What Does Canadian Medicare Cover and Not Cover?
Canada's public health insurance is managed by provinces and territories, with federal funding through the Canada Health Transfer. Each province and territory runs its own plan and decides which services are "medically necessary" and covered.
Who is eligible?
All eligible residents, including citizens and permanent residents, can apply. Provinces set their own residency rules. To keep coverage, you must register, renew, and stay in your province for a certain number of days each year.
What is covered?
Under the Canada Health Act, plans must cover medically necessary hospital, physician, and certain surgical-dental services. Provinces decide what is medically necessary, often with input from medical professionals.
Provinces may also cover other services like prescription drugs, dental, optometry, chiropractic, and ambulance, but often only for specific groups like children, seniors, or social assistance recipients.
What is not covered?
Services not considered medically necessary are not covered, and patients pay for them. Examples include cosmetic procedures, court testimony, private nursing, hospital phone/TV, preferred accommodation (unless prescribed), and medical certificates for work or school.
Public insurance typically does not cover prescription drugs (except in hospitals), most dental care, eyeglasses, or ambulance services.
Costs and waiting periods
Residents do not pay directly for medically necessary services, but care is funded through taxes. Non-covered services may incur patient charges.
New residents may wait up to 3 months for coverage in some provinces. The official page advises: "Make sure you have private health insurance to cover your health care needs during this waiting period." This is official advice, not ours.
Travel within Canada and abroad
Short trips within Canada: emergency hospital and physician services are covered, but non-emergency care usually requires prior approval. Extra services like prescription drugs and ambulance may not be covered. The official page suggests having adequate coverage, which may include private insurance.
Travel outside Canada: only some emergency costs are covered, based on what your province would pay at home. You pay the difference. The official page says: "You should purchase private health insurance before travelling outside Canada to protect yourself."
How to get a health card
Apply through your provincial or territorial government. Contact information is on the "About health insurance cards" page.
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