What Does Private Medical Insurance in Canada Cover?

Posted on December 5, 2017

All Canadians are covered by public insurance, but what does private medical insurance cover? We've got the details for you here.

Most Canadians are covered by Medicare or employer insurance plans. But for a growing number of people, Medicare isn't enough. At this point, nearly 30% of Canadians are now seeking private medical insurance.

Maybe your coverage isn't enough for your family's needs. Recent changes in employment while dealing with an illness might drive you to look at other options. If you change jobs, private medical insurance can be a great help.

Canadians have options when it comes to getting medical care. When contemplating a private policy, you'll have to decide whether you want premium or basic private insurance.

If you're considering getting private medical insurance in Canada, here are some of the things you can expect to have covered.

Basic Private Coverage

Private insurance with basic coverage can be used at private or public hospitals. You'll get more options when selecting a doctor. If you've worked with someone for years, this will ensure you're not dealing with a stranger in times of stress.

Premium policies cover your accommodations when you're staying at a hospital and will cover any kinds of fees during surgery. If you or members of your family are anxious about a hospital stay, private coverage might offer them a little more comfort.

Expect your policy to cover anything you would find covered by your Medicare benefits. Any kinds of specialists that you're currently seeing should be covered by your private insurance. You'll also be covered if you need blood tests, x-rays or basic exams.

Better policies will cover dental and oral surgeries including Cleft Lip and Palate surgeries. This could be a more affordable option instead of supplemental dental insurance.

It has become more common for these premium policies to also cover psychiatric care and medications. There are likely to be options for psychologists and analysis.

There are several reasons you might want private medical insurance even if something is covered by Medicare. Medicare contributes toward your public hospital visits. However, it will be more restrictive in how closely you can schedule elective surgeries.

Private medical insurance gives you the option to choose the doctor you want for your surgery without so many restrictions.

The limited number of dental, chiropractic, optical, or therapeutic services covered depends on your plan.

Premium Coverage

If you're not pleased with basic private coverage, you might want to seek something for additional non-medical services.

People who need a lot of extra dental care will find a good ancillary coverage plan can come in handy. If you've been struggling to budget orthodontic or dental surgery for you or your family, extra coverage plans can meet your needs.

If your family has a history of problems that will need you to seek out specialists consider this supplemental policy. For people with a family history of macular degeneration, a supplemental policy will give you control over your treatment. People with serious dental issues or mental health problems will also find private insurance useful.

Physically demanding jobs that could lead to hearing loss or injury will make good use of supplemental coverage. Many supplemental plans cover occupational therapy.

Premium coverage can be great for elective or non-essential surgical needs. These can be used for rhinoplasty to fix breathing issues or plastic surgeries that follow an accident.

You'll find more comprehensive premium plans will take care of all your major dental, optical, and chiropractic needs. Private insurance plans will take care of most dental issues and optical issues. You'll find a long list of services, with some restrictions.

For your comfort during a hospital stay, a premium private medical care plan will put you at ease. If you need some extra accommodation or on-call staff in a smaller, private facility, a premium policy might have you covered.

Limits of Private Coverage

Every insurance plan around has a list of conditions or services that aren't covered at all. These can be elective treatments or coverage dealing with chronic medical issues.

Certain restrictions will also apply, affecting which provinces or facilities you can get your treatment in.

There are also limitations related to time periods. If you try to get several treatments too close together, you might find your insurance won't cover you or will make you wait.

You may also find restrictions based on how recently you got your insurance. Purchasing insurance and going in for a transplant the next day will raise some flags for sure.

There will be some out of pocket fees, especially when it comes to co-pays. In exchange for that premium service, you might end up paying for each office visit, unlike with Medicare.

Extended care will have limits on private insurance. If you're looking for a private room, you may also see an extra figure added to your bill.

Be aware of the things that Medicare covers when choosing your private insurance plan. Your plan should be able to cover everything a Medicare plan does, and then some. Otherwise, you might not find a private plan worth the price.

If you seek out alternative medicine or holistic treatments, be sure your insurance plan makes room for them. The kind of personal one-on-one care you get with alternative care may not be covered by every private plan.

Consider Getting Private Medical Insurance

If you're unhappy with your Medicare options or aren't able to work with the doctors you want to, private medical insurance might be great for you. Consider your family history, your budget, and the options for doctors in your area before you decide.

If you're still trying to decide which private medical insurance is right for you and your family, contact us. We want you to feel like you're covered for anything that comes your way.

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