The healthcare system in Canada is renowned for offering medical services without any direct costs to patients upfront. Across the country, each province plays a role in providing access to healthcare. However, it’s crucial to note that not all services are free. Understanding which services are covered by provincial health insurance and those that may need family health insurance coverage or out of pocket expenses is paramount.
What is provincial health insurance?
In Canada each province and territory has a health insurance program. It's supported by taxes to cover the majority of healthcare needs for residents in the region. Usually your coverage is signified by a provincial health card. If you have a health card for province where you live, you can seek medical care at a doctors office or hospital without concern, for most services being charged to you.
What's covered by provincial health insurance?
While there are slight variations from province to province, they all cover a wide range of services, especially those considered essential to your health and well-being. These are some of the main services covered:
Doctors visits
Visits to your family physician or a specialist are completely covered by provincial health care. Whether its for check ups or consultations regarding health concerns, like illnesses and injuries or more complex medical issues that require specialist care.
Hospital services
If you need attention at a hospital and have a health card your accommodation in a shared room (ward), meals provided during your stay at the hospital, and necessary medical treatment will be taken care of without any additional charges being billed to you for these essential services. This coverage also extends to procedures such as X-rays and blood tests you may need while you're being treated.
Surgeries and procedures
Provincial health insurance provides coverage for surgeries and procedures that are deemed necessary by doctors for your well being and health care needs. This includes a variety of interventions ranging from treatments to critical life saving operations such as heart surgery or appendectomies. It is important to note that only procedures that physicians determine as vital for maintaining your health are covered.
Maternity and prenatal care
When it comes to pregnancy healthcare in Canada most services are taken care of, from appointments and ultrasounds to hospital deliveries. If you choose to give birth at home or in a hospital setting don’t worry about the expenses as they are mostly covered. However, a private room in the hospital isn’t included unless you have additional insurance coverage.
Certain eye exams
Most provincial plans provide coverage for eye check ups for individuals younger than 20 and older than 65, as well as for those with certain health conditions like diabetes. Routine eye exams for adults aged 20 to 64 are not included unless there is a necessity.
What isn’t covered by provincial health?
While the provinces cover many essential services, there are some significant areas where it falls short.
Dental care
Regular dental services like cleanings and fillings are not included in provincial coverage. You’ll have to pay for them yourself or use insurance unless its an emergency dental treatment at a hospital. However, the federal government recently introduced the Canadian Dental Care Plan. It's aim is to make dental care "more affordable to eligible Canadian residents", specifically those with low income.
Prescription drugs
Most residents under provincial health care do not receive coverage for prescription drugs. However, many provinces have PharmaCare programs that aid low income families and seniors with the cost of prescription medications.
Vision care
Routine eye check ups for adults between the ages of 20 and 64 are not included in provincial coverage unless there is a need, for them. Moreover, glasses, contacts lenses, and laser eye surgery are not covered. You'll need private insurance or personal funds to pay for these services.
Cosmetic surgery
Cosmetic treatments like Botox injections or elective plastic surgeries are not covered by your provincial health card. There are some exceptions, such as reconstructive surgery following an accident or for underlying health reasons. These would be assessed on a case by case basis.
Physiotherapy and chiropractic care
Most physiotherapy and chiropractic services aren't covered by provincial health care. There are some exceptions for low income residents. However, for most paramedical services like physiotherapy, you'll need private insurance.
Private health insurance to fill the gaps
We are fortunate as Canadians to have so many of our health care needs provided free of charge by provincial services. As highlighted though, private health insurance is needed to cover additional things like dental and vision care, prescription drugs, cosmetic procedures, and many paramedical services like physiotherapy.
Some organizations provide group insurance packages that encompass these perks. Depending on your needs, you may want to investigate additional private coverage. For example, if you prefer a private room for hospital stays, or if you vacation often and want travel insurance coverage.
Have a look at our health insurance options and make sure you have the coverage to maintain your well being and happiness. As always, contact one of our insurance advisors if you have questions or would like a quote.