How does the health care system in Canada work?
In Canada, health care is a shared responsibility between the federal government, provinces and territories. The federal government is largely responsible for administering national standards and providing financial support.
The 13 provinces and territories are responsible for managing and delivering health care services. Therefore, the Canadian health care system has 13 provincial and territorial health care insurance plans, through which patients can access free health care.
Free health care is reserved for those who live in the province or territory, and certain conditions apply. If you qualify for free health care, you will be treated according to your medical condition. There may be some differences in how each plan works from one province to the next.
Who can benefit from health insurance?
In Canada, everyone benefits from free health care. In fact, no matter what province you settle in, you are obligated to sign up for health insurance. Registration is free and care is paid for by the government. This allows you to be treated for free in almost any health care facility in your province.
What if you are in staying in Canada temporarily?
Are you a temporary or seasonal worker? You also have the right to a coverage plan during your stay. Your spouse and dependents receive coverage too if they are accompanying you to Canada.
In Quebec, the same applies if you receive a scholarship or internship grant through a program offered by the Ministry of Education. If you don’t, you may still be eligible if your home country has an education agreement with the Régie de l’assurance maladie du Québec. The following countries are eligible:
In Ontario, international students are not eligible for OHIP, the province’s health insurance plan. Instead, Ontario schools offer special health care plans included in the cost of tuition and student fees. Public universities generally use the University Health Insurance Plan (UHIP), while colleges and universities use other plans.
In both Québec and Ontario, if you have applied for refugee status, you are not eligible for provincial health care. However, you can benefit from the Interim Federal Health Program.
Additionally, tourists are not covered. When visiting Canada for tourism, you must sign up for travel insurance.
What if you are traveling outside of your home province?
In Canada, provincial and territorial plans must cover their residents when they travel elsewhere in the country.
Are you a permanent resident, foreign worker or student in Québec or Ontario, planning on traveling to another country? You are covered up to a maximum amount equal to the rates in effect in your home province, even if you end up paying more for your health care services abroad. For this reason, travel insurance is highly recommended.
How do you sign up for a health insurance plan?
To sign up in Québec, you must contact the Régie de l’assurance maladie du Québec. Depending on your situation, you will have to provide certain documents, such as a piece of identity, permanent residence card, employment authorization, proof of residence in Quebec, etc.
In Ontario, ServiceOntario can help you apply for OHIP. Like in Québec, you’ll have to fill out an application and provide certain documents, including proof of citizenship, proof of residency and documents that confirm your identity. You can book an appointment or simply drop by a ServiceOntario centre near you. Plus, you can access information about health care in Ontario in 27 different languages.
Are your documents in a language other than French or English? If so, they need to be translated by a certified professional at your expense. If residing in Québec they should be translated to French; in Ontario, they should be translated to English.
What is the waiting time?
Newcomers to Canada who are eligible for health insurance should expect a waiting period, i.e., a period of time that must pass before you are eligible for coverage. This could be up to three months after registration.
If you need health care during the waiting period, you must pay for it yourself. There are, however, some exceptions: services for victims of domestic violence or sexual assault, pregnancy-related services (including abortion) and services to people whose illness may impact public health.
It is strongly recommended that you sign up for private health insurance once you arrive in Canada. It will protect you while you wait for public coverage. Beyond this protection, other insurances are also recommended.
If you are moving to Québec and your home country has an agreement with the Régie de l’assurance maladie du Québec (see the list above), you could be eligible to skip the waiting period. In Ontario, however, there are very few exceptions. When it comes those immigrating to the province, only convention refugees or other protected persons (defined by the Immigration and Refugee Board of Canada) are eligible to skip the three-month waiting period.
Where and how do you see a doctor?
In the Canadian health care system, health care coverage is usually the same from province to province. For serious or urgent situations, you should always go to the hospital for treatment. Otherwise, you can see a general practitioner or a nurse at a clinic or community centre, such as a Local Community Service Centre (CLSC) in Québec or a Community Health Centre (CHC) in Ontario. There are generally two types of consultations:
- With an appointment. If you have a family doctor, you can make an appointment for a consultation. Wait times for appointments vary between a few days and a few weeks. If you do not have a family doctor, you can sign up to be assigned one through the guichet d’accès à un médecin de famille in Quebec, or, though Health Care Connect in Ontario. Keep in mind that it could take many months, sometimes even years, before you are assigned a family doctor.
- Without an appointment. You simply have to call or go to a walk-in clinic. Normally, you should be able to get a consultation the same day, however, these facilities generally function under the principle of “first come, first serve.”
But what if you need to see a specialist? First, you must have a consultation with a general practitioner. They will give you a referral to a specialist if deemed necessary.
What kind of care is covered?
Your province will provide you with a health card that you can use to access different types of medical care: consultations, exams, diagnosis, surgery, anesthesia, etc. Procedures for aesthetic reasons only are not covered, except in certain cases.
Your health card also covers the vast majority of doctors in your province. However, there are a few that do not accept health insurance plans. If you have a consultation with a doctor who does not accept your insurance, you will be notified beforehand and will have to pay their fees directly. These doctors set their own rates.
In Québec, Ontario and other parts of Canada, you may have to pay for certain care provided by other professionals. This is the case for most dental care. The same goes for services such as optometry, acupuncture, massage therapy, ambulance transport, etc. Private insurance may, however, partially or fully cover some of these treatments.
Do you have to pay for medication?
To fill your prescriptions in Canada, you simply have to visit a pharmacy. There, you’ll need to pay for your medications out-of-pocket, however, insurance is often available to partially or fully reimburse you for the cost. Often, the pharmacy can even submit your insurance claim directly to your insurer for you—you simply pay the difference if there is one. Keep in mind, insurance typically only covers “over the counter” medications; that is, medications you need a prescription for.
In Québec, in order to be eligible for the public health insurance plan, you must have prescription drug coverage. You have two options:
- Private plan. You may be eligible for insurance through your job, a professional association (or order) or even through your spouse or parents. A person covered by private insurance is obligated to share benefits with their spouse and children, unless they are already covered by another private plan. If you are eligible for more than one private plan, you can simply choose the one that is best for you.
- Public plan. This is intended for people who do not have a private plan, people aged 65 years or older, recipients of social welfare and children of those covered by the public plan. To benefit from this type of insurance, you must sign up with the Régie de l’assurance maladie du Québec. Except in certain cases, people staying temporarily in Québec are not eligible for this plan.
In Ontario, OHIP does not require you to have prescription drug insurance. Private plans exist as they do in Québec, however, there is no public plan for prescription drug coverage. Children, youth and young adults aged 24 and under, however, can benefit from OHIP+, a program that covers the costs of more that 4,400 prescription drugs.
Getting used to a new country can be challenging for any newcomer, but understanding the health care system gets you one step closer. Now, you can confidently begin your new life in Canada without any unpleasant surprises when it comes to health care for you and your family.