How much is health insurance in Canada? What Canadians pay for private coverage

So for Sarah, that meant buying private health insurance. Most Canadians who buy private health insurance pay between $50 and $300 per month for individual coverage. Of course, that premium depends on age, province, health status and the type of plan and coverage they have.

What does provincial health care actually cover?

For Canadians, the publicly funded health-care system covers things that are deemed medically necessary, such as physician services and hospital care. These are covered through provincial and territorial health insurance plans, and are free for residents of that province or territory.

What many Canadians don't realize is how much falls outside of that coverage. Here’s a breakdown of what is and isn’t covered by the provincial healthcare plans.

What's typically covered:

• Visits to family doctors and specialists
• Hospital treatment and inpatient care
• Medically necessary surgeries
• Many diagnostic tests and imaging services
• Emergency medical care

What's typically not covered:

• Prescription drugs outside a hospital setting
• Routine dental care
• Eye exams and prescription eyewear for most adults
• Physiotherapy, massage therapy and chiropractic care
• Psychological and counselling services
• Ambulance fees in some provinces
• Private or semi-private hospital rooms
• Many other paramedical services

It should be noted that coverage varies significantly across Canada, depending on the province or territory in which you reside. Some provinces offer drug coverage programs for seniors, children or low-income residents. Others offer broader assistance through provincial drug plans for prescription medications.

Before going ahead and purchasing private medical coverage, it’s worth reviewing exactly what your province or territory already covers.

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How much does private health insurance cost in Canada?

Like coverage, private health insurance costs vary widely by province or territory. Most Canadians can expect to pay within these ranges:

• Individual plans: approximately $50 to $300 per month
• Family plans: approximately $100 to $600+ per month
• Comprehensive plans with extensive dental and drug coverage: often at the higher end of those ranges

Just as with most other insurance, a variety of factors have a direct impact on the cost of the insurance plan. Here are some of those factors that most provinces and territories will take into account:

Age

Age is one of the biggest factors in determining the price of insurance. Premiums increase as you get older because of a higher risk of injury and disease, especially after the age of 50.

Province

As we’ve been saying, where you live matters because each province and territory offers different healthcare insurance coverage.

Smoking status and health history

One of the most important parts of your health history and current health status is whether you are a smoker or a non-smoker. Smokers face much higher premiums and coverage restrictions because of the higher risk of disease or death. This is also true for people who have certain pre-existing conditions.

Coverage level

Basic plans focused on emergency medical and prescription drug coverage typically cost less than comprehensive plans that include dental, vision and paramedical benefits.

Deductibles and co-insurance

Plans with higher deductibles often have lower monthly premiums. Similarly, agreeing to pay a larger share of claims through co-insurance can reduce your monthly costs.

Let’s take a look at an example of how these factors can impact what you pay for private healthcare insurance:

A 35-year-old non-smoker in Ontario is looking to purchase a mid-tier individual healthcare plan. This plan includes prescription drug coverage, dental coverage, and vision benefits. For this plan, they should reasonably expect to pay between $130 to $180 per month.

Employer-sponsored group plans are usually much more affordable. Insurers can afford to provide larger groups of people with a lower rate, and employers also typically subsidize part of the premium. Total group benefit costs frequently range from $100 to $400 per month per employee, with costs shared between employers and workers.

Rather than focusing on a single insurer's advertised price, Canadians should compare quotes from multiple providers. Major insurers offer online quote tools that can provide personalized estimates based on industry-standard parameters.

What does private health insurance typically cover?

Private health insurance is designed to fill the gaps left by provincial health plans. These aren’t necessarily all-inclusive plans, but rather are meant to work in tandem with the universal healthcare provided by your province or territory.

Most plans include some combination of the following coverage areas:

Prescription drugs

This is one of the most valuable parts of private health insurance plans for most Canadians. Coverage for medications prescribed outside of hospitals can save thousands of dollars each year for a single Canadian resident. These are the prescriptions usually written by doctors that are picked up at a pharmacy. Coverage levels can vary, and some plans will have annual maximums and drug formularies that often apply.

Dental care

Dental coverage in private healthcare plans commonly includes:

• Preventive care, such as cleanings and exams
• Basic restorative services like fillings
• Major dental work, such as crowns, bridges and root canals, depending on the plan, there could be a price limit per year

Some plans will include orthodontic care for things like braces, and dental paraphernalia like a retainer or mouth guard.

Vision care

Many Canadian private healthcare plans include:

• Basic eye exams
• Prescription glasses
• Contact lenses
• Vision correction allowances. Usually, these are not 100% covered.

Paramedical services

Coverage may extend to:

• Physiotherapy
• Registered massage therapy
• Chiropractic treatment
• Psychotherapy
• Registered counselling services

Travel health insurance

Many Canadians do not know that their private healthcare plans often include travel insurance as a perk. Emergency medical coverage while travelling outside of the country is common with extended health plans, and can save quite a bit of money for those who purchase travel insurance through a third-party insurer.

Optional life and disability insurance

Some insurers allow policyholders to add life insurance, critical illness insurance or disability coverage for an additional premium.

Basic vs. mid-tier vs. comprehensive plans

A basic private insurance plan may focus primarily on prescription drugs and emergency medical expenses, but not include any additional coverage for things like travel insurance or paramedical services.

A mid-tier private insurance plan often adds routine dental care, vision coverage and higher annual limits for paramedical services. These also cost more than a basic tier of coverage.

A comprehensive plan generally offers broader coverage, higher annual maximums and more generous reimbursement rates across multiple categories.

However, more coverage doesn't necessarily mean unlimited coverage.

Most plans include annual benefit maximums. For example, a plan may reimburse up to $500 annually for massage therapy, $300 every two years for eyewear or a set maximum for major dental procedures. Understanding these limits is critical when comparing plans and is necessary to know if you want to maximize your benefits.

Common exclusions may include cosmetic procedures, expenses already covered by provincial plans and certain pre-existing conditions, depending on the insurer and policy.

Group plan vs. individual plan — which is better for you?

The right choice often depends on your employment situation, as well as the coverage you already receive from your provincial plan. Here is a breakdown of group insurance plans vs an individual insurance plan.

Group plans

Group plans are typically offered through employers, unions or professional associations. The true benefit of these plans is in the size of the group of people covered under the same plan. With a larger group of people, insurers generally offer better coverage and lower prices.

Advantages include:

• Lower effective cost due to employer contributions
• Broader coverage at competitive rates
• Minimal or no medical underwriting
• Easier access to coverage for people with health conditions

Individual plans

Individual plans are purchased directly from an insurer or through a broker. While these can potentially cost more than a group plan, they can offer increased flexibility and allow for entrepreneurs and gig workers to get the appropriate healthcare coverage they need.