Health Insurance by Province and Territory: What’s Covered in Canada (2025 Guide)

Canada’s public health care system is admired around the world, but it is also widely misunderstood.

While every Canadian resident has access to essential hospital and physician services, much of what people think of as “health insurance” including prescription drugs, dental, vision, ambulance, home care, mental health, and travel coverage is not fully covered by government plans.

Each province and territory operates its own health insurance plan, setting its own rules, eligibility, and coverage levels. This is why someone in Alberta may pay nothing for a medication that someone in Nova Scotia must cover out of pocket.

This guide breaks down what is covered and what is not, across every province and territory in Canada, including senior drug benefits, ambulance fees, and home care coverage.

Whether you are retired, self employed, or simply want to understand your provincial benefits, this is your one stop reference.

Tip from Aeva: Even with strong public coverage, most Canadians still pay out of pocket for services like prescriptions, dental, and vision care. Aeva.ca makes it easy to compare private health insurance plans that fill those gaps in minutes.

How Public Health Insurance Works in Canada

Canada’s health care system is federally guided but provincially managed.

Here is the structure:

All provinces and territories must meet five principles under the Canada Health Act:

1. Public Administration – Non profit management of health insurance plans
2. Comprehensiveness – All medically necessary hospital and doctor services must be covered
3. Universality – All eligible residents are covered on equal terms
4. Portability – Coverage continues when moving or traveling within Canada
5. Accessibility – Reasonable access without financial barriers

To access public coverage, residents must hold a valid provincial or territorial health card. Coverage typically begins within three months of establishing residency.

What Is Generally Covered and What Is Not

All provinces and territories cover:

• Hospital care (room, meals, nursing, diagnostics, surgeries)
• Physician services (consultations, examinations, treatment)
• Maternity and newborn care
• Medically necessary surgeries and diagnostics

Public health insurance does not usually cover:

• Prescription drugs outside hospitals
• Dental work provided in private practices
• Eye exams, eyeglasses, or contact lenses
• Paramedical services (massage, physiotherapy, chiropractic, naturopathy, etc.)
• Ambulance transportation (except in limited or subsidized cases)
• Mental health care provided outside hospitals
• Private or semi private hospital rooms
• Travel medical insurance (including some interprovincial travel gaps)

Each province and territory runs targeted programs for groups such as seniors, low income residents, and children.

Overview: What Is Covered by Public Health Insurance (2025)

Every province and territory covers the basics. What happens outside hospitals varies significantly.

Ambulance fees are among the most inconsistent costs in Canadian health care. Many provinces subsidize services for residents but bill full rates for visitors.

Filling the Gaps

Canada’s public health care system protects residents from catastrophic medical bills, but it does not cover the everyday costs most people face.

Private health insurance can help. Whether you are:

• Retired or approaching retirement (and soon to lose employee group benefits)
• Self employed and need coverage
• A student studying away from home
• An employee without workplace benefits

You can compare plans from leading insurers in minutes at Aeva.ca.

Alberta

• Public plan: Alberta Health Care Insurance Plan (AHCIP)
• Drug benefit plan: Coverage for Seniors (administered by Alberta Blue Cross)

Who’s eligible

• Alberta residents with an active AHCIP card.
• Seniors 65 and older, plus their eligible spouses/partners (regardless of age) for the Coverage for Seniors drug plan.
• Low-income residents and those in continuing care may qualify for additional subsidies through the Alberta Adult Health Benefit.

What’s covered

When private coverage helps

• Routine dental, vision, and paramedical services aren’t covered.
• Out-of-country travel emergencies can cost thousands.

Aeva Insight: Most Alberta seniors use supplemental insurance to cap drug costs and add dental + travel coverage. Explore personalized options at Aeva.ca.

British Columbia

• Public plan: Medical Services Plan (MSP)
• Drug benefit program: PharmaCare (Plan A – regular; Plan B – nursing homes; Plan C – income assistance; Fair PharmaCare for most residents)

Who’s eligible

• All BC residents with MSP coverage.
• Seniors 65 + are automatically enrolled in Fair PharmaCare upon turning 65 (if registered).

What’s covered

When private coverage helps

• Dental and vision care are the largest out-of-pocket expenses in BC.
• Add travel and paramedical benefits for complete protection.

Aeva Insight: BC residents spend the most in Canada on dental services. Compare plans that bundle dental, drug, and vision coverage at Aeva.ca.

Manitoba

• Public plan: Manitoba Health Services Insurance Plan (MHSIP)
• Drug benefit program: Manitoba Pharmacare Program

Who’s eligible

• All permanent Manitoba residents with a valid MHSIP card.
• Seniors and households whose annual prescription costs exceed an income-based deductible qualify for Pharmacare reimbursement.

What’s covered

When private coverage helps

• Routine dental and eye care aren’t covered.
• Paramedical therapy and equipment can be costly.

Aeva Insight: The average Manitoban household pays over $1,000 per year for medical supplies and equipment. A comprehensive plan from Aeva.ca can help to reimburse these costs.

New Brunswick

• Public plan: Medicare (hospital + physician)
• Drug programs: New Brunswick Drug Plans (11 plans total, including Plan A for seniors on GIS)

Who’s eligible

• All residents with a valid Medicare card.
• Seniors 65+ receiving GIS qualify for Plan A, paying only small co-pays.
• Other residents can buy into the NB Drug Plan or private Blue Cross coverage.

What’s covered

When private coverage helps

• Dental, vision, and paramedical services not included in Medicare.

Aeva Insight: New Brunswick seniors on GIS are well-protected for prescriptions, but others face premiums and co-pays. Explore supplemental dental and vision plans at Aeva.ca.

Newfoundland and Labrador

• Public plan: Medical Care Plan (MCP)
• Drug program: Newfoundland and Labrador Prescription Drug Program (NLPDP)

Who’s eligible

• All MCP-insured residents.
• Seniors receiving GIS qualify for the 65Plus Plan (pays nearly all drug costs except a small dispensing fee).
• Low-income families and special-needs groups covered through other NLPDP plans.

What’s covered

When private coverage helps

• Working-age adults without GIS receive little drug or dental coverage.

Aeva Insight: If you are under 65 in NL, a private plan can fill gaps for prescriptions, dental, and paramedical care. See options on Aeva.ca.

Nova Scotia

• Public plan: Medical Service Insurance (MSI)
• Drug programs: Six Pharmacare Programs (for example Seniors, Family Health Benefit, Cancer, Palliative Care, Diabetes)

Who’s eligible

• All residents with MSI coverage.
• Seniors 65 and older may join the Nova Scotia Seniors’ Pharmacare Program (voluntary; income-tested).

What’s covered

When private coverage helps

• Adults under 65 without employer benefits get no routine drug or dental coverage.

Aeva Insight: For most Nova Scotians under 65, adding a private plan means real savings on prescriptions, dental, and paramedical services. Compare plans at Aeva.ca.

Ontario

• Public plan: Ontario Health Insurance Plan (OHIP)
• Drug programs: Ontario Drug Benefit (ODB), Trillium Drug Program, OHIP Plus (under 24)

Who’s eligible

• All residents with OHIP coverage.
• Seniors 65 and older automatically qualify for the Ontario Drug Benefit.
• Low-income seniors and those receiving GIS get enhanced cost relief.
• Anyone under 24 without private coverage qualifies for OHIP Plus.

What’s covered

When private coverage helps

• Routine dental, vision, and paramedical services remain private pay.

Aeva Insight: An Ontario retiree can combine ODB with a supplemental plan from Aeva.ca to add dental, vision, and travel coverage without duplication.

Prince Edward Island

• Public plan: PEI Health Card
• Drug programs: PEI Pharmacare (13 sub-programs, including Seniors Drug Program)

Who’s eligible

• PEI residents with a valid Health Card.
• Seniors 65 and older automatically eligible for the Seniors Drug Program.

What’s covered

When private coverage helps

• Dental, vision, and most paramedical costs not covered.

Aeva Insight: A flat $16 per fill for drugs is helpful, but dental and vision gaps add up. See supplemental plans on Aeva.ca.

Québec

• Public plan: Régie de l’Assurance Maladie du Québec (RAMQ)
• Drug program: Public Prescription Drug Insurance Plan (mandatory if no private plan)

Who’s eligible

• All Québec residents.
• Anyone not covered by an employer or private drug plan must join the public RAMQ plan.
• Seniors 65 and older automatically enrolled.

What’s covered

When private coverage helps

• Premiums plus co-pays can still add up, especially for non-seniors.

Aeva Insight: Aeva’s comparison tool lets Québec residents estimate whether a private plan is cheaper than staying on public-only RAMQ coverage. See options on Aeva.ca.

Saskatchewan

• Public plan: Saskatchewan Health Card
• Drug program: Children’s and Seniors’ Drug Plans

Who’s eligible

• All residents with a valid Health Card.
• Seniors 65 and older qualify if their income is below the upper threshold (excludes highest-income earners).

What’s covered

When private coverage helps

• Dental and vision costs among the highest in Canada.

Aeva Insight: A private plan covering dental and eye care can save Saskatchewan residents approx. $1,300 per year. Compare plans at Aeva.ca.

Yukon

• Public plan: Yukon Health Care Insurance Plan
• Drug program: Yukon Pharmacare and Extended Health Care Benefits Program

Who’s eligible

• Residents with a Yukon Health Card.
• Seniors 65 and older (and 60 to 64 if spouse is 65 plus) automatically qualify for Pharmacare and Extended Health Benefits.

What’s covered

When private coverage helps

• For non-formulary drugs and out-of-territory care.

Aeva Insight: Yukon offers Canada’s most comprehensive senior benefits, but travel coverage is essential. Compare supplemental plans at Aeva.ca.

Northwest Territories

• Public plan: NWT Health Care Plan
• Drug program: Extended Health Benefits for Seniors and Specified Conditions

Who’s eligible

• Residents aged 60 and older automatically enrolled (Seniors Plan).
• Others may qualify for specified conditions (for example diabetes or cancer).

What’s covered

When private coverage helps

• For out-of-territory medical or travel needs.

Aeva Insight: NWT residents are well-protected at home but should add travel medical insurance. Explore plans at Aeva.ca.

Nunavut

• Public plan: Nunavut Health Care Plan
• Drug program: Extended Health Benefits for Seniors and Specified Conditions

Who’s eligible

• All residents with a Nunavut Health Card.
• Seniors 65 and older and those with specific conditions qualify for Extended Health Benefits.

What’s covered

When private coverage helps

• For non-formulary medications and travel outside Nunavut.

Aeva Insight: Nunavut seniors enjoy strong coverage but face high travel and equipment costs. A travel and supplies add-on from Aeva.ca can help.

NIHB (Non-Insured Health Benefits) at a glance

Who it’s for: Eligible First Nations and recognized Inuit across Canada.

What it covers (nationwide, with prior authorization rules):

• Prescription drugs on the NIHB formulary (exceptions possible)
• Dental care (diagnostics, preventive, restorative, endodontic, prosthodontic — limits and approvals apply)
• Vision care (eye exams in some cases; corrective lenses and frames)
• Medical supplies and equipment (for example mobility aids, orthotics, diabetic supplies)
• Mental health counselling (benefit-funded sessions with approved providers)
• Medical transportation (when needed to access insured services)

How it coordinates:

• If you are eligible for NIHB and provincial or territorial plans (or private insurance), NIHB usually pays first for eligible benefits (pharmacy and providers bill NIHB directly), and other plans can coordinate for anything NIHB does not cover.
• In the territories, NIHB often acts as primary drug, dental, and vision coverage; territorial extended benefits may top up.

What to do:

• Tell your pharmacist or clinic you have NIHB.
• Bring your status or benefit details; they will check prior authorization where needed.
• Ask your provider to coordinate benefits with provincial or private plans.

Aeva Insight: If you are NIHB-eligible but travel often or want broader paramedical coverage, a supplemental plan can be a smart add-on. Compare options at Aeva.ca.

Out-of-pocket health costs in Canada (why gaps matter)

Even with strong public coverage for hospital and physician care, Canadians typically spend thousands per year on items government plans do not fully cover. The major categories:

Provincial pattern (high-level):

• BC, Ontario, Quebec households: significant dental, drug, and paramedical spending.
• Prairies and Atlantic: dental and supplies or equipment often drive costs.
• Territories: strong public and territorial benefits for seniors and NIHB-eligible residents, but travel and non-formulary gaps remain.

Practical tip: Add up last year’s receipts (pharmacy, dentist, optometrist, physio or psych, ambulance or travel). If the total meaningfully exceeds a good private plan’s annual premium, supplemental coverage is worth it.

“Do I need private health insurance?” — a simple decision guide

Start here:

Do you fill prescriptions more than occasionally?

• Yes → Look for a plan with a meaningful annual drug maximum (and check your province’s cost-sharing to avoid duplication).
• No → You may still want coverage for dental, vision, or paramedical.

Do you get routine dental and eye care each year?

• Yes → A plan with predictable dental and vision benefits often pays for itself.
• No → Consider a lower-tier plan plus travel medical.

Do you rely on physio, massage, chiro, psychotherapy, or counselling?

• Yes → Choose a plan with paramedical coverage (and adequate per-visit and annual maximums).

Do you travel outside your province or abroad?

• Yes → Add emergency travel medical (international care is not fully reimbursed by public plans).

Are you a student, self-employed, or without group benefits?

• Yes → You are bearing 100 percent of non-hospital costs; a balanced private plan can smooth cashflow and reduce surprise bills.

Aeva Insight: You can plug your province and priorities into Aeva.ca to see only plans that complement your public coverage (no overlap, better value).

Province and Territory quick picks — when supplemental coverage helps most

• Alberta, Saskatchewan, PEI: Good seniors’ drug help; dental, vision, paramedical are the main add-ons.
• BC, Manitoba: Income-tested drug deductibles mean early-year out-of-pocket costs — private drug coverage plus dental or vision can smooth expenses.
• Ontario: ODB helps at 65 and older, but dental and vision remain gaps for most; travel medical is smart.
• Quebec: RAMQ drug premiums, deductibles, coinsurance add complexity — compare public-only vs. private plan for net cost.
• Nova Scotia, New Brunswick, Newfoundland and Labrador: Strong targeted programs for low-income and seniors, but working-age residents face large dental, vision, and paramedical bills.
• Yukon, NWT, Nunavut: Seniors have robust drug, dental, vision, and equipment benefits; travel and non-formulary drugs are the typical private add-ons.

Make your coverage work like a system

• Public coverage is your foundation. The right private plan fills the real-life gaps.
• Build a complementary plan in minutes at Aeva.ca.
• Compare supplemental health insurance that matches your province or territory, your stage of life, and your budget, so you are covered where public plans stop.

FAQ

Q1: Can I have both public and private health insurance?

Yes. Public insurance is your base. Private plans stack on top to cover prescriptions, dental, vision, paramedical, travel, and equipment where public coverage is limited.

Q2: I’m moving provinces. What happens to my coverage?

Your old province covers you up to three months while you register in the new province. Apply for your new health card immediately. Bring proof of residency and ID.

Q3: Are prescriptions covered publicly?

It depends on your province or territory and your situation (age, income, special programs). Many plans use deductibles, co-pays, or caps; seniors often get better terms. Pharmacists can check your formulary quickly.

Q4: Do provinces cover dental, vision, and paramedical?

Usually not for adults, except targeted programs (children, low-income, seniors). Expect to pay privately for routine checkups, glasses, physio, massage, chiro, and counselling unless you have a supplemental plan.

Q5: Do I need travel medical insurance in Canada?

For out-of-country travel: yes. Public plans reimburse only at in-province rates. For inter-provincial travel, an emergency plan still helps with ambulance and return transport gaps.

Q6: I’m a student. Am I covered?

You will have provincial or territorial coverage if eligible, and many colleges and universities include student health plans (dental, drug, vision). If not, consider a low-premium private plan.

Q7: I’m NIHB-eligible. Should I still consider private insurance?

Possibly. NIHB is generous for drugs, dental, vision, and medical transportation. If you want paramedical, travel, or non-formulary drug coverage, a private plan can complement NIHB.

Q8: How do I choose the right private plan?

List your likely expenses (drugs, dental, vision, paramedical, travel). Pick a plan with limits that match your needs and avoid overlap with your province’s benefits. Aeva.ca shows side-by-side comparisons by province and priority.