How Does Public Health Insurance Work With Private Plans?

Canada’s public health care system is a point of pride, but it does not cover every medical cost. That is where private insurance comes in, helping you manage the gaps that public plans do not address. If you have ever wondered why people buy private coverage in a country with universal health care, or how the two systems interact, you are not alone.

Understanding the roles of both systems helps you make smart decisions about your coverage, especially as your needs change over time.

Understanding the Scope of Public Health Coverage

All provinces and territories offer public insurance that covers medically necessary hospital and physician services. But outside those core areas, coverage drops off quickly. Public insurance does not typically include prescriptions, dental care, vision, or many forms of mental health and paramedical treatment.

This is where private insurance often offered through an employer or purchased individually steps in to fill the gaps.

How the Two Systems Work Together

In most cases, public insurance pays first. It covers eligible services like doctor visits, hospital stays, and surgeries. If a service is not included under your province’s public plan, your private insurer may cover all or part of the cost — depending on your policy.

Here’s how the two systems typically align:

Service Category	Public Insurance	Private Insurance
Doctor and hospital care	Fully covered	Not needed unless out-of-province or for semi-private rooms
Prescription drugs	Limited coverage (mostly in-hospital or for seniors/low-income)	Covers outpatient prescriptions for many people
Dental care	Not covered (except in hospitals)	Covers routine checkups, cleanings, and procedures
Vision care	Limited (for children or specific medical needs)	Covers eye exams, glasses, contacts
Paramedical services	Not covered (chiropractic, physio, massage)	Often included in extended health plans
Medical devices	Partially covered, if medically necessary	Supplements cost or expands device options
Emergency travel medical	Not covered outside Canada	Covers international medical care

Tip: If you have group benefits through work, your private plan likely covers most of the services public insurance excludes. Always review your coverage annually to make sure it still meets your needs.

When Private Insurance Is Most Useful

Private insurance becomes especially valuable when:

You use services not covered publicly, like physiotherapy, counselling, or dental work
You need prescription drugs for ongoing or chronic conditions
You travel frequently outside your home province or internationally
You want faster access to specialists, semi-private hospital rooms, or expanded medical device options

Note: You do not need to choose between public and private insurance. In Canada, they work alongside each other — not in competition. You can (and often should) use both to create a more complete safety net.

Coordinating Benefits Across Multiple Plans

If you and your spouse or partner both have private coverage, you may be able to coordinate benefits. This means you can submit expenses to one plan first, and then claim any remaining balance from the second.

This is especially helpful for:

Dental care and orthodontics
Expensive prescriptions
Services with annual limits, like massage or therapy

Caution: Each insurer has its own rules for coordination. Always follow your provider’s instructions and submit in the correct order to avoid delays or denied claims.

A Stronger Health Strategy With Both Systems in Place

Public insurance provides a solid base, but private insurance gives you flexibility, speed, and access to services that matter in daily life. Together, they reduce financial stress and help you manage your health more proactively.

Whether you are managing a chronic condition, raising a family, or preparing for retirement, using both systems in tandem can make your health care more responsive, more affordable, and more complete.