What's Covered, What's Not: Canada's Health Insurance Explained

Posted on December 26, 2018

Canada has a great health care system worth bragging about, but plenty of Canadians need health insurance explained. Without supplemental insurance, some of the basics of good health are left behind. However, if you don't know what you're getting from the system, you won't know what you're missing.

Here's everything you need to know about the country's health insurance system if you're a new resident or applying for the first time.

1. The Basics

Every resident of Canada must begin their healthcare journey by applying within the territory or province where they live. Once they've applied, they get their own Health Card that qualifies them for the care they're seeking. If you have children or babies, they need to have health cards starting from day one.

The system is funded by taxes but administered at the local level. That means, in general, that a province like Ontario gets a large budget to provide healthcare for everyone. They then take the budget and divide it into credits to cover every resident of the territory.

As hospitals and medical facilities run by a variety of groups, there are all types of care provided. Trusts, volunteer organizations, and municipalities all offer their own type of care to help comply with national laws. The Nation sets forth policies for disease prevention and ways to promote good health.

The programs are created by the government, with the lower level institutions receiving the marching orders, for lack of a better term. The whole system is covered by the Canada Health Act, which sets the laws and limits around the healthcare system.

2. The Rules

The Canadian government sets forth the rules and regulations for how healthcare is administered. Their focus is on giving everyone the same level of dignified care and access that transcends boundaries or biases. By removing much of the profit model from the system, care is affordable and accessible to all permanent residents.

The law states that services must be given at a not-for-profit level, with every public group under the umbrella of each province or territory. They ensure that the most necessary services including doctors to essential surgical dentistry get covered.

In the eyes of the law, if you have a Health Card, you're entitled to the same level of care as everyone else in the country. No special consideration or limits should be placed on any individual cardholder.

If someone needs to move, they are entitled to coverage from their home province. With hospitals legally funded, everyone is provided the same level of access, regardless of income or status. The fairness of this system ensures that no one feels left out or discriminated against.

If you're a new resident of Canada, expect to have to wait a few months before you're covered. Arrange your current or a private health insurance plan to cover you during this interim. Rather than living without coverage, apply for a supplement to help during that period starting on your first day or permanent residence.

3. Preventative Care

One of the effects of providing this level of care is that many of the costs in other countries get eliminated. The Canadian health care system ensures that preventative care gets top priority.

When people are kept out of the hospital, it ensures that the government pays less for care. It also ensures that the quality of life across the country improves.

Preventative care is meant to keep people in good health before problems reach a level requiring surgery or intervention. When people get adequate care before things get out of control, they spend less time sick, less time in the hospital, and less money on health care costs.

The Canadian system covers most of the essential elements of preventative care.

4. Emergencies

One of the things that most insurance coverage provides for, including the Canadian health care system, is for emergencies. If you end up having to go to the emergency room because of an accident or an unexpected illness, the Canadian health care system protects you.

In most cases, emergency care gets administered even without an insurance card. This is a basic element of compassionate care that sets the Canadian model apart from models in more profit-hungry countries.

However, if a specialist is brought in for care, it might require patients to have health insurance or apply while at the hospital. The Health Card needs to be shown whenever any kind of specialized treatment comes into play.

5. What's Not Covered

While the system is better than most, there are still some things that aren't covered by this system.

If you need prescription medication, you likely need to pay for drugs out of pocket. Thankfully, they're not as expensive as they are in other countries.

Dental care isn't covered in a comprehensive way by the Health Card. Except for dental surgeries, you need to have insurance to supplement the national plan. Get a supplemental dental plan and a vision plan as well, since neither are covered by the Health Card.

While emergencies are covered, as stated above, ambulances aren't covered. There's a small fee to pay in some provinces but an ambulance ride could cost you hundreds of dollars. If you need to be flown somewhere in an emergency, the full cost of that ride will end up costing you.

Health Insurance Explained Isn't Enough

If you're looking to learn everything you need to know by having health insurance explained, you're going to miss out on some basic facts. With Canada's health care system, you need to have a grasp on what your needs are and what your specific province doesn't cover.

For more about staying well, check out our guide to preventative care.

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