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Compare Health Insurance in Canada: What to Look For
Private health insurance in Canada fills the gaps your provincial plan doesn't. Drugs, dental, vision, mental health, and travel costs can add up fast. Here's how to compare plans confidently and avoid surprises.
What Provincial Plans Don't Cover
Your provincial plan (OHIP, MSP, RAMQ, etc.) covers doctor visits, hospital stays, and emergency care. It does not cover:
Prescriptions: Many drugs are not covered or only partially covered by provincial formularies. Look for higher annual maximums, 80-100% reimbursement, dispensing fee coverage.
Vision: Exams, glasses, and contacts are out-of-pocket. Check allowance amounts and claim frequency.
Dental: Preventive (cleanings), basic (fillings), and major (crowns, surgery) services all require private coverage. Check recall intervals, annual maximums, and wait periods.
Paramedical & mental health: Physio, chiro, counselling, massage. Look for per-practitioner vs. pooled maximums.
Travel medical: Out-of-province emergencies need private coverage. Check trip length and pre-existing condition clauses.
Medical equipment: Orthotics, braces, hearing aids, private duty nursing, hospital cash.
Why Buy Coverage Early
The fundamental rule of insurance: buy it before you need it.
Pre-Existing Conditions Can Disqualify You
If you develop a health condition before applying for private insurance, that condition may be excluded from coverage or you may be declined entirely. For example, if you wait until you need dental work to buy coverage, that dental condition will likely not be covered.
Guaranteed issue plans (available when leaving group coverage) have no health questions, but come with lower maximums and higher premiums.
Premiums Increase with Age
Health insurance premiums are age-banded. The older you are when you buy, the higher your premium. Premiums typically increase every 5 years as you move into a new age bracket.
Buying at 30 locks in lower rates for that 5-year period compared to waiting until 35 or 40. Over a lifetime, starting early can save thousands.
Medical Underwriting Becomes Harder
Medically underwritten plans (which offer higher maximums and better value) ask detailed health questions. The more health history you have (prescriptions, diagnoses, procedures) the more likely you are to be rated (higher premium), have exclusions, or be declined.
Healthy applicants in their 20s and 30s typically sail through underwriting. Applicants in their 50s with multiple conditions may only qualify for guaranteed issue plans with lower coverage.
You Lock In Coverage Before You Need It
Once approved and enrolled, your coverage typically continues even if your health changes (as long as you pay your premiums). You can't be cancelled because you get sick or file claims. Buying early means you have protection in place before unexpected diagnoses, accidents, or chronic conditions develop.
Bottom Line
If you're healthy today, buy coverage now. You can't predict when you'll need it, and waiting until you need it often means you can't get it or it's far more expensive with limited benefits.
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How to Compare Plans (Fast Checklist)
Check off each category as you compare plans. Your progress saves automatically. This checklist covers the major coverage categories, but is not exhaustive. Focus on high-value items like drugs and dental (these costs rise significantly over time). While paramedical coverage (massage, physio) is useful, don't over-optimize for it; the real financial protection comes from prescription drug and dental maximums.
Copy the full checklist to take with you while comparing plans
Picking for Your Situation
Younger & Healthy
Maximize drug and dental coverage now. Drug costs rise with age and inflation. Strong dental coverage locks in preventive care before major work is needed. Ensure solid travel medical for trips. Lock in coverage before health issues appear.
Families
Prioritize dental recall frequency (6-month intervals), orthodontic options for children, vision cycles that match growth spurts, and pooled paramedical maximums for flexibility across family members.
Older Adults / Pre-Existing Conditions
Look for guaranteed issue or guaranteed acceptance options if moving from a group plan. Understand stability periods for travel medical, drug tiering (generic vs. brand-name coverage), and coordination of benefits if you have coverage from a spouse's plan.
Leaving a Group Plan
Apply within the replacement or continuation window (typically 60-90 days after your group plan ends). Bring proof of prior coverage to qualify for guaranteed issue replacement tiers. These plans have no medical questions but may have lower maximums. Act quickly to avoid gaps in coverage.
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Start comparing plansPlan Types in Canada
Guaranteed Issue / Replacement Plans
No medical questions required. Lower annual maximums. Good for continuity when leaving a group plan. Must apply within 60-90 days of losing prior coverage.
Medically Underwritten Plans
Health questions required. Higher annual maximums and better pricing if approved. May exclude pre-existing conditions or decline coverage based on health history.
Guaranteed Acceptance Plans
Similar to guaranteed issue but available to anyone regardless of group plan history. No medical questions. Lower coverage limits and higher premiums. Good option if declined for underwritten coverage or missed replacement windows.
Costs & How Pricing Works
Pricing drivers: Age band, province, coverage tier (basic, enhanced, comprehensive), family size, underwriting outcome (approved, declined, rated, excluded conditions).
Tip: Compare reimbursement %, annual maximums, and per-visit caps-not just premium. A lower premium with 60% reimbursement and $1,000 annual max can cost more out-of-pocket than a higher premium with 80% reimbursement and $5,000 max.
Premiums typically increase every 5 years as you age. Some plans offer level premiums or smaller annual increases. Ask about rate stability and renewal terms.
How to Compare with Carrier Sites
Download plan summaries or benefit booklets from each carrier. Create a side-by-side spreadsheet with columns for drug, dental, vision, paramedical, travel, and equipment coverage.
Map coverage: Note annual maximums, % coinsurance, and wait periods for each benefit. Highlight differences in recall frequency, trip length, pooled vs. per-practitioner maximums.
Watch for exclusions: Major dental wait periods (6-12 months), pre-existing condition clauses for travel, dispensing fee caps, orthodontic age limits, vision exam frequency.
Confirm claims process: E-claims, direct pay for pharmacies and dental, mobile app access, turnaround time (typically 3-10 business days).
FAQ
Common questions
Do I need health insurance in Canada if I have GHIP?
Yes, if you want coverage for prescriptions, dental, vision, paramedical care (physio, chiro, counselling), and travel medical. Provincial plans (GHIP) cover doctor visits, hospital stays, and emergency care—but not these high-cost items.
What is the difference between guaranteed issue and underwritten?
Guaranteed issue plans have no medical questions, lower annual maximums, and are available when leaving a group plan (within 60-90 days). Underwritten plans ask health questions and offer higher maximums and better pricing if you qualify.
Can I switch later?
Yes, but switching plans can restart wait periods and may require new health questions. You may lose coverage for pre-existing conditions. Check terms before switching and ask about upgrade windows.
How do coordination of benefits work with a spouse plan?
This is called Coordination of Benefits (COB). Your primary plan pays first, then your secondary plan covers some or all of the remainder, up to 100% of the eligible cost. For example, if your plan covers 80% and your spouse's plan covers 80%, together you might get 100% back. Each insurer has COB rules—ask before you double-claim.
Why focus on drugs, dental, and vision when younger?
Drug and dental costs inflate over time. Maximizing coverage when you are younger and healthier locks in protection before costs rise. Dental wait periods (6-12 months for major work) mean early coverage pays off sooner.
Are there waiting periods for all benefits?
It depends on the benefit and plan type. Preventive dental (cleanings, exams) often has no wait. Basic dental may have a 3-6 month wait, and major dental can require 6-12 months. Drugs, vision, and paramedical typically have no wait periods.
How do I submit a claim?
Most insurers let you submit claims through a mobile app, online portal, or by mail. Take a photo of your receipt, enter the details, and submit. Some providers (pharmacies, dentists) offer direct billing so you only pay your portion at the counter. Claims typically process in 3-10 business days.
Does travel medical insurance matter within Canada?
Yes. Some services and ambulance costs may not transfer fully between provinces. Travel medical also covers trips outside Canada, where provincial coverage is very limited or non-existent.
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