Canada's publicly funded health system is a source of national identity and genuine pride. The Canada Health Act requires that all medically necessary hospital and physician services be covered without direct charge to patients, and that coverage be universal, comprehensive, portable, accessible, and publicly administered. It delivers on those promises in its defined scope. What newcomers to Canada, and many long-term residents, frequently underestimate is how narrow that scope actually is.
What Provincial Health Plans Cover
Provincial health plans cover medically necessary hospital services (emergency and inpatient care, surgery, diagnostic imaging, laboratory services) and medically necessary physician services (appointments with family doctors and specialists, referrals). These are the core services that most people think of as "healthcare," and they are genuinely covered comprehensively and at no point-of-care cost to insured residents.
The Major Gaps — What Is NOT Covered
Dental care is not covered under provincial health plans for most adult Canadians. A single dental check-up and cleaning costs $200 to $350. A crown can cost $800 to $1,500. Root canal treatment runs $800 to $1,200 per tooth. The federal Canadian Dental Care Plan (CDCP), introduced in 2024, provides coverage for uninsured Canadians with household incomes below $90,000, with phased implementation still ongoing. For those above the income threshold or not yet enrolled, private dental insurance or out-of-pocket payment is required.
Prescription drugs are not covered for most Canadians outside of hospital settings. Each province has its own formulary and eligibility rules for public drug benefits — Ontario's ODB program covers residents 65 and older and social assistance recipients; BC's Fair PharmaCare provides income-tested subsidies; Quebec requires all residents to have prescription drug coverage, either through an employer plan or the provincial RAMQ plan. Canadians without coverage pay out-of-pocket or through private insurance. Annual prescription drug costs for Canadians with chronic conditions can run $2,000 to $10,000 or more.
Eye exams are covered for children under a certain age (varies by province, typically 18) and for seniors (65+) in most provinces. Adults between these ages pay out-of-pocket for routine eye exams ($80 to $130) and prescription eyewear ($200 to $800+ depending on lens type). Contact lenses are not covered. Some provinces cover eye exams for adults with specific conditions.
Physiotherapy, chiropractic care, massage therapy, occupational therapy, speech therapy, and psychological services are generally not covered under provincial health plans outside of hospital settings. A physiotherapy session costs $100 to $160. Registered psychotherapy runs $150 to $250 per session. These costs accumulate rapidly for anyone managing a musculoskeletal injury or mental health condition.
Ground ambulance transport is not fully covered in most provinces. In Ontario, a land ambulance call costs patients $45 to $240 (after a provincial subsidy). In BC, ground ambulance can cost $80 to $1,800 depending on circumstances. Air ambulance transport can cost tens of thousands of dollars and is generally not covered for inter-facility transfers.
How to Fill the Gaps
Employer group benefits are the most common source of supplemental health coverage for working Canadians. Most group plans include basic dental (preventive and restorative to a maximum), prescription drugs, vision, and sometimes paramedical services. Review your group benefit booklet carefully — most plans have annual maximums that are lower than people assume.
Individual health and dental insurance is available through providers including Manulife, Sun Life, Blue Cross, and others. Premiums vary based on age and coverage level; a basic individual plan runs $80 to $150/month. Pre-existing conditions may be excluded from coverage for a waiting period. Comparing plans through an independent insurance broker is generally more effective than going directly to a single provider.
Provincial programs should be reviewed carefully for eligibility. The federal Canadian Dental Care Plan (CDCP) is expanding coverage, and income-tested drug benefit programs in each province may cover costs for qualifying residents. The Ontario Drug Benefit (ODB), BC's Fair PharmaCare, and Alberta's Pharmaceutical Assistance for Cancer Patients are examples of publicly funded programs that many eligible residents are not enrolled in.
Workplace wellness accounts and HSAs (Health Spending Accounts) allow tax-advantaged spending on health expenses not covered by provincial plans or group insurance. Some employers offer these as part of their benefits package; self-employed Canadians can structure eligible health costs through a Private Health Services Plan (PHSP).