Everything You Need To Know About Private Health Insurance Canada

In Canada, most of us have access to some form of government or provincial health insurance. And these plans are great for basic coverage but the reality is that they don’t cover all the costs associated with your medical and healthcare needs. This can leave us with gaps in coverage that can put a serious financial dent in our pockets. It’s why private health insurance is a popular choice for individuals and families looking for extra coverage and peace of mind.

Let’s explore why private health insurance is valuable for all Canadians and how you can get the coverage that works best for your healthcare needs.

Private health insurance in Canada is a supplementary option to the publicly funded healthcare system. While the government provides universal healthcare coverage through provincial and territorial plans, these plans typically cover only essential medical services, such as doctor visits and hospital stays. 

Private health insurance steps in to fill the gaps, offering coverage for services not included in the public system, like prescription medications, dental care, vision care, and other types of services to keep you healthy.

Approximately 60% of Canadians have private health insurance, often provided as part of an employment benefits package. This type of insurance helps individuals and families manage healthcare costs that aren’t covered by the public system. 

For example, while the public system may cover a visit to the doctor, it often does not cover the cost of prescription drugs or paramedical services, which can be costly. Private insurance can make these expenses more manageable, ensuring broader access to necessary healthcare services.

Private health insurance policies in Canada can vary widely in terms of coverage, premiums, and deductibles. Some plans may cover a wide range of services with low out-of-pocket costs, while others might only offer limited coverage. 

Those who are self-employed or not covered by an employer's plan can also purchase private insurance independently. But this means they’ll have to cover premiums and associated costs themselves. 

Private health insurance in Canada offers several key benefits that complement the public healthcare system. One of the most significant advantages is its expanded coverage for healthcare services not included in provincial or territorial plans. 

This includes prescription medications, dental care, vision care, mental health support, and more. Private insurance helps individuals and families access a broader range of treatments without facing substantial out-of-pocket expenses.

Another important benefit is the flexibility and choice that private health insurance offers. While government healthcare plans offer basic coverage, everyone’s healthcare needs are different. With private health insurance, Canadians can choose the supplementary coverage that is most important to them.

Private health insurance also plays a vital role in promoting overall well-being by covering preventive services that might not be fully covered by the public system. 

For instance, many private plans include coverage for wellness programs, gym memberships, and alternative paramedical therapies like chiropractic care or acupuncture. These benefits encourage a proactive approach to health, helping to prevent illnesses and maintain a higher quality of life.

The key to finding the right private health insurance plan is making sure that it meets your needs and your financial situation. 

The first step is to assess your healthcare needs, including any ongoing medical conditions, prescription medications, and anticipated future health services such as dental or vision care. This helps you determine what type of coverage you’ll need. 

Cost is another critical factor when choosing a private health insurance plan. The biggest cost will be your monthly premiums, which is the amount you pay to maintain your coverage. 

But you should also make sure that you understand the details of any out-of-pocket expenses like deductibles, co-pays, and coverage limits. While lower premiums might seem appealing, they often come with higher out-of-pocket costs, so balancing affordability and comprehensive coverage is essential. 

Additionally, if you're bundling your health insurance with other products,  such as life insurance, your provider may offer packages or discounts to help you save on costs. 

Government healthcare plans cover approximately 70% of Canada’'s total health expenditure, the remaining 30% is paid privately through employer-provided insurance, personal plans, or out-of-pocket payments. 

So what exactly is covered by private health insurance plans? And what coverage should you be looking for?

One of the most common coverage options in private health insurance plans is prescription drug coverage. Some provincial plans may cover some medications for certain populations. However, many Canadians are left without drug coverage. Private healthcare also provides more comprehensive coverage, including drugs not listed under provincial formularies. This is especially beneficial for individuals who require regular medication, as it can significantly reduce out-of-pocket expenses.

Private health insurance plans also typically cover dental and vision care in addition to prescription drugs. These services aren’t covered for most Canadians by provincial or territorial plans, making private insurance essential for those who want regular check-ups, cleanings, and glasses. Some plans even extend coverage to more advanced dental procedures like orthodontics and restorative work, ensuring a broader range of dental care options.

Depending on your choice of coverage, you may also get coverage for specialized therapies and services, this can include physiotherapy, chiropractic care, massage therapy, mental health services, and alternative treatments such as acupuncture. 

When it comes to private health insurance in Canada, you’ve got tons of great options to choose from. So take the time to evaluate and compare different plans to find the right plan for you.

Some things to look out for include:

The range of coverage is one of the most critical factors to consider when comparing private health insurance providers. Some providers may offer more comprehensive plans that cover a wide range of services, while others might have more basic plans with limited coverage. 

Different providers offer varying levels of coverage for services such as prescription medications, dental care, vision care, and other additional services. For example, some plans have limitations on vision care or may only cover up to a semi-private hospital room. If additional coverage in certain areas is important to you, it’s important to make sure that your plan covers those things. 

Cost is another important consideration when comparing insurance providers. Your total costs include your monthly premium and out-of-pocket expenses like deductibles, co-pays, and maximum coverage limits. 

Some providers may offer lower premiums but have higher out-of-pocket co-pays, while others might have higher premiums with more comprehensive coverage and lower out-of-pocket costs. Understanding exactly all the costs associated with your plan is important for considering the short-term and long-term financial impact.

The most important part of your health insurance experience is what happens after you purchase your plan. The quality of customer service and the efficiency of the claims process can greatly influence your experience with a private health insurance provider. Providers with strong customer service reputations are more likely to offer responsive support, clear communication, and help you resolve any issues along the way.

It’s also important to choose a provider that has a streamlined claims process, so you can submit claims and get reimbursed quickly.

A great way to get a sense of the customer service and claims process for potential providers is to read customer reviews and ratings.

Some private health insurance providers offer additional benefits and perks that can add value to your plan. These may include wellness programs, discounts on fitness memberships, coverage for alternative therapies, or even bundled insurance options with life insurance or disability insurance. 

These extras can enhance your overall healthcare experience and make a particular provider more attractive compared to others.

Purchasing private health insurance in Canada can be really easy,  especially when using services like PolicyMe. 

All you need to do is answer a few basic questions about your healthcare needs and budget. PolicyMe will then provide personalized recommendations that align with your specific situation, making it easier to find the right coverage without unnecessary guesswork.

In just 60 seconds, you can receive a quote and compare 3 health insurance plans. This quick comparison lets you see the differences in coverage options and costs, so you can make an informed decision with confidence. 

Once you've selected the plan that fits your needs, you can purchase your plan in just a few clicks.

With PolicyMe, the application process can be completed online in less than five minutes without answering medical questions, making it even more accessible. If you prefer a more personalized approach, you can also speak with an advisor over the phone who can guide you through the options and answer any questions.

PolicyMe offers multiple plans, ensuring you'll find one that suits your healthcare needs and budget perfectly. 

Canada's healthcare system is known for its universal coverage. This means most Canadians don’t need insurance for basic healthcare, so there’s a significant distinction between what is offered through public health insurance and what private insurance can provide. 

Let’s look at some of the biggest differences between public and private health insurance in Canada,

Public health insurance in Canada, funded by the government, primarily covers essential medical services such as doctor visits, hospital stays, and emergency care. However, it often does not include coverage for prescription medications, dental care, vision care, or additional medical services.

Private health insurance fills these gaps by offering coverage for these additional services, giving individuals more comprehensive healthcare options.

Public health insurance is funded through taxes and is available to all Canadian citizens and permanent residents at no direct cost when accessing covered services. In contrast, private health insurance is paid for by the insured. If the insurance plan is provided through the workplace, the employer may cover the cost of the premiums. 

There may also be additional out-of-pocket expenses, such as deductibles, co-pays, or maximum coverage amounts.

When it comes to public healthcare, everyone has access to the same coverage. With a few exceptions based on demographics, such as age or household income, the level of care is standardized.

With Private health insurance, you get to choose your own plan, and it offers a higher degree of flexibility compared to public health insurance. You can choose a plan that fits your budget and needs, including options for additional coverage or higher limits on certain services. 

• Private health insurance offers health and medical services beyond what is covered by provincial or territorial plans, such as vision, dental, paramedical services, and prescription drugs.
• The majority of Canadians have private health insurance through employment benefits or will purchase them individually. 
• When selecting a private health insurance plan, carefully evaluate coverage and costs to make sure the plan meets your needs. 
• PolicyMe makes purchasing private health insurance a breeze, so you can enjoy peace of mind knowing that your healthcare needs are covered.