reasonable access to insured services based on medical need, not ability to pay.

What "medically necessary" means

The Act does not list specific services. Health Canada explains that each province and territory decides what is medically necessary, in consultation with its medical profession. As a result, the core is the same everywhere (hospital stays, doctor visits, diagnostic tests ordered in hospital, surgery), but the edges differ. A service insured in one province may be billed to the patient in another.

What public plans do not cover

Provincial plans generally do not pay for prescription drugs taken outside hospital, dental care, vision care, most paramedical services or ambulance fees. Health Canada calls these supplementary services and notes that they are typically paid for through targeted provincial programmes, private insurance or your own pocket.

Service	Covered by the provincial plan?	How people usually pay
Hospital care, including drugs given in hospital	Yes	Health card
Prescription drugs from a pharmacy	Generally no, except for groups covered by provincial drug programmes	Group or individual plan, public drug programme, out of pocket
Routine dental care	Generally no (some surgical-dental services in hospital are covered)	Group or individual plan, Canadian Dental Care Plan if eligible, out of pocket
Eye exams, glasses and contact lenses	Varies by province and age; glasses generally not	Group or individual plan, out of pocket
Physiotherapy, chiropractic, massage, psychology outside hospital	Limited or none, varies by province	Group or individual plan, out of pocket
Ambulance	Varies; a fee often applies	Group or individual plan, out of pocket
Care outside Canada	Only a small part, at home-province rates	Travel medical insurance

Public drug programmes

There is no single national drug plan that covers every resident for every medicine. Instead, each province runs its own drug programme, usually aimed at seniors, children, people on social assistance or families with high drug costs relative to income. Two examples show how different the designs are.

Ontario. The Ontario Drug Benefit covers people aged 65 and over, people aged 24 and under who do not have a private plan (known as OHIP+), residents of long-term care homes and people receiving certain social or home care services. Ontario says the programme covers more than 5,900 medications on its formulary. Most seniors pay an annual deductible of CAD 100 and then a co-payment of up to CAD 6.11 per prescription; lower-income seniors can qualify for a co-payment of up to CAD 2 with no deductible.
British Columbia. Fair PharmaCare is income-based. A family first pays a deductible set according to its income. After that, PharmaCare pays 70% of eligible costs (75% if a family member was born before 1940) until the family reaches its annual maximum, and 100% for the rest of the year. You must be enrolled in MSP and register for the plan.

The Canadian Dental Care Plan

The Canadian Dental Care Plan (CDCP) is a federal programme that helps pay for dental care for eligible residents who have no dental insurance. The Government of Canada lists four conditions, all of which must be met:

You have no access to dental insurance or coverage, including through an employer, a pension, a family member's plan, a professional or student organization or a plan you bought yourself. A health spending account that covers dental costs counts as access.
Your adjusted family net income is less than CAD 90,000.
You are a Canadian resident for tax purposes.
You, and your spouse or common-law partner if you have one, have filed a tax return.

The CDCP is not always free. The plan pays a percentage of its own established fees, depending on income.

Adjusted family net income	CDCP pays	You pay
Below CAD 70,000	100% of eligible costs at CDCP fees	0%
CAD 70,000 to CAD 79,999	60%	40%
CAD 80,000 to CAD 89,999	40%	60%

Eligibility and newcomer waiting periods by province

You qualify for a provincial plan by being a resident of that province with eligible immigration status, not by being a citizen or by paying tax. Some provinces cover eligible newcomers from the day they arrive; others impose a waiting period, which the Canada Health Act caps at three months.

IRCC tells newcomers that in some provinces they may wait up to three months for public coverage to start, and that they should have private health insurance for that period. The table below summarizes what the provincial ministries themselves publish. Rules vary by immigration status, so treat it as a starting point and confirm with the ministry.

Province (plan)	Residency test	Arriving from outside Canada	Moving from another province
Ontario (OHIP)	Ontario is your primary home; physically present 153 days in any 12-month period and 153 of your first 183 days	No waiting period; eligible applicants have immediate coverage	No OHIP waiting period; your old province's rules on when its coverage ends still apply
British Columbia (MSP)	Make your home in B.C.; physically present at least six months in a calendar year	Wait period of the rest of the month you establish residence plus two months	Same wait period; your former province normally covers you meanwhile
Alberta (AHCIP)	Committed to being in Alberta at least 183 days in any 12-month period	Coverage may start from the date you establish residency if you apply within three months with entry documents	First day of the third month after you establish residency
Quebec (RAMQ)	Settled in Quebec with eligible status	Generally a waiting period of up to three months; some exceptions apply	Check RAMQ; your former province normally covers you during the transition
Manitoba (Manitoba Health)	Make your home in Manitoba; physically present six months (183 days) in a calendar year	Permanent residents may apply from the date they arrive; work permit holders with a permit of 12 months or more from the permit date	First day of the third month after you arrive
Saskatchewan	Live in Saskatchewan and be present at least five months a year	Coverage may begin on or before the first day of the third month after arrival in Canada	First day of the third month after you move
Nova Scotia (MSI)	Resident of Nova Scotia	Permanent residents usually covered from the date they become residents	First day of the third month after becoming a resident

We did not verify the other provinces and territories for this guide. If you are moving to New Brunswick, Prince Edward Island, Newfoundland and Labrador, Yukon, the Northwest Territories or Nunavut, check the health ministry page directly.

How to handle a waiting period

Apply on day one. In provinces with a waiting period, the clock often runs from the date you establish residence or register. Alberta, for example, asks you to apply within three months of arriving to get the best effective date.
Buy bridging cover before or right after you land. Emergency medical policies for newcomers usually exclude anything that started before the policy did. Quebec's government tells temporary workers who want private insurance to arrange it no later than the first five days after arrival.

How to apply for a health card

You apply to your province or territory, usually with three kinds of proof: immigration or citizenship status, residence in the province and identity. Coverage is not automatic when you land; you must register.

The process differs by province:

Ontario. You must apply in person at a ServiceOntario centre and bring three separate original documents: one proving citizenship or eligible immigration status, one proving that you live in Ontario and one proving your identity. Photocopies of status documents are not accepted.
British Columbia. You can apply for MSP online, in person or by mail. Most adults then visit an ICBC driver licensing office to show identification, declare B.C. residency and have a photo taken for the BC Services Card.
Quebec. You register with RAMQ on arrival. The Quebec government warns that registering late delays your eligibility.

Practical tips that apply almost everywhere:

If your family arrives later, add them when they land rather than before.
Renew on time and update your address. An expired card or a wrong address is a common cause of surprise bills.
Respect the residency rule. Long absences can end your eligibility. Ontario, for instance, expects you to be physically present 153 days in any 12-month period.

International students

International students do not get free health care automatically. The Government of Canada does not pay the medical costs of foreign students, and whether a provincial plan covers you depends entirely on the province. Where it does not, your school will normally require you to join a private plan.

Province	What official sources say for international students
Ontario	International students must have health coverage through the University Health Insurance Plan (UHIP) or the plan their school requires. Study permit holders are not in the list of people who qualify for OHIP.
British Columbia	Holders of study permits valid for six months or longer may be deemed residents and can enrol in MSP after the wait period. Check with the province whether a health fee applies to you, and hold private cover while you wait.
Alberta	Study permit holders may qualify for AHCIP if they establish residency, intend to live in Alberta for at least 12 consecutive months and can show full-time attendance at an Alberta institution.
Saskatchewan	International students living in the province temporarily may qualify with proof of full-time enrolment and a valid study permit.
Nova Scotia	Study permit holders can generally apply for a health card on the first day of the 13th month after arrival, so private or school cover is needed for the first year. Some teaching and research assistants are covered sooner.
Quebec, Manitoba and others	Check your province and school. Rules depend on agreements, permit length and the institution.

Things to settle before you travel:

Ask the school's international office which plan is mandatory, what it costs, when it starts and whether you can opt out with equivalent coverage.
Check the start date against your arrival date. If you land before the school plan begins, you need a short private policy for the gap.
Budget for the premium alongside tuition and rent. Our guide on how to pay for studying abroad covers the wider cost picture, and the student bank account guide explains how to set up the account your refunds will be paid into.

Temporary workers

Many work permit holders qualify for a provincial plan, but only if the permit and the job meet that province's conditions. Until provincial coverage begins, you need private insurance, and in some programmes your employer must pay for it.

Examples of provincial conditions:

Ontario lists people on a valid work permit who work full-time in Ontario for an Ontario employer for at least six months among those who can qualify for OHIP.
British Columbia may treat holders of work permits valid for six months or longer as residents for MSP.
Quebec applies a three-month waiting period to most temporary workers, with an exception for seasonal agricultural workers, who are eligible without the wait.

When the employer must pay

Under the Temporary Foreign Worker Program's low-wage stream, Employment and Social Development Canada requires employers to obtain and pay for private health insurance that covers emergency medical care for any period when the worker is not covered by the provincial or territorial plan. The cover must begin on the worker's first day of work, and the employer cannot recover the cost from the worker. If you are in this stream and are asked to pay for that policy, that is a breach of programme rules worth raising.

International Experience Canada

Working holiday and other International Experience Canada participants must have health insurance for the entire time they are in Canada. IRCC says the policy must cover medical care, hospitalization and repatriation, that you can be refused entry without it, and that a work permit may be issued only for as long as the insurance lasts. Buy a policy that matches the full length of your planned stay.

Visitors and the super visa insurance requirement

Visitors are not covered by any provincial plan. IRCC states that Canada does not pay for hospital or medical services for visitors and that you should get health insurance to cover medical costs before you come.

Super visa: insurance is mandatory

The super visa lets parents and grandparents of Canadian citizens and permanent residents stay for extended periods. Private health insurance is a condition of the visa. According to IRCC, the policy must:

provide a minimum of CAD 100,000 in emergency coverage;
be valid for a minimum of one year from the date of entry, and for each entry to Canada;
cover health care, hospitalization and repatriation;
be paid in full or in instalments with a deposit (quotes are not accepted);
come from a Canadian insurance company, or from an insurer outside Canada that is authorized by the Office of the Superintendent of Financial Institutions (OSFI), appears on OSFI's public list and issued the policy while doing insurance business in Canada.

Buying tips for families

CAD 100,000 is a minimum, not a recommendation. Consider the applicant's age and health when choosing the limit.
Read the pre-existing condition and stability wording before you pay. It is the most common reason claims on visitor policies are refused.

Refugees, asylum claimants and the IFHP

The Interim Federal Health Program (IFHP) gives limited, temporary health coverage to resettled refugees, asylum claimants, protected persons and certain other groups who are not yet eligible for a provincial or territorial plan. It is a federal programme run by IRCC.

Group	How long IFHP coverage lasts, according to IRCC
Asylum claimants	From the time they receive their claim documents until they qualify for provincial or territorial insurance or leave Canada
Protected persons in Canada	For 90 days after a positive decision, or until they qualify for provincial or territorial insurance
Resettled refugees	Basic coverage until they qualify for provincial or territorial insurance; supplemental benefits while they receive income support

What the IFHP pays for

Basic coverage, at no cost: in-patient and out-patient hospital services and services from doctors, nurses and other licensed health professionals, including prenatal and postnatal care.
Prescription drugs, with a co-payment of CAD 4 for each prescription filled or refilled.
Supplemental coverage, such as urgent dental care, vision care, mental health counselling, physiotherapy and assistive devices. The programme pays 70% of eligible costs and the patient pays 30%.

Moving between provinces

When you move within Canada, your old province keeps covering you during the new province's waiting period, so there should be no gap for insured services. Health Canada says you will continue to be covered by your home province or territory for three months, and that coverage in the new one begins after that period, provided you have registered.

What to do:

Tell your current plan that you are leaving and when.
Register in the new province as soon as you arrive. Alberta, Manitoba, Saskatchewan and Nova Scotia all start coverage for interprovincial movers on the first day of the third month after you establish residence, and British Columbia uses the rest of the month of arrival plus two months.

Out-of-country coverage and travel insurance

Your provincial plan pays very little outside Canada. It reimburses emergency care at roughly what the service would have cost at home, which can be a small fraction of a foreign hospital bill, and the Government of Canada will not pay your medical bills abroad.

Ontario publishes its limits, and they illustrate the gap. For emergencies outside Canada, OHIP pays up to CAD 50 a day for out-patient services and up to CAD 200 a day for in-patient care, or up to CAD 400 a day for higher levels such as intensive care, plus doctors' services at Ontario rates. Ontario states that it is essential to buy travel medical insurance and that OHIP does not pay to bring you home.

Travel.gc.ca, the federal travel advice site, says your provincial or territorial plan may cover none, or only a small part, of the costs. It advises looking for three things in a travel health policy:

Medical evacuation to Canada or the nearest place with appropriate care, including a medical escort.
Pre-existing conditions, confirmed in writing, with a clear stability clause.
Repatriation in case of death.

Before you buy, check what you already hold. FCAC points out that a workplace plan or a credit card may include some out-of-country medical cover. Check the trip length limit, the age limit and whether the card must be used to pay for the trip. For a fuller walk-through, see our guide to what travel insurance covers and what it does not.

Private and supplemental health insurance

Private health insurance in Canada supplements the public plan; it does not replace it. It pays for the things medicare leaves out: prescription drugs, dental, vision, paramedical practitioners, medical equipment, ambulance, semi-private hospital rooms and emergency care while travelling.

Employer group benefits

This is how most privately insured Canadians are covered. The employer buys one contract for all eligible employees and usually pays part or all of the premium. Because risk is pooled across the group, there is normally no medical questionnaire for basic coverage, and pre-existing conditions are generally covered from the start. Spouses and dependent children can usually be added. FCAC notes that a policy may cover your partner and children under 19, with plan-specific rules for older students.

Individual and family plans

If you are self-employed, a contractor, between jobs or retired, you can buy a plan directly. These come in two broad kinds:

Medically underwritten plans ask health questions. They may offer higher limits, but the insurer can decline you, charge more or exclude a condition.
Guaranteed-acceptance plans ask few or no health questions. Anyone eligible is accepted, but drug and dental limits tend to be lower and the price per dollar of benefit higher.

Conversion plans when you leave a job

Many insurers let people leaving a group plan move to an individual plan without medical questions if they apply within a short window after group coverage ends. The window is set by the insurer and is strict, so ask your human resources contact or the insurer about it before your last day. A conversion plan is often less generous than the group plan, but it can be the only way to keep drug coverage for a known condition.

Self-employed people and small business owners

Options include an individual plan, a group plan through a professional association or chamber of commerce, or a small-business group plan that can start with very few employees. Some owners pair a basic insured plan with a health spending account. Think about income protection at the same time: with no employer sick pay, disability insurance may matter more than a rich dental plan.

Seniors and retirees

At 65, provincial drug programmes for seniors begin in several provinces, which changes what you need from a private plan. Retiree benefits from a former employer, if offered, are usually worth keeping. Otherwise, compare an individual plan against simply paying dental and vision costs yourself, and check whether you might qualify for the CDCP. Travel medical cover deserves the most attention, because premiums and health questions increase with age.

Several other products are sold alongside health insurance and are easy to confuse with it. Supplemental health insurance reimburses bills; most of the others pay cash to you when a defined event occurs.

Product	What it pays	When it pays	Points to check
Critical illness insurance	A one-time lump sum you can spend as you wish	On diagnosis of an illness listed and defined in the policy	FCAC warns that covered illnesses and definitions differ between insurers; check the survival period and exclusions
Disability insurance	A monthly income, which FCAC describes as replacing roughly 60% to 85% of income up to a maximum	When illness or injury stops you from working, after a waiting period	Definition of disability (your own job or any job), benefit period, and tax: benefits are generally tax-free if you paid the whole premium and taxable if your employer paid any of it
Long-term care insurance	A benefit toward care costs	When you can no longer care for yourself or need help with daily activities	Trigger for payment, waiting period, benefit duration, and whether it covers home care as well as facilities
Travel medical insurance	Emergency medical bills, evacuation and repatriation	Sudden illness or injury outside your province or Canada	Stability clause, trip length limit, exclusions, direct billing
Health spending account	Reimbursement of eligible medical expenses up to a fixed annual amount	When you submit receipts	An employer benefit, not insurance; unused amounts may expire; having one that covers dental can affect CDCP eligibility

Life insurance is a separate decision again. If you are weighing it at the same time, see our explainers on whole life versus term life insurance and life insurance with no medical exam.

Coordination of benefits

Coordination of benefits is the set of industry rules that decides which plan pays first when you are covered by more than one, such as your own workplace plan and your spouse's. Used properly, two plans can together reimburse up to 100% of an eligible expense, but never more.

CLHIA, the industry association, publishes the rules that insurers follow. The main ones:

Your own plan pays first for your own claims. The plan that covers you as an employee or member is primary; a plan that covers you as a dependant is secondary.
Order depends on status, not generosity. Between group plans, coverage as an active full-time employee comes before part-time or retiree coverage. It does not matter which plan is better.
Children: the birthday rule. For dependent children, the plan of the parent whose birthday falls earlier in the calendar year (month and day, not year of birth) pays first.

Deductibles, co-insurance and maximums, with a worked example

The premium tells you what a plan costs; the deductible, co-insurance and maximums tell you what it actually pays. FCAC advises checking whether an insurer covers only a percentage of each claim and whether there is a maximum annual amount.

Term	Meaning
Premium	The price of the plan, usually charged monthly
Deductible	The amount you pay each year before the plan starts to reimburse, per person or per family
Co-insurance	The percentage split after the deductible, for example the plan pays 80% and you pay 20%
Annual or lifetime maximum	The most the plan will pay for a benefit in a year or over the life of the policy
Eligible expense	The amount the plan recognizes for a service, which can be lower than the provider's actual charge

Illustrative example: the Okafor family

The following example is fictional. The plan design, the premium and every amount are invented to show the arithmetic and are not based on any real insurer or price.

The Okafors, two adults and two children, have a family plan with these features: a CAD 100 annual family deductible that applies to drugs; 80% co-insurance on drugs; 80% on basic dental with a CAD 1,500 annual maximum per person; a vision allowance of CAD 250 per person; and physiotherapy at 80% up to CAD 500 per person per year.

Expense in the year	Billed	How the plan calculates	Plan pays	Family pays
Prescription drugs	CAD 1,800	(1,800 - 100 deductible) x 80%	CAD 1,360	CAD 440
Dental work for one child	CAD 2,400	2,400 x 80% = 1,920, capped at the 1,500 maximum	CAD 1,500	CAD 900
Glasses for one adult	CAD 420	Flat allowance of 250	CAD 250	CAD 170
Physiotherapy for one adult	CAD 900	900 x 80% = 720, capped at the 500 maximum	CAD 500	CAD 400
Total	CAD 5,520		CAD 3,610	CAD 1,910

Now add the premium. Assume the plan costs CAD 210 a month, or CAD 2,520 a year.

If an employer pays half the premium, the family pays CAD 1,260 in premiums plus CAD 1,910 in uncovered costs, for a total of CAD 3,170. Without any plan they would have paid CAD 5,520, so they are CAD 2,350 better off.
If they buy the same plan themselves, they pay CAD 2,520 plus CAD 1,910, a total of CAD 4,430. They are still CAD 1,090 ahead in this particular year.
In a quiet year with only CAD 1,000 of drug claims, the plan would pay (1,000 - 100) x 80% = CAD 720. A family paying the full CAD 2,520 premium would be CAD 1,800 worse off than if it had no plan.

What affects your premium

For an individual plan, the price mainly reflects who is covered, how much the plan can pay and how likely you are to claim. We do not quote prices because they vary by insurer, province and date.

Age. Premiums generally rise with age, and some plans have age bands or maximum entry ages.
Who is covered. Single, couple and family rates differ.
Plan design. Higher drug limits, major dental, orthodontics and travel benefits add cost. Higher deductibles and lower co-insurance reduce it.
Health history. On underwritten plans, your answers can raise the price or lead to exclusions. Guaranteed-acceptance plans price that uncertainty into everyone's premium.

Tax notes

Three CRA rules matter to most households: premiums you pay for a private health plan can count as medical expenses, employer-paid premiums to a private plan are generally not a taxable benefit federally, and only unreimbursed costs can be claimed.

The medical expense tax credit

You claim eligible medical expenses on lines 33099 and 33199 of your return, for any 12-month period ending in the tax year.
The credit is non-refundable. For expenses claimed on line 33099, you can claim only the amount above a threshold: the lesser of 3% of your net income or a fixed dollar amount that the CRA updates each year. For the 2025 tax year that amount was CAD 2,834.
You can claim only the part of an expense that has not been, and will not be, reimbursed by a plan.
The CRA lists premiums paid to private health services plans, including medical, dental and hospitalization plans, as an eligible expense, provided 90% or more of the premiums paid under the plan are for eligible medical expenses.

Employer plans

The CRA's payroll guidance says that when an employer contributes to a private health services plan for employees, there is generally no taxable benefit to the employee for federal purposes, as long as the plan meets the CRA's conditions. If the employee pays part of the premium, that part can be claimed as a medical expense. By contrast, if an employer pays a provincial health plan premium on an employee's behalf, that is a taxable benefit. Quebec has its own provincial tax rules, so Quebec residents should check with Revenu Quebec.

How to choose a plan, step by step

Start from your real expenses and the coverage you already have, not from a brochure. The right plan is the one that covers your largest likely costs at a price that still makes sense in a quiet year.

Confirm your public coverage. Is your health card active? Are you in a waiting period? Which provincial drug programme, if any, applies to your age and income?
List what you already have. Your workplace plan, your spouse's plan, a student plan, credit card travel benefits. FCAC advises checking existing cover first so that you do not pay twice.
Add up last year's uncovered costs. Prescriptions, dental, glasses, physiotherapy, counselling. Separate recurring costs from one-off ones.
Compare like with like. For each quote, line up the deductible, co-insurance, annual maximum per benefit, drug formulary rules, dental recall frequency, waiting periods and travel days covered.
Check the insurer and the seller. Confirm the advisor's licence with the provincial regulator and that the insurer is an Assuris member.
Answer every question truthfully. FCAC warns that if you do not, the insurer could cancel your policy or refuse a future claim.

Pre-existing conditions and stability clauses

A pre-existing condition is a health problem that existed before your coverage started. Public plans cover medically necessary care regardless of your history. Private plans may not, and the wording matters more than anything else in the policy.

In supplemental health plans

Group plans generally cover employees without medical questions. Individual underwritten plans can exclude a condition or limit the related drug coverage, while guaranteed-acceptance and conversion plans avoid the questions but cap the benefits. If you take a costly ongoing medication, the timing of any switch between plans is critical: confirm in writing that the drug is covered before you cancel the old plan.

In travel and visitor policies

FCAC notes that travel policies typically do not cover conditions you had before applying. Many will cover a pre-existing condition only if it has been stable for a set period before departure or before the policy starts. Travel.gc.ca advises getting any agreement to cover a pre-existing condition in writing and making sure you understand the stability clause.

"Stable" is defined by the policy, not by how you feel. Depending on the wording, a condition may be treated as unstable if, during the stability period, there was a new diagnosis, a new or changed medication or dose, new or worsening symptoms, a hospital stay or tests still pending. This catches many travellers and visiting parents out, because a routine dose adjustment a few weeks before a trip can void cover for that condition.

Claims, appeals and complaints

Most claims are paid quickly through direct billing at the pharmacy or dental office or through an online portal. When a claim is refused, you have a clear path: the insurer's internal process first, then an independent ombudservice or your provincial regulator.

Making a claim

Use direct billing where the provider offers it, and keep the receipt showing what the plan paid.

If a claim is denied

Get the reason in writing and compare it with the policy wording. Many denials are fixable: a missing prescription, a wrong code or a provider who is not recognized by the plan.
Appeal to the insurer. FCAC advises preparing your policy number and documents, using the company's complaint-handling process, and keeping notes of dates, names and what was said. For group plans, your plan administrator can also help.
Ask for the insurer's final position in writing. The OmbudService for Life and Health Insurance (OLHI) says you should first follow the insurer's internal complaint process and obtain its final position; if you are still not satisfied, you can then bring the complaint to OLHI.
Go to OLHI. It offers free, independent and impartial complaint resolution for consumers across Canada, in English and French. It says it aims to conclude most complaints within 120 days of acknowledging them in writing.
Contact the regulator. FCAC notes that you can contact your provincial or territorial insurance regulator at any point, and that in Quebec complaints go to the Autorite des marches financiers. FCAC itself does not resolve individual complaints.

Assuris protection and licensed advisors

If a life and health insurer fails, Assuris protects its policyholders up to set limits, and you do not need to register for it. Assuris describes itself as Canada's life and health insurance guarantee fund and says Canadian citizens and residents who bought a policy from a member company are automatically protected, for both individual and group products.

Benefit type	Assuris protection if a member insurer fails
Health expense	CAD 250,000 or 90% of the promised benefit, whichever is higher
Monthly income (such as disability benefits)	CAD 5,000 a month or 90%, whichever is higher
Death benefit	CAD 1,000,000 or 90%, whichever is higher

Working with a licensed advisor

Anyone who sells you health, disability or critical illness insurance must be licensed in your province or territory. FCAC explains that an agent represents one insurer while a broker can offer products from several, and that you should confirm the licence with your provincial or territorial regulator.

Questions worth asking:

Which insurers can you offer, and how are you paid?
What exactly is excluded, and where is that in the policy?

Scams and red flags

Health coverage attracts fraud because it involves personal data, government programmes and people who are new to the country. The safest rule is to deal only with your provincial ministry, canada.ca pages and licensed insurers and advisors you have checked yourself.

The Canadian Anti-Fraud Centre describes phishing as messages that imitate real organizations, create urgency, promise a refund or ask you to click a link. It warns in particular about messages claiming to come from the Government of Canada, which it says will never contact you to offer funds by email or e-transfer. The Government of Canada also warns of fraudulent messages about the Canadian Dental Care Plan.

Red flag	Why it matters	What to do
A text or email saying your health card or dental plan is expiring, with a link	Classic phishing for card numbers and identity data	Do not click; go to the official site by typing the address yourself
A fee to apply for a health card or the CDCP	There is no fee to apply for or renew CDCP coverage, and provincial registration is done with the ministry	Apply only through official channels
Super visa or visitor "insurance" at a price far below every other quote, from an unknown seller	The policy may not meet IRCC rules or may not exist	Check that the insurer is Canadian or on OSFI's list; verify the policy with the insurer
A provider offering to bill your plan for services you did not receive, or to split the proceeds	This is benefits fraud, and the plan member can face loss of coverage, loss of a job or prosecution	Refuse, and report it to your insurer

If you have shared information or lost money, contact your bank or card issuer, your insurer and the local police, and report to the Canadian Anti-Fraud Centre through its online reporting system. Many of the warning signs are the same as in lending fraud, which we cover in how to avoid loan scams and fake offers.

Common mistakes

Most costly errors come from assuming that "free health care" covers everything, everywhere, from day one.

Arriving without bridging insurance. A single emergency visit during a waiting period can cost far more than three months of cover.
Assuming a study permit means provincial coverage. It depends on the province and, in Nova Scotia for example, on how long you have been there.
Letting group coverage lapse after leaving a job without asking about a conversion plan in time.

Checklist

Use this list when you arrive, change jobs or review your coverage.

I know which provincial or territorial plan applies to me and whether I meet its residency rule.
I have applied for my health card and know the date my coverage starts.
I have private emergency cover for any waiting period, starting on my arrival date.
I have checked whether I qualify for the Canadian Dental Care Plan.
I have travel medical insurance for every trip outside my province, and I understand its stability clause.
I have confirmed that my advisor is licensed and my insurer is an Assuris member.
For visiting parents: the policy meets IRCC's super visa rules and I have proof of payment.

FAQ

Is healthcare free in Canada?

Partly. Eligible residents do not pay at the point of care for medically necessary hospital and doctor services, which are funded through taxes. Prescription drugs from a pharmacy, dental care, vision care and many other services are not covered by the basic plan, and the Canadian Institute for Health Information (CIHI) estimates that about 29% of health spending in Canada is private.

Do newcomers have to wait for health coverage?

It depends on the province and your status. Ontario has no waiting period for eligible applicants. British Columbia applies a wait of the rest of the month of arrival plus two months, and Quebec generally applies up to three months. The Canada Health Act caps any waiting period at three months. Buy private cover for the gap.

Do international students get free healthcare in Canada?

Not automatically. The federal government does not pay medical costs for foreign students. Some provinces let eligible students join the provincial plan, sometimes after a waiting period, while in others, such as Ontario, students must buy a plan such as UHIP through their school. Check your province and school.

Can visitors use the Canadian health care system?

Visitors can receive care but must pay for it. IRCC states that Canada does not pay for hospital or medical services for visitors and advises buying health insurance before travelling.

How much health insurance is required for a super visa?

IRCC requires private health insurance with at least CAD 100,000 of emergency coverage, valid for at least one year from the date of entry, covering health care, hospitalization and repatriation, and paid in full or by instalments with a deposit. A quote is not enough.

What happens to my health coverage if I move to another province?

Your former province continues to cover you during the new province's waiting period, generally up to three months, as long as you register in the new province. Supplementary benefits such as drug programmes do not transfer, so review them after you move.

Does my provincial health card cover me outside Canada?

Only to a very limited extent. Provinces reimburse emergency care abroad at their own rates; Ontario, for example, pays up to CAD 200 to CAD 400 a day for emergency in-patient care. Foreign hospital bills can be far higher, so governments advise buying travel medical insurance for every trip.

What is a stability clause in travel insurance?

It is a condition that a pre-existing medical problem must have been stable for a set period before your trip or policy start date for related claims to be paid. The policy defines "stable", and changes in medication, new symptoms or pending tests can break it. Get any coverage for a pre-existing condition confirmed in writing.

If I have two health plans, which one pays first?

Under CLHIA's coordination of benefits rules, the plan that covers you as an employee or member pays first, and the plan that covers you as a dependant pays second. For children, the plan of the parent whose birthday comes earlier in the calendar year is first. Combined payments cannot exceed 100% of the eligible expense.

Can I claim health insurance premiums on my tax return?

The CRA lists premiums you pay to private health services plans, including medical, dental and hospitalization plans, as eligible medical expenses, subject to conditions. The credit is non-refundable and applies only to the portion of total medical expenses above a threshold tied to your net income. Provincial plan premiums do not qualify.

What happens if my health insurance company goes out of business?

If the insurer is an Assuris member, your benefits are protected up to set limits. For health expense benefits, Assuris guarantees CAD 250,000 or 90% of the promised benefit, whichever is higher. Protection is automatic.

Who do I complain to about a denied health insurance claim?

First use the insurer's internal complaint process and ask for its final position in writing. If you are still unhappy, the OmbudService for Life and Health Insurance (OLHI) reviews complaints free of charge. You can also contact your provincial insurance regulator, or the Autorite des marches financiers in Quebec.

Bottom line

Canada's public system is strong where it applies: if you are an eligible resident with a valid health card, you will not be billed for medically necessary doctor and hospital care. The risks sit at the edges. They are the months before your card is active, the services medicare never covered, and every trip outside your province.

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