Wondering, “What does health insurance cover in Canada?” You are in the right place. The Canadian healthcare system is a mix between the system of national insurance, better known as Medicare, and the system of private insurance, so that the citizens can be provided with the help they require. There is no guarantee that these plans offer all the basic requirements, with the exception being medical scheduling and visiting the hospital, missing out on other vital needs like dental, vision, or prescription drugs.
In this guide, we are going to explain what is included in the plan, what is not, and what you can do with Summit Insurance to get your protection to the maximum possible.
The Canadian Public Health Insurance Basics
The Canadian public health insurance is run in accordance with the Canada Health Act, ensuring "medically required" services are provided for free at the time of use. Every province, beginning with Ontario's OHIP to British Columbia's MSP, operates its own program. The five pillars of the plan are general administration, universality, accessibility, portability, and fullness. This framework gives everyone in Canada access to healthcare services at the core, although the details vary according to region.
What's Included In Public Health Insurance?
Public plans offer a strong base of services. What's usually included is:
- Hospital & Surgical Care:
Inpatient and emergency hospitalizations, surgery, as well as medically required procedures, are all covered by the government. - Doctor Services:
Visits to specialists, family doctors, as well as consultations via telehealth are covered, without a bill. - Diagnostics & Lab Tests:
The X-rays, MRIs, or blood tests, as well as DNA testing, are all included upon request by a physician. - Surgical-Dental:
Dental procedures that are performed in hospitals, like the removal of wisdom teeth under anesthesia, create a cut. - Out-of-Province Portability:
You're traveling within Canada? You're covered for emergency situations; however, reimbursement rates differ depending on the province.
What Public Insurance Doesn't Cover (Common Gaps)
The public coverage isn't without its limitations. The most common exclusions are:
- Prescription drugs (outside hospitals)
- Dental treatment (check-ups, braces, fillings)
- Eyewear and vision (glasses or contacts)
- Paramedical services (physiotherapy and chiropractic care)
- Ambulance services (varies depending on the province, but usually with co-pays)
- Medical devices and home care (hearing aids and wheelchairs)
Provincial variations can be confusing. For example, does Quebec cover prescription drugs? In part, via an insurance plan for public drugs that includes cost-sharing. Ontario? Only for youth and seniors with the OHIP+. These gaps point to the need for additional security.
Role of Private / Supplemental Insurance
Private health insurance—whether employer-sponsored or individual—picks up where public plans stop. It typically covers:
- Prescription medications
- Dental and vision care
- Paramedical treatments (massage, physiotherapy)
- Ambulance and short-term travel health
- Medical supplies (crutches, braces)
Even with Canada’s 2024 pharmacare legislation expanding public drug coverage, gaps persist. Around 70% of Canadians use supplemental private health insurance in Canada for full peace of mind. Summit's private health and wellness insurance plans tailor coverage to your needs.
Provincial Coverage Snapshot
Coverage differs across Canada. Here’s a look at three provinces:
- Ontario (OHIP):
Funds hospital stays and doctor visits; offers drug coverage for seniors (OHIP+) and youth (Trillium), but skips routine dental and vision except eye exams for kids and seniors. - British Columbia (MSP + PharmaCare):
MSP handles hospital and doctor care; PharmaCare provides income-based drug support, with limited dental or paramedical for specific groups. - Quebec:
It covers doctor, hospital, as well as a public drug plan with co-pays. Private insurance typically covers dental, vision, hospital, and other services.
These photos show why supplemental plans are important regardless of the location you reside in.
Why does Summit Insurance Recommend Supplemental Coverage?
The public plans allow for expenses out of pocket, such as dental visits, prescriptions, or physiotherapy. Summit Insurance recommends supplemental coverage to:
- Beware of the financial pitfalls
- You can rest assured that you will have access to vision, dental medications, and many more
- Fit unique needs (self-employed, retirees, newcomers facing wait periods)
Our consultants and provincial guides can help you choose the right program quickly.
How to Choose the Right Coverage
Picking coverage is straightforward with these steps:
- Check Your Public Plan:
See what your province offers. - List Your Needs:
Note frequent services (e.g., dental, prescriptions). - Compare Options:
Weigh premiums, reimbursements, and limits. - Ask Summit:
Find out whether you can get family coverage, pharmacy rides, or travel accessories.
Our representatives simplify the process and ensure you're covered when you need it.
Read more: What’s Tenant Insurance?
Final Thoughts
What does health insurance cover in Canada? The public plans cover hospital stays as well as doctor visits and diagnostics. However, they don't cover prescriptions, dental, vision as well or paramedical services. Private insurance helps fill the gaps. Still unsure? Get in touch with Summit Insurance Kelowna to spot your gaps in coverage or request an estimate for your specific needs now. Do not wait, talk to an advisor right now!
