Canada prides itself on its free and accessible health care system. Unlike our neighbours to the south, Canada offers medically necessary care at no cost, which means Canadians are not required or expected to pay for medical attention out-of-pocket.
However, only some things are covered. While Canadians may be able to visit their doctors or receive emergency care in hospitals, several health-related items are not covered, like dental and vision care, and even paramedic services.
For this reason, roughly two-thirds of Canadians have private, employer or group insurance plans to help with the costs of care not covered under the public health care system.
Key Points
- Canada offers medically necessary health care services to Canadians, which are covered under provincial health care plans.
- While necessary medical care may be free, several other services are not included, like dental and vision care.
- Many Canadians who don’t have access to employer-sponsored medical benefits choose to take out private medical insurance plans to ensure adequate coverage for services not covered under provincial health care plans.
If Health Care Is Free, Do You Really Need Private Health Care Insurance?
Provincial health care plans across the country provide Canadians with access to free physician and hospital care where medically necessary. However, there are several limitations to such plans. As such, many Canadians choose to supplement their provincial health care coverage with private insurance, for various reasons that include the following:
Overloaded Health Care System
The Canadian health care system is currently facing significant strain. Several factors have led to excessively long wait times, delays, and staffing shortages.
For instance, Ontario is currently experiencing a nurse shortage number of over 10,000, which is expected to reach 13,200 by the end of this year. The province is also seeing unacceptable hospital room wait times, with patients admitted to hospitals spending nearly 22 hours on average waiting in an ER for an inpatient bed.
Those who wish to avoid such waiting times may choose to pay for medical services and cover these costs through private insurance plans instead.
Limitations In Provincial Health Care Coverage
As mentioned, not everything is covered under provincial health care plans. Only medically necessary care is provided, and even then, it may not be enough.
For example, prescription medication, routine dental care, physiotherapy, vision care, and many other services are generally not covered. Paying for such services out-of-pocket can prove to be too expensive for many Canadians. In this case, it may be more affordable to pay insurance premiums for a policy to ensure adequate coverage without having to incur high costs of various forms of medical care.
Lack Of Employer-Based Health Insurance
Employers often provide some sort of group health insurance plan to their staff. Unfortunately, those who are not traditionally employed or unemployed do not have such advantages. Further, many employers don’t provide medical benefits at all.
For instance, a recent report found that around one-third of employees in Ontario don’t have medical or dental benefits through their employers. Further, over half of Canadian employees who do have some sort of employer-based plans say their benefits are not adequate enough to meet their needs. One way to resolve this issue is to take out a private insurance policy.
Benefits Of Private Health Care Insurance
Private health care insurance in Canada offers a number of benefits, particularly when used in conjunction with the public health care system. Key benefits include the following:
Timely Diagnosis
Faster access to medical care or testing can ensure that potential medical issues are caught early. If there is an issue, it can be diagnosed in a more timely fashion, which can increase the odds of a successful outcome. Missed or late diagnoses can lead to poorer health outcomes.
A recent physician survey conducted by the Fraser Institute found that patients across Canada experienced a median wait time of 27.7 weeks between a referral from a general practitioner and treatment. This figure represents a whopping 198% longer than the 9.3 weeks reported in 1993. But with private health care options, Canadians can access care and testing in as little as a few days rather than waiting weeks, months, or longer.
Better Quality Experience
Private health care insurance may provide a better experience with medical attention and treatment options. Not only are wait times shortened, but there may be less crowding that is often typical of conventional physician and hospital waiting rooms.
Additional Health And Wellness Programs And Treatments
Many private insurance plans include access to wellness programs, such as preventive health screenings, nutritional counselling, mental health services, chiropractic, and physiotherapy, among others. Such programs can support overall wellness and help prevent health issues in the future.
Reduced Out-of-Pocket Expenses
For health care services that are not covered by provincial health care plans — such as dental and vision care — private health insurance helps minimize expenses that would otherwise be required to pay out-of-pocket for each individual service.
Where Can You Get Private Health Insurance In Canada?
Several insurance providers offer private health insurance plans to Canadians to help supplement public health care coverage:
PolicyMe
PolicyMe offers health and dental insurance coverage under their Guaranteed Issue Plan and Protect Plan, each of which contains several plans with various types of and levels of coverage.
Guaranteed Issue Plan
Under the Guaranteed Issue Plan umbrella, several health and dental insurance plans are available that offer a range of coverage, from basic to comprehensive:
- Dental Care Plan
- Economic Plan
- Classic Plan
- Advanced Plan
Prescription Drug Benefits Features
The Economic, Classic, and Advanced plans all provide some level of prescription drug coverage (excluding the Dental Care plan). Depending on the plan you choose, you can get up to $700 in coverage per year (up to 70%) for prescription medication.
Dental Plan Features
All PolicyMe plans provide coverage for basic preventative and restorative dental care, up to a specific limit. Coverage amounts range from $500 to $1,200 per year, with 70% to 90% of costs covered.
Under the Advanced Plan, coverage is also provided for major services, including crowns, bridges, endodontic/periodontal treatment, and orthodontics treatments.
Vision Plan Features
All PolicyMe plans provide coverage for eye examinations, prescription lenses and frames, contact lenses, and laser eye surgery. Coverage amounts for eye exams vary from $60 to $100 every two years, and for lenses and glasses, coverage ranges from $200 to $400 every two years.
Extended Health Care Benefits
PolicyMe plans also provide additional coverage for extended health care benefits. Depending on the plan you choose, you may receive coverage for the following:
- Accidental dental care
- Ambulance services
- Hearing aids
- Diagnostic services (Quebec only)
- Home care and nursing, prosthetic appliances, and medical equipment
- Chiropractor, massage therapist, physiotherapist, acupuncturist, chiropodist, podiatrist, dietitian, naturopath, and osteopath.
- Speech therapy
- Mental health services
- Access to telehealth
Protect Plan
For extra coverage for your prescription medication, PolicyMe’s Protect Plan may be worth considering. Like the Guaranteed Issue Plan, the Protect Plan includes three different plan options with various amounts of coverage:
- Economic Plan
- Classic Plan
- Advanced Plan
Dental care, vision care, and extended health care benefits are the same for both the Protect Plan and the Guaranteed Issue Plan. However, the Protect Plan provides extra coverage for prescription drugs, which range from $1,000 to $2,800 per year with 80% coverage.
SunLife
SunLife provides three different private health insurance plans that vary in cost and coverage amount:
Basic Plan
Sun Life’s basic plan is a low-cost plan that covers basic medical and dental needs. It’s best for those looking for affordable coverage
Standard Plan
The standard plan includes additional coverage from the basic plan, including:
- Prescription drugs
- Emergency medical coverage for travel
- Optional preventive dental coverage
Enhanced Plan
This is Sun Life’s most comprehensive plan and includes additional coverage from the previous plans, including:
- Highest amount of coverage for prescription medication
- Optional dental coverage that includes restorative and orthodontic care
Blue Cross
Blue Cross is a popular insurance company in Canada and offers several insurance plan options to Canadians, including private health insurance plans. The insurer’s plans are specific to each province in Canada, so each provincial plan may differ slightly. That said, Blue Cross private insurance plans typically include coverage for the following:
- Prescription drugs
- Dental care
- Vision care
- Ambulance services
- Post-hospital care
- Massage therapy
- Virtual physician care
Manulife
Manulife provides three health and dental insurance plans to choose from, based on how much you want to spend and the coverage amount you need:
Flexcare Health & Dental Insurance
Flexible and affordable private health insurance includes:
- Prescription medication
- Dental care
- Combination of prescription medication and dental care with vision care and extended health care coverage
- TELUS Health Virtual Care
Health & Dental Guaranteed Issue Enhanced Insurance
More comprehensive plan that includes:
- Prescription medication
- Dental care
- Registered specialists and therapists
- Vision care
- Nursing
- Mental health and therapy
- Ambulance services
- Medical equipment
- Emergency medical travel insurance
- TELUS Health Virtual Care
FollowMe Health & Dental Insurance
This protection is designed to start when you leave work and your employee health benefits end:
- Prescription drugs
- Dental care
- Vision care
- Registered specialists and therapists
- Emergency medical travel coverage
- TELUS Health Virtual Care
Health Plus
Health Plus provides health care insurance plans that are designed for the self-employed, small business owners, freelancers, and other Canadians who don’t have coverage under an employer-sponsored plan. The Health Plus plans include the following:
Priority Plan
- 70% Health services such as prescription medication, hearing aids, diagnostic services and ambulance services.
- 70% Paramedical services
- 100% Semi-private hospital rooms, including private nursing and travel emergency care
- 70% Dental care, including:
- Accidental injury
- 50% coverage for major restorative dental services
Optimum Plan
- 90% Health services
- 90% Paramedical services
- 100% Semi-private hospital rooms, including:
- Vision care
- 80% Dental care, including:
- 90% for accidental injury
- 50% for major restorative dental services
GreenShield
GreenShield has been in the insurance industry for over 65 years and provides flexible plans for Canadians, including the following:
- Comprehensive health and dental plans
- Guaranteed acceptance plans with no medical questions
- Complete coverage plans that include dental care, prescription drugs, vision care and mental health services
- Individual health solutions, including mental health services and pharmacy services
GMS
GMS offers private health insurance plans to bridge the gap between what’s covered under public health care plans and what’s not. Plans include the following:
Personal Health Coverage
The Personal Health benefits plan provides flexibility to help you tailor your plan to what works for you. Under this plan, coverage may include:
- Optometrists, glasses, and contact lenses
- Acupuncture, physiotherapy, massage, and other treatments
- Dental care
- Prescription medication
Replacement Health Coverage
Canadians who are retiring or leaving their jobs may need alternative health coverage once their employer-sponsored plan ends. Under the Replacement Health Coverage Plan, coverage may include:
- Optometrists, glasses, and contact lenses
- Chiropractic, naturopath, and massage therapy
- Dental care
- Prescription medication
- Orthopedic shoes
Problems With Private Health Insurance
While the benefits of private health care insurance may be plentiful, there are a few potential drawbacks to consider:
Expensive
Provincial health care plans are provided to residents for free, with the exception of certain services, like routine dental and vision care. Private health insurance plans, on the other hand, require regular premium payments and can be quite expensive for more comprehensive coverage. Plus, there may be deductibles required before insurance coverage kicks in.
Overlap With Public Health Care
Depending on the type of health care you wish to receive, private health care plans may seem like you’re paying money for services that you’d already receive under provincial health care plans. Plus, you may be paying for coverage you don’t use or need.
Limited Coverage For Pre-Existing Conditions
Private medical insurance often has stipulations when it comes to covering pre-existing conditions. You can either be turned down for insurance, or your condition may not be covered, which limits the benefits accessible to you.
Does Private Health Insurance Cover Long-Term Care?
Long-term care is one of the health care services that is not fully covered by government health care plans in Canada. Public health care programs may only cover a small portion of these costs, and sometimes none at all, depending on the situation.
Private health insurance plans may offer coverage depending on the provider and plan you choose. Insurance plans that offer long-term care coverage may include things like:
- Nursing care
- Rehabilitation and therapy
- Personal care, like help getting dressed, bathing, and eating
- Meal preparation
- House cleaning
- General assistance as needed
Long-term care insurance can cover care in a variety of settings, including at a nursing home, retirement residence, or at-home care. These policies also provide regular income-style benefit payouts without the need to submit receipts for reimbursement.
Does Private Health Care Exist In Canada?
Despite provincial health care plans, private medical facilities do exist throughout Canada. That said, there is plenty of confusion and ambiguity when it comes to the legality of private health care in Canada.
Under the Canada Health Act, it’s illegal to get a service covered by private insurance if it is covered under the Act. No other country in the world has such stipulations. Interestingly, however, this “law” has limited legal effect. Unlike the Canadian Charter, the CHA is not a constitutional statute that establishes rules that could impose criminal consequences if violated.
Instead, the CHA states that Canadians must have access to free and reasonably timely health care that is considered “medically necessary”, and that such care must be publicly paid for. However, rather than explicitly defining what should be publicly supported on the national level, the CHA leaves the provinces and territories in charge of defining what it means to be “medically necessary” care. In turn, inconsistencies in coverage across the provinces exist, and the federal government has appeared to be tolerant when it comes to this issue.
Ultimately, the CHA may say “no” to private health care, but such care still exists. There are many places throughout the country that provide health care services to those who are willing to pay for it. Examples of such clinics include Medcan and Axxess Imaging in Toronto. In exchange, such services are provided with little to no wait time.
Final Thoughts
Unless your employer offers comprehensive health benefits, you may want to consider buying a private health care insurance plan to ensure adequate coverage. This is especially true if you’re self-employed or unemployed, or if you need more extensive services that are not covered by provincial health plans or your employer-sponsored plan.
