What Is Public Health Insurance in Canada and What Does It Cover?
Learn how Canada’s health care system works, and what expenses you may still need to plan for privately
Canada’s public health insurance system provides essential medical coverage for all residents, but that does not mean every health care cost is covered. If you have ever been surprised by a medical bill or unsure whether a service is publicly funded, you are not alone.
Understanding what public health insurance includes, and what it does not, is a key step in building a complete and realistic financial plan.
The Basics of Public Health Coverage in Canada
Public health insurance in Canada is governed at the provincial and territorial level. Each region runs its own system, but all follow the principles set out by the Canada Health Act, including universal access, comprehensiveness, and portability.
You are typically covered if you are:
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A Canadian citizen or permanent resident
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Registered with your province’s health insurance program
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Living in your province for a minimum number of days each year (usually 183)
Once enrolled, you receive a health card that grants access to medically necessary services — but not all services fall into that category.
What Is Covered vs. Not Covered
While Canada’s health system is generous in its core offerings, it does not eliminate all out-of-pocket costs. Many health-related expenses are not publicly insured and may require private coverage or personal savings.
| Covered by Public Insurance | Not Covered by Public Insurance |
|---|---|
| Visits to your family doctor or walk-in clinics | Prescription medications (outside hospitals) |
| Hospital stays, surgeries, and emergency care | Dental care (except some surgical procedures) |
| Medically necessary diagnostic tests (X-rays, MRIs) | Vision care for adults (eye exams, glasses, contacts) |
| Specialist consultations with a referral | Ambulance services (varies by province) |
| Maternity care and obstetrics | Physiotherapy, massage, chiropractic |
| Psychiatric care in hospitals | Mental health services outside hospitals (in many cases) |
Tip: If your employer offers a group benefits plan, it likely covers many of the services excluded from public insurance. These plans often include dental, vision, prescriptions, and paramedical services.
Why This Matters in Financial Planning
Just because a large part of your health care is public does not mean your exposure to medical costs is zero. Even basic expenses like prescription drugs or ambulance rides can add up quickly — and are not always predictable.
This becomes especially important when:
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You are self-employed or between jobs and do not have group benefits
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You are planning for retirement and will lose employer health coverage
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You are budgeting for chronic conditions or long-term care
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You are supporting dependents with health needs not fully covered
Caution: Many Canadians assume their provincial plan covers everything. This misunderstanding can lead to gaps in coverage, especially later in life or when transitioning between jobs or provinces.
How to Address the Gaps
If you want broader protection, you may consider:
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Individual health insurance: To supplement public coverage and manage recurring or high-cost expenses.
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Critical illness or disability insurance: To provide income or lump-sum benefits if you cannot work due to illness.
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Emergency medical travel insurance: If you spend time outside your home province or travel internationally.
Note: These private solutions are not just for those with medical concerns. They help reduce financial volatility and protect long-term goals, especially when combined with savings and retirement planning.
Public Health Insurance Provides a Strong Foundation — But Not the Full Picture
Canada’s health system offers a strong baseline of protection. It covers medically necessary care, access to doctors and hospitals, and ensures no one is denied treatment due to income. But it does not cover everything.
To build a resilient plan, it is important to know what your public insurance includes — and where it stops. Filling the gaps with targeted private coverage or savings strategies can help you stay protected and avoid surprises.