What Medical Services Are Not Covered by Public Insurance?
Learn which common health expenses fall outside your provincial plan, and how to prepare for them
While Canada’s public health system provides broad access to doctors and hospitals, it does not cover every aspect of your medical needs. Many day-to-day health expenses like prescriptions, dental care, and vision services are not included in public plans. These uncovered services can lead to out-of-pocket costs that catch people off guard, especially during life transitions or times of illness.
Understanding what falls outside public insurance helps you plan ahead and avoid financial strain when care is needed most.
Key Services Not Covered by Provincial Plans
Most provinces limit public coverage to medically necessary hospital and physician care. Anything considered non-essential, non-urgent, or outside a hospital setting is generally excluded. That includes many services Canadians use regularly.
Here is a breakdown of common medical services and whether they are publicly covered:
| Service | Covered by Public Insurance? | Details |
|---|---|---|
| Prescription drugs (outside hospitals) | No | Covered only for seniors, low-income groups, or through provincial programs |
| Dental care | No | Emergency dental in hospitals may be covered, but routine care is not |
| Eye exams and vision correction | No (except for children or seniors in some provinces) | Most adults pay for exams, glasses, and contacts out of pocket |
| Paramedical services | No | Includes massage, physiotherapy, chiropractic, and acupuncture |
| Mental health services (non-hospital) | No | Psychologists and therapists outside of hospitals are often not covered |
| Ambulance services | Not fully | Some provinces charge flat fees or partial costs |
| Private or semi-private hospital rooms | No unless medically necessary | Covered only if your condition requires it, or if you have private insurance |
| Cosmetic surgery | No | Only covered if medically required due to trauma or congenital conditions |
| Travel medical care | No | Emergency care outside your province or abroad is not included |
Tip: The cost of these services can add up quickly, especially if used regularly or during a time of recovery. Even routine dental and vision care can become major expenses without private coverage.
How to Plan for Uncovered Services
Because these services are often necessary but not insured publicly, many Canadians rely on:
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Employer health benefits plans for dental, vision, prescriptions, and therapy
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Individual health insurance for extended coverage if self-employed or between jobs
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Health spending accounts (HSAs) to pay for medical expenses using tax-effective funds
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Critical illness or disability insurance to support income needs during longer-term medical situations
Know Your Coverage to Avoid Surprises
While public health insurance is a strong foundation, it is not all-inclusive. Many Canadians assume more is covered than actually is, which can lead to stress when bills arrive for services like counselling, prescriptions, or emergency transport.
Caution: Do not wait until you are unwell or facing a diagnosis to explore coverage options. Having a plan in place beforehand gives you access to the care you need, when you need it, without compromising your finances.