Canada is a country with a universal healthcare system and all Canadians are provided with healthcare services through provincial and territorial health plans. With a universal healthcare system in place, Canadians are covered for most of their medical needs. However, not everything is covered under the national healthcare system, which is why many Canadians are taking out additional health insurance plans.

In this article, we explore what is covered by the universal healthcare system in Canada together with statistics on health insurance coverage.

Health Insurance Coverage Statistics for Canadians

  • 99.7% of Canadians are covered by the Canadian universal healthcare system.
  • In most provinces and territories, free healthcare starts after 183 days of residency.
  • Almost ¾ of Canadians have supplementary health insurance.
  • The vast majority of private health insurance plans in Canada are provided by employers.
  • Over $40 billion was paid out in health insurance claims in 2022.
  • 22 million Canadians had life insurance in 2022.
  • Canada’s life and health insurance companies employ over 170,000 people.
  • The average Canadian can save around $2,000 per year on prescription drugs, dental care, and optical care with private health insurance.
  • The Territories have the lowest policyholder median age.
  • Canada’s health and life insurers collected over $140 billion in premium revenues in 2022.
  • More than 80% of Canadian health insurance policyholders say the plan has helped them save money.

The Public Healthcare System in Canada

Canada has a publicly funded healthcare system, which is based on five pillars set out in the Canada Health Act (CHA). The five pillars are:

  • Publicly administered
  • Comprehensive coverage conditions
  • Universal
  • Portable across provinces and territories
  • Accessible

Each of Canada’s thirteen provinces and territories has its own health insurance plan and they receive funding from Canada’s federal government. The funding is on a per-capita basis. Additional funding is organised at the provincial/ territorial level through, for example, payroll and sales tax.

According to Statistics Canada, 99.7% of Canadians are covered under the universal healthcare plans. While there will be regional variations to the healthcare system, their basics remain the same: to ensure that all Canadians have reasonable access to necessary medical care provided on the basis of need and not on the patient’s ability to pay.

Universal Healthcare Eligibility and Coverage

To be eligible for universal healthcare, you must be a resident of Canada. The minimum qualifications vary between provinces and territories. However, the waiting time for establishing eligibility in any province or territory must not exceed three months. Most Canadian provinces and territories require you to be present for a minimum of 183 days in order to access free healthcare.

However, this does not mean that you would be without health insurance coverage during the waiting period. Until your new province or territory takes over your healthcare coverage, you will still be covered by Canadian health insurance.

While universal healthcare insurance does not cover all medical expenses, it will cover most essential medical treatments and services such as medical appointments at your doctor or at the hospital, diagnostics, standard hospital accommodation, treatments, surgeries, and dental surgeries that are medically necessary. What is covered will vary between provinces and territories so it is always best to check locally what you are covered for.

What is the Role of Private Health Insurance in Canada?

Even though the universal healthcare system provides extensive coverage for all Canadians, private health insurance still has a role in Canada. In 2022, 29 million Canadians, representing 74% of the population, had private health insurance policies. Some of these policies are provided by employers while others are individually purchased.

Canadians use private health insurance to cover potential expenses not covered by the public healthcare system, which include prescription medicines, vision care, dental care, and ambulance services.

In addition to paying for treatments and medicines not covered by the universal healthcare system, private health insurance will offer you protection if you are not able to work. If you are prevented from working for an extended period because of a serious illness or injury, health insurance will supplement your income. This is a key reason why so many Canadians have private health insurance.

Many private health insurance plans will also cover you while you are travelling. This means that your medical expenses are covered if you get injured or sick while in another country.

Over Eight Out of Ten Private Health Insurance Plans Are Provided Through Group Plans

According to the Canadian Life and Health Insurance Association (CLHIA), 83% of private health insurance policies in Canada are provided through group plans rather than purchased individually. For this reason, CLHIA always recommends you check with your employer before you buy additional private health coverage.

In 2022, Canadian Health Insurance Companies Paid Out Over $43 Billion in Claims

According to CLHIA, health insurance companies in Canada paid out approximately $43.9 billion in 2022. $32.5 billion were paid in supplementary health benefits, $9.4 billion in disability benefits, and $2 billion in accident and other benefits. The disability payments included $1.7 billion for short-term disabilities and $7.7 billion for long-term disabilities.

Almost half of the supplementary health payments were for prescription drugs. You can find a breakdown of the payments below.

  • Prescription drugs $14.3 billion
  • Dental care $10 billion
  • Hospital (including accommodation, food, etc.) $1.7 billion
  • Optical care $1.3 billion
  • Other paramedical $1.3 billion
  • Therapeutic massage $1.1 billion
  • Physiotherapy $0.8 billion
  • Chiropractic services $0.7 billion
  • Travel $0.7 billion
  • Mental health $0.6 billion

Mental Health-Related Claims Have Increased Rapidly Since the COVID-19 Pandemic

Claims for mental health therapies and counselling have seen continuous growth since the onset of the global pandemic. In 2022, the claims reached $650 million, which was nearly twice as much as before the pandemic in 2019. Travel insurance claims grew by 60% in 2022 as Canadians began travelling again in 2022 and reached $680 million.

Claims for Prescription Drugs Grew Almost 8%

Another segment that has seen rapid growth is the claims for prescription drugs, including specialty medications for serious, chronic, and complex health conditions. In 2022, there were 7.6% more claims for prescription drugs than the previous year. The claims for drugs to treat diabetes, depression, and inflammatory conditions accounted for almost a third of all the claims.

Health Insurance Providers Also Provide Life Insurance and Retirement Plans

In 2022, 22 million Canadians had life insurance and over 9 million had retirement plans through insurance providers. Live insurance claims were up about 12% in 2022. In the same year, over $53 billion was paid out in retirement benefits.
Canada Has Almost 130 Health Insurers

According to CLHIA, there are over 150 health and life insurers in Canada. 128 of these companies provide health insurance, 77 provide life insurance, and 37 provide retirement solutions. In total, the companies employ over 170,000 Canadians and provide insurance products to more than 100 million people worldwide.

Health and Life Insurance Companies Make an Important Contribution to the Economy

In 2022, Canadian life and health insurance companies paid $9.3 billion in taxes. $6.3 billion was paid in provincial and territorial taxes and $3 billion in federal taxes. Just over half, $4.8 billion was paid directly by the insurance companies and $4.5 billion was paid through sales taxes and payroll taxes. 

In addition to taxes, insurers also make investments that support the Canadian economy. In 2022, they invested $59 billion in infrastructures, $98 billion in provincial, territorial, and municipal government bonds, and $23 billion in federal government bonds.

The Average Protection Per Household

In Canada, the average protection per insured household varies slightly between different provinces and territories. The lowest average protection per household is in Newfoundland and Labrador, while the highest is in Alberta. Below are the average protection amounts across Canada.

  • Newfoundland and Labrador $363
  • Nova Scotia $370
  • New Brunswick $377
  • Quebec $391
    The Territories $392
  • Prince Edward Island $404
  • Manitoba $462
  • Ontario $504
  • British Columbia $511
  • Saskatchewan $519
  • Alberta $567

The average Canadian with a health insurance plan can save almost $2,000 per year. This includes $913 on prescription drugs, $816 on dental care, and $339 on eye care.

The Territories Have the Youngest Median Age of Policyholders

Similarly to the average protection, the age of polícyholders also varies across the country. The median age of policyholders is the lowest across the Territories and highest in Newfoundland and Labrador.

  • The Territories 34
  • Alberta 38
  • Saskatchewan 38
  • Manitoba 38
  • Ontario 40
  • British Columbia 42
  • Prince Edward Island 42
  • Quebec 43
  • Nova Scotia 44
  • New Brunswick 46
  • Newfoundland and Labrador 48

Life and Health Insurers in Canada Collected Over $140 Billion in Premium Revenues

The total premium revenue collected by life and health insurers in Canada reached $145 billion in 2022. Health insurance premium revenues saw the biggest increase and were up by 9.4%, while life insurance premium revenues were up 5.5%.

In 2022, 19% of the revenue came from life insurance plans and 38% from health insurance plans. The majority of the revenue, 43%, came from annuities.

Almost Nine Out of Ten Policyholders Value the Benefits of Private Health Insurance

88% of Canadians who have a private health insurance plan either through an employer or individually say they value the benefits of their insurance plan. 46% of policyholders said they value the benefits a great deal, while 42% valued the benefits quite a bit. Only 12% could not see much value in having private health insurance. In addition, 83% of Canadian policyholders say their insurance plan has been very or quite helpful in saving them money.

Over 70% of Canadians Without Private Health Insurance Would Value a Plan

Most Canadians who currently do not have access to a private health insurance plan say they would value having one. 38% would value access to a health insurance plan a great deal, while 33% would value it quite a bit. 29% of those without a plan do not see much value in having one.

Conclusion

Canada is one of the few countries that have universal, free healthcare. That means that Canadians do not have to worry about being able to pay for necessary medical appointments or treatment.

Despite this, almost ¾ of Canadians have supplementary health insurance plans. Often these plans are provided by employers, other times they are taken out by individuals. A health insurance plan can cover the cost of treatments, such as dental and optical care, that are not included under the universal healthcare plan, the cost of prescription drugs, and support you financially if you cannot work because of an illness or injury.

Because private health insurance will give you a more comprehensive cover, it is worth considering one. But always check if you have one through your employer as 83% of private health insurance plans are provided by employers in Canada.

Frequently Asked Questions

Even though Canada has a universal health care plan, many Canadians opt for private, supplementary health insurance. This is because not all types of treatments are covered under the universal health care plan. Private health insurance can cover the cost of treatments not included in Canada’s universal healthcare plan. It can also cover the cost of prescription drugs and provide financial support if you cannot work for an extended period because of illness or injury. 

The cost of private health insurance varies depending on the provider and the coverage you wish to have. However, research by CIHI shows an average cost of $750 per year. However, this research was conducted before the pandemic and it is likely that the average is now higher. When looking to get private health insurance, it is always advisable to obtain several quotes.

Approximately 29 million Canadians, which is about 74% of the population have private health insurance. Around 80% of these are provided through an employer.

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