Healthcare Gaps in Canada’s Public System: What does Canadian healthcare not cover?

Under the Canada Health Act, provincial and territorial governments run provincial healthcare plans and territorial health insurance plans that generally provide public health insurance coverage for medically necessary hospital and physician services for eligible residents. However, many everyday health care services fall outside that coverage, including most prescription medications, dental care, vision care, routine mental health counselling, and allied health care such as physiotherapy and chiropractic care.

For newcomers to Canada, that gap matters right away. Each province sets its own residency requirements; permanent residents are eligible for public health insurance, and some newcomers face waiting periods of up to 90 days before coverage starts. This guide explains what Canadian healthcare does not cover, how health coverage and prescription drug coverage vary across provinces and territories, what you may pay for services outside primary care and visits to family doctors or other health care providers, and when private insurance can help you avoid unexpected costs while settling in Canada.

What’s Not Covered By Canada’s Public Health System?

Newcomers may not have access to provincial health care for their first few months in Canada (rules vary from province to province). 

Here’s a complete list of common exclusions:

• Prescription Medications: Many prescription medications are not covered under most provincial health plans. The availability of government-funded prescriptions varies from province to province. 
• Dental Care: Routine dental check-ups, cleanings, fillings, and orthodontics are not typically covered by Canada’s public healthcare system.
• Vision Care: Eye exams, prescription glasses, and contact lenses are typically excluded.
• Mental Health Services: ‘Acute’ mental health services for individuals in distress can be available, but there is limited public coverage for counseling and therapy.
• Allied Health Service Providers: Limited or no public coverage outside of certain traumatic injury recovery services. Your treatment for ‘run of the mill’ injuries or soreness would often require private insurance.

These services are usually paid out of pocket or through private insurance.

To give you a sense of what these services cost out of pocket in Canada, here are typical prices you can expect to pay without private insurance:

Example of Common Healthcare Costs in Canada: What’s Covered and What You’ll Pay Out of Pocket

Does Canada Have Prescription Coverage?

Canada’s prescription drug coverage can be difficult to understand within Canada’s health care system.

Generally speaking, if you’re at a hospital and the doctors give you medication, it is free under public health insurance. But if you go to a doctor at a clinic who prescribes you medication that you’ll then pick up from a pharmacy, there may be extra costs. (The doctor visit is free for Canadian permanent residents and citizens, and some temporary residents with provincial health insurance.)

But for the most part, whether there are extra costs for the prescribed drugs depends on the province or territory you live in, because provinces and territories manage health coverage differently through provincial and territorial governments and territorial governments. (With a few exceptions coming at the federal level, since the Canadian federal government is taking steps to make contraception and insulin available to everyone for free.)

Each province and territory has a drug plan that includes varying amounts of coverage for certain drugs and they have different exclusions, so plans do not always cover prescription drugs in the same way. Nova Scotia offers various Pharmacare Programs for eligible groups, which is one example of how other health services and drug benefits can differ. For drugs that aren’t covered by provincial or territorial drug plans, there are usually out-of-pocket costs and these can be expensive if you don’t have supplementary private health insurance or private supplemental insurance.

Newcomers to Canada are particularly hard hit when it comes to prescription insurance coverage. Statistics Canada reported that in 2021, 29% of immigrants did not have prescription coverage compared to just 17% of non-immigrants in Canada. Newcomers to Canada are also less likely than Canadian-born workers to have access to employer-sponsored drug insurance. 

If you’re new to Canada and you want to close the gap, consider a free quote from a health insurance provider in Canada, such as Moving2Canada partner Cigna Healthcare.

Dental Care is Not Covered by Public Healthcare in Canada

We won’t sugar coat it, dental care in Canada can be expensive without private insurance. As a result, there are significant gaps between people who have private insurance and those who don’t in terms of who accesses dental care in Canada each year. Don’t let a gap in coverage become an avoidable gap between your teeth.  

Unfortunately, dental care is not covered by Canada’s public healthcare system whether it’s an emergency or preventative. There are limited exceptions, such as emergency dental surgeries performed in hospitals in some provinces. Some provinces offer targeted help; for example, Alberta provides financial assistance for dental and optical care for certain residents. But, on the whole, you should assume that you will need to pay privately for your dental care in Canada.

For newcomers, this is important to know because dental coverage won’t become available under your provincial or territorial public healthcare plan. It’s something that you need to plan to cover personally or through an employer-sponsored plan, though eligible people may also qualify for the canadian dental care plan; even so, routine dental services are still not universally covered.

There is a range of dental-only plans and dental enhancements you can add to your health insurance plans in Canada.

Vision Care is not covered in Canada

Regular eye exams are important for detecting vision problems and eye diseases early. However, Canada’s public healthcare system does not cover routine eye examinations, nor does it usually cover the cost of getting glasses or contact lenses. These expenses are generally out-of-pocket unless you have private health insurance. 

Mental Health is Health!.. But it is not covered in Canada

Mental health is health, too! And newcomers to Canada are more likely to experience anxiety and depression among newcomers, with 25% of newcomers who have lived in Canada for 5 years or less reporting at least moderate symptoms of anxiety. 

These newcomers also face barriers accessing mental health services, largely due to cost. Publicly funded mental health care often does not include counseling or therapy for mental health conditions unless those services are provided in a hospital setting or through limited public programs. For the most part, if newcomers do not have coverage for mental health support through their employer, they are unable to afford this care.

Allied Health Services

Allied health services, like acupuncture, remedial massage, physiotherapy, chiropractic, dieticians and nutritionists, and similar services, can be beneficial for your overall wellness and preventative care. These services are also rarely covered by Canada’s public health system, so private health insurance or employer-sponsored insurance helps make these services more accessible. 

Private Health Insurance to Cover Healthcare Gaps in Canada’s Public System

If you’re a newcomer to Canada, you will likely face unique challenges in accessing Canada’s public healthcare system, including: 

• Limited to no access to provincial health care in your first few months in Canada. 
• Limited or intermittent access to employer-sponsored health care, since many employers have a waiting period before employer-sponsored healthcare coverage begins. This is often 3-6 months. This means newcomers to Canada face 3-6 month waiting periods for any coverage to kick in. 
• Newcomers to Canada often face periods of un- or under-employment as they seek to gain Canadian work experience, which means there may be multiple job shifts in the early years in Canada, and intermittent access to employer-sponsored coverage. 
• Insufficient coverage provided by employer-sponsored insurance. While group plans are common, they often have lower limits, such as $500 for mental health services, which equates to just 2-3 sessions, so supplementary private health insurance may still be needed.
• If you are eligible for publicly-funded support, access is often very slow. Access to private clinics and providers can mean that you are able to access health and wellness supports you or your children need much faster than if you wait .

Given the significant gaps in Canada’s public health care and the unique challenges newcomers face, private health insurance can offer an affordable solution to closing these gaps in health care coverage. Nearly 70% of Canadians have private health insurance, over two-thirds rely on extended benefits to fill gaps in public care, and in 2022, 90% of plans were group policies, which shows how common private supplemental insurance is for broadening health coverage. Increased access to healthcare in your early years in Canada can set you up for better health and wellness in your future, while easing the anxiety that too often comes while settling into your new home country. It can also ease the financial burden of accessing much-needed medical resources, including dental and prescription medications.

Moving2Canada’s partner, Cigna Healthcare, offers flexible health insurance coverage for newcomers to Canada. Cigna’s International health insurance offers:

• 24/7 access to multilingual service centers.
• Global network of 1.5 million hospitals and healthcare professionals, and plans that offer coverage in Canada and your original home country so you’re covered during return visits. 
• Access to medical support in over 200 markets and territories.
• Quote in 2 minutes, buy online in under 10 minutes.

Get your free quote