What is health insurance in Canada?
Under the Canada Health Act, provinces and territories must provide health insurance plans that meet certain criteria and conditions. This ensures that individuals in Canada are able to access necessary medical services.
Each province or territory determines which services are considered medically necessary for insurance purposes. This is done by extensive consultation with physician colleges and groups. If a service is deemed not medically required, the provincial or territorial health insurance plan doesn’t need to cover it.
This is where supplemental health insurance comes in. Supplemental or private health insurance is purchased individually or provided through your place of employment. These plans cover additional services and fees, thereby reducing your costs. Some insurance providers will require you to pay the fee for services and insured items upfront, then reimburse you while others will cover the cost directly.
Public health insurance vs. private health insurance
You may be asking yourself, what does health insurance cover in Canada? The public system provides essential and emergency services – here are some facts about the system.
Canada’s universal health care system:
- Is funded through taxes
- Is administered by provinces and territories
- Is not the same across all provinces and territories' health care plans
- Uses a provincial or territorial health card to receive benefits
- Covers most health care services
- Covers emergency medical services
- Generally does not cover medication if not provided by a doctor
- Does not cover most dental services
As you can see, there are some gaps in the public insurance system. While some of these might be filled in by provincial or territorial insurance, others will require you to have additional, private insurance.
Private health insurance plans offer different types of coverage. Some may require you to have a physical performed before insuring you, and some may include or exclude certain things. It’s important to consider what your requirements are and what you might need in the future when looking at private health insurance.
Typically, all or part of the following costs are covered by private health insurance:
- Ambulance services
- Dental care
- Eyeglasses obtained through prescription
- Physiotherapy
- Prescription medication
Employers may provide health insurance in their benefits package. You should speak with them about what is and what isn’t provided before acquiring additional private insurance.
How much does health insurance cost?
As with any insurance, there are a number of factors that influence your health insurance costs. Not only does your current health status, and any underlying conditions you may have, impact your premiums, but your age, your gender, your earnings, where you live, and how much additional coverage you want all impact the price.
In order to get an accurate idea of the cost of health insurance, you should speak to an insurance provider directly or consult an insurance broker. To give you a picture of what to expect, however, you can consider the following table, outlining health insurance premiums for a potential policyholder.
Canada health insurance cost | ||
Age | Low price ($) | High price ($) |
18 | 82.55 | 91.30 |
25 | 82.55 | 91.30 |
30 | 82.55 | 91.30 |
35 | 82.55 | 91.30 |
40 | 97.18 | 107.48 |
45 | 97.18 | 107.48 |
50 | 104.15 | 115.19 |
55 | 104.15 | 115.19 |
60 | 100.07 | 110.67 |
65 | 100.07 | 110.67 |
Methodology: The above rates are calculated for individual insurance policies for residents of Ontario that have OHIP coverage (provincial insurance). The full health insurance plans include medication, dental care, diagnostic services, health professional visits, vision care, and travel emergency health care coverage. The amount of coverage provided differs between policies.
Once more, these statistics should be used simply to give you an idea of what health insurance premiums are. You should talk to an insurance provider for the exact pricing of your situation.
