Thinking of dropping your supplemental health plan? Suze Orman says you should review it. Here’s what Canadians need to know

While Canada’s publicly funded healthcare system is very different from the America’s, the underlying personal finance dilemma is the same: are you paying for supplemental health coverage that actually works for you?

Why the debate matters for your wallet

Orman’s warning in the U.S. context was simple: some plans look affordable and comprehensive on paper, but the real test comes when you’re sick, injured or navigating a chronic condition. She urged people to carefully review their annual notice of change and consider their alternatives before staying put (2).

That advice resonates in Canada, where provincial public health plans cover the essentials — doctor visits, hospital stays and emergency care — but leave significant gaps, particularly for retirees and seniors.

Canadian Medicare covers approximately 70% of Canadians’ healthcare needs (3). The remaining 30% is paid privately — out of pocket or through private supplemental insurance. That 30% includes prescription drugs not on a provincial formulary, vision, hearing aids, paramedical services (such as physiotherapy and chiropractic care) and many home care services.

For seniors, those gaps can be financially significant. According to data from PolicyMe’s health insurance access and affordability research, 21% of older Canadians are uninsured for supplemental coverage, and 47% of Canadians aged 55+ are delaying medical visits due to cost — including 35% who have delayed dental care, 28% who have delayed vision care and 21% who have delayed mental health services (4).

What Canadian public health coverage actually gives you

Canada’s publicly funded healthcare system, informally called Medicare and governed by the Canada Health Act, provides universal coverage for medically necessary services through each province and territory. But “medically necessary” has a specific, limited meaning.

Provincial health plans generally cover:

• Doctor and specialist visits
• Hospital stays and emergency care
• Approved diagnostic tests (X-rays, MRIs, bloodwork)
• Some prescription drugs through senior drug benefit programs — for example, the Ontario Drug Benefit (ODB), BC PharmaCare, the Nova Scotia Seniors’ Pharmacare Program

Provincial health plans generally don’t cover:

• Prescription eyeglasses or contact lenses
• Hearing aids
• Paramedical services such as physiotherapy, chiropractic care, massage therapy, psychology
• Brand-name or nonformulary prescription drugs
• Home nursing care or long-term home support
• Semi-private or private hospital rooms

The Canada Health Act doesn’t cover prescription drugs, home care, long-term care or dental care. Provinces provide partial coverage for children, people living in poverty and seniors, but programs vary significantly by jurisdiction (4).

Because of those gaps, more than 67% of Canadians carry some form of private supplemental health insurance, with many receiving it through employer-sponsored group plans. (5)

The retirement “coverage cliff” effect

One of the most financially dangerous moments for Canadian seniors comes at retirement, when employer-sponsored group benefits end, or transition to a less comprehensive retiree plan.

According to Statistics Canada’s 2024 Labour Force Survey, 75.1% of core-age employees (25 to 54 years old) had access to supplemental medical or dental benefits through their main job. For employees aged 55 and older, that figure dips to 67.4%. (6) When those employees retire, the coverage often disappears entirely.

For workers without a retiree benefits package, the transition out of a group plan can leave a costly gap at the exact moment their healthcare needs are likely increasing.

The average monthly cost of a private health insurance plan for Canadian seniors ranges between $50 and $300 each month, depending on province, age, coverage level and provider (7). Full coverage plans — including dental, vision, paramedical and prescription drug coverage — can range from $100 to $200-plus each month for a single senior aged 65 and over (8).

What the Canadian Dental Care Plan changes

A significant shift in Canada’s coverage range is the introduction and implementation of the Canadian Dental Care Plan (CDCP), a federal program launched in late 2023 and fully expanded to all eligible Canadians in 2025.

The CDCP provides government-funded dental coverage to eligible residents who don’t have dental insurance and whose adjusted annual family net income is less than $90,000. As of February 2026, the plan had approved almost 6.4 million Canadians (7).

Coverage under the CDCP includes preventive services (cleaning, X-rays), restorative services (fillings), endodontic care and oral surgery. However, individuals with adjusted family incomes between $70,000 and $79,000 must pay a 40% copayment, and those with incomes between $80,000 and $89,999 must pay 60% (9).

The CDCP doesn’t cover all dental services or apply to individuals who already have private dental insurance. Also, the CDCP only covers procedures up to a set fee established by Health Canada. If your dentist charges more than that amount, you’ll pay the difference out of pocket — a practice called “balance billing.”

Orman’s advice in the U.S. context — to carefully review what your plan actually covers — applies equally here: the existence of a program doesn’t guarantee it covers everything you need.

The Suze Orman test: Does your plan actually work for you?

Orman’s criticism of U.S. privatized plans centred on a core concern: that the incentives within a plan aren’t always aligned with the policyholder’s interests. She urged people to read their annual notice of change carefully and not to passively stay in a plan that no longer serves them.