Canadian Medicare Overview
Canada's healthcare system is publicly funded but privately delivered. Each province operates its own health insurance plan under the framework of the Canada Health Act. Once enrolled, most medically necessary services are free at point of use.
What's Covered (Generally)
- Hospital services: Inpatient and outpatient care, surgeries
- Physician services: Family doctors, specialists
- Diagnostic tests: Blood work, X-rays, MRIs (when medically necessary)
- Emergency care: Emergency room visits
- Maternity care: Prenatal, delivery, postnatal
What's NOT Covered
- Prescription drugs: Outside hospital (varies by province/age)
- Dental care: Most adult dental services
- Vision care: Eye exams, glasses, contacts
- Mental health: Private psychologists, therapists
- Physiotherapy: Outside hospital settings
- Ambulance: Fees vary by province
- Cosmetic procedures: Non-medically necessary
- Private/semi-private rooms: In hospital
Most employed Canadians have supplemental insurance through employers covering drugs, dental, and vision. Self-employed and unemployed individuals often purchase private plans or pay out-of-pocket. This is a significant gap in "universal" coverage.
Eligibility for Americans
Your eligibility for provincial health insurance depends on your immigration status and which province you live in.
Who Qualifies
| Status | Eligible? | Notes |
|---|---|---|
| Permanent Residents | Yes | Waiting period may apply |
| Work Permit Holders | Usually | 6+ month permit typically required |
| TN Visa Holders | Yes | Most provinces accept TN workers |
| Student Permit Holders | Varies | Province-dependent, some require private |
| Visitors | No | Must have travel insurance |
| Waiting for PR | Varies | Some provinces cover, others don't |
Most provinces have waiting periods (up to 3 months) before coverage begins. Apply for your provincial health card the day you establish residency. Don't wait—the clock starts when you apply in most provinces, not when you arrive.
Provincial Waiting Periods
Each province sets its own waiting period before new residents can access provincial health insurance.
| Province | Waiting Period | Notes |
|---|---|---|
| Ontario | 3 months | OHIP coverage begins first day of 3rd month after arrival |
| British Columbia | None (as of 2024) | MSP coverage effective first day of residence |
| Alberta | None | AHCIP coverage effective immediately |
| Quebec | 3 months | RAMQ; some exceptions for workers |
| Manitoba | None | Must register within 6 months of arrival |
| Saskatchewan | 3 months | Exceptions for covered workers |
| Nova Scotia | None | MSI effective immediately |
| New Brunswick | 3 months | Medicare |
As of January 2024, British Columbia no longer has a waiting period. If you're moving to BC, you can enroll in MSP and be covered from day one—a significant advantage over Ontario and Quebec.
Bridging the Gap: Private Insurance
During waiting periods (and for non-covered services), private insurance is essential.
Options for New Arrivals
- Travel insurance: Short-term, covers emergencies only
- Newcomer insurance: Designed for immigrants, 3-12 month terms
- Employer coverage: Some employers provide private coverage during waiting periods
- US insurance: Your US plan may have some international coverage
Major Private Insurers
- Manulife: CoverMe plans for newcomers
- Blue Cross: Visitor and immigrant plans
- Allianz: International health coverage
- GMS: Group Medical Services immigrant coverage
- MSH International: Comprehensive expat plans
Typical Costs
| Coverage Type | Monthly Cost | Coverage Level |
|---|---|---|
| Basic emergency only | $50-100 | $50K-$100K |
| Comprehensive newcomer | $150-300 | $500K-$1M |
| Family newcomer plan | $300-600 | Varies |
| Premium international | $500+ | Unlimited |
Private insurance for newcomers typically excludes or limits pre-existing conditions. If you have ongoing health issues, arrange coverage before leaving the US. Some conditions may not be coverable during the waiting period at any price.
Prescription Drug Coverage
Unlike hospital and physician services, prescription drugs are NOT universally covered. This is one of the biggest gaps in Canadian healthcare.
Who Gets Drug Coverage
- Seniors (65+): Most provinces provide coverage
- Low-income: Provincial programs exist (income-tested)
- Children: Some provinces cover under-25s
- Employed: Usually through employer benefits
- Everyone else: Pay out-of-pocket or buy private insurance
Provincial Drug Programs
| Province | Program | Coverage |
|---|---|---|
| Ontario | OHIP+, Trillium | Under 25 and seniors free; others income-based |
| BC | Fair PharmaCare | Income-based deductible, then 70% coverage |
| Quebec | RAMQ Drug Insurance | Mandatory if no private coverage; premium required |
| Alberta | Various programs | Seniors, low-income, some conditions |
Canadian prescription drug prices are generally lower than US prices due to price negotiations. However, without insurance, out-of-pocket costs for brand-name medications can still be significant. Generic alternatives are usually much cheaper.
Finding a Family Doctor
One of the biggest challenges in Canadian healthcare is finding a family doctor. Many areas face physician shortages.
The Doctor Shortage Reality
- 4-5 million Canadians don't have a family doctor
- Wait lists in many cities exceed 1-2 years
- Situation varies dramatically by region
- Specialists require referral from family doctor (usually)
Finding Care Options
- Provincial registries: Most provinces have "find a doctor" services
- Walk-in clinics: No appointment needed, episodic care
- Urgent care centers: For non-emergency but urgent issues
- Virtual care: Telehealth, apps like Maple, Telus Health
- Nurse practitioners: Can handle many primary care needs
- Emergency rooms: Open to all, but long waits for non-emergencies
Don't wait until you're sick to find a family doctor. Register with your provincial doctor-finding service on day one. In the meantime, identify nearby walk-in clinics and understand virtual care options.
Wait Times
Wait times for non-emergency care are a significant issue in Canada and often longer than what Americans expect.
Typical Wait Times (2024)
| Service | Median Wait | Notes |
|---|---|---|
| GP to specialist referral | 4-12 weeks | Varies by specialty and region |
| Specialist to treatment | 6-20 weeks | Depends on urgency |
| MRI scan | 8-16 weeks | Urgent cases faster |
| Hip replacement | 20-40 weeks | Highly variable by province |
| Knee replacement | 20-40 weeks | Similar to hip |
| Cataract surgery | 10-20 weeks | Higher volume, more predictable |
Strategies for Faster Care
- Private imaging: Pay for faster MRI/CT in some provinces
- Travel to shorter-wait areas: Rural areas often faster
- Get on multiple wait lists: If seeing any surgeon works
- Return to US for treatment: Option for some Americans
- Advocate aggressively: Squeaky wheel sometimes gets faster care
Quality of Care
Despite access challenges, the quality of Canadian healthcare is generally excellent.
Healthcare Rankings
- Life expectancy: 82+ years (higher than US)
- Cancer survival rates: Comparable to US for most cancers
- Maternal mortality: Lower than US
- Medical school quality: World-class institutions
- Research: Significant medical research sector
Major Hospital Networks
- Toronto: University Health Network, SickKids, Sunnybrook
- Montreal: McGill University Health Centre, CHUM
- Vancouver: Vancouver General, BC Children's
- Calgary: Foothills Medical Centre, Alberta Children's
- Ottawa: The Ottawa Hospital, CHEO
One major advantage: Canadians don't face medical bankruptcy from covered services. Even complex care like cancer treatment or heart surgery won't result in bills that bankrupt you (though lost income from illness can still be devastating).
Supplemental Insurance
Once you have provincial coverage, you'll likely want supplemental insurance for gaps.
What Supplemental Plans Cover
- Prescription drugs: 80-100% coverage typically
- Dental: Cleanings, fillings, sometimes orthodontics
- Vision: Eye exams, glasses allowance
- Paramedical: Physio, massage, chiro, psychology
- Travel insurance: Out-of-province and international
- Private/semi-private rooms: Hospital upgrades
Getting Supplemental Coverage
- Employer plans: Most common, employer typically pays 50-100%
- Professional associations: Engineers, accountants often have group plans
- Individual plans: Green Shield, Blue Cross, Manulife, Sun Life
- Chamber of Commerce: Small business group plans
Typical Monthly Costs (Individual)
| Plan Type | Monthly | Coverage |
|---|---|---|
| Basic (drugs only) | $50-100 | 80% drugs, limited other |
| Standard (drugs + dental) | $150-250 | 80% drugs, basic dental |
| Comprehensive | $300-500 | Drugs, dental, vision, paramedical |
| Family comprehensive | $600-1,000 | Full family coverage |
US Health Insurance in Canada
Your US health insurance has limited value in Canada, but understanding your options matters.
US Plans in Canada
- Most US plans: Cover emergencies only, and at out-of-network rates
- Medicare: Does NOT cover care outside the US
- Some employer plans: May have international coverage (check carefully)
- Travel insurance add-on: May be available
If You Return to US for Care
- Your Canadian provincial coverage has limited/no coverage in the US
- Some provinces provide emergency coverage only (Ontario: $400/day max)
- If you maintain a US address/employer, you may still qualify for US coverage
- Cross-border insurance products exist but are expensive and complex
Neither US nor Canadian insurance provides comprehensive coverage across the border. If you plan to spend significant time in both countries, you'll need explicit international or travel coverage for the "other" country.