The cheapest health insurance plan isn’t always the best option. Public health plans in Canada cover basic medical services like hospital and physician visits. However, coverage for services such as vision, prescription drugs, dental, and mental health services varies by province and is usually available through specific programs for seniors, children, and low-income residents. According to a report by the C.D. Howe Institute published in 2023, around 27 million Canadians or roughly two-thirds of the population, rely on private health insurance to reduce out-of-pocket costs for the care they need most. In this guide, you will find 2025 costs, the cheapest insurers, and ways to lower your premium while keeping major benefits.

At PolicyAdvisor, we make it easy to compare affordable health insurance quotes from leading providers (Manulife, Blue Cross, Sun Life, GMS, etc.) in minutes. Our licensed advisors help you choose the most affordable plans that cover the services you need, completely free of charge.

What does health insurance cover in Canada?

Canadians have access to basic medical care through a combination of provincial and private health insurance plans. The extent of coverage, particularly for essential healthcare services, differs significantly between what is provided by private insurance plans and what is supported by the government.

Around two-thirds of Canadians rely on their private health insurance to cover gaps in public plans. Private plans may be individual or group. Individuals buying health insurance in Canada must check their public healthcare plan to identify the benefits they require. 

Connect with our experts at PolicyAdvisor to identify the gaps in your public healthcare plan. Our advisors will help you compare different health insurance quotes and choose an affordable plan that is suitable for your financial needs.

Services covered under health insurance

Private health insurance covers major services such as vision, dental care, prescription drugs, and paramedical services to supplement coverage gaps.

• Vision exams: The private healthcare plan covers regular eye check-ups, prescription glasses, and contact lenses
• Preventive dental care: Routine cleaning, basic fillings, and regular checkups are covered
• Certain prescription drugs: Generic drugs or those falling under the “essential drugs” category are covered

• Paramedical benefits: Coverage may include essential medical services such as mental health counselling, physiotherapy, chiropractic care, and massage therapy

You can get a better value for your private health insurance by bundling vision, paramedical, and drug coverage.

What is excluded from a basic private health insurance plan?

There are certain services not covered by a basic health insurance plan in Canada. It is important to be aware of them before buying coverage.

• Cosmetic dental procedures, such as teeth whitening and implants, are often excluded 
• Braces and adult orthodontic treatments excluded, except for children in certain situations
• No coverage for expensive special therapies and drugs 
• Extensive paramedical care that goes beyond the coverage limit

PolicyAdvisor serves as a trusted guide for easily comparing health insurance policies. Our PolicyAdvisor advisors ensure that their customers find plans that can be tailored to their specific health requirements while maximizing value and affordability by clearly defining the inclusions and exclusions of various insurance policies.

How to get cheap health insurance in Canada?

To find a suitable health insurance plan in Canada, one must be able to compare health insurance quotes, understand the benefits offered by group and private health plans, and utilize methods to lower premiums, such as taking advantage of tax breaks and maximizing deductibles.

This guide will help you understand the steps for securing the necessary coverage without paying more than necessary.

Compare health insurance quotes in Canada

• Use online tools to get health insurance quotes: You can use PolicyAdvisor’s free online tool to get instant health insurance quotes from multiple insurers

• Check for exclusions and hidden charges: Stay cautious of policies with extensive exclusions, low annual maximums, or hidden fees that can increase the overall cost despite the lower premiums

Maximizing deductibles to lower premiums

• Increase the deductibles to reduce premiums: Premiums can be lowered by increasing the deductibles. However, this strategy also increases the out-of-pocket expenses
• Choose a suitable deductible: Select a deductible that balances reduced premium rates with your capacity to pay unexpected expenses

Tax benefits and health spending accounts

• Medical expenses tax credit: The medical expense tax credit lowers your tax payable by claiming eligible medical expenses on your tax return
• Health spending accounts (HSAs): Let self-employed Canadians set aside a pre-tax amount for eligible medical expenses, which may reduce overall taxes 

Can I get health insurance without a job in Canada?

Being unemployed in Canada doesn’t mean you lack access to health insurance. Canadians have access to provincial health insurance that covers the cost of essential medical services. However, public healthcare plans don’t cover essential services like dental care, mental health benefits, and prescription drugs, so private health insurance can supplement those gaps.

Not only unemployed people, but also senior citizens, freelancers, students, and self-employed individuals can buy private health insurance covering different healthcare services in Canada. 

Canadian insurers like Manulife, Blue Cross, and Sun Life offer guaranteed-acceptance health insurance plans to those without a job or switching from employee coverage to private coverage. To buy suitable health coverage, take into account age, health status, monthly premium rates, and exclusions. Students who rely on university-sponsored insurance should consider a private health plan, as university coverage may not be enough.

Unemployed individuals can contact our advisors at PolicyAdvisor for guidance on plans catered to their specific needs. Our expert advisors provide help in comparing different health insurance quotes in Canada.

What are the cheapest health insurance options for seniors in Canada?

Canadian Seniors should consider health coverage that fills provincial plan gaps, such as vision, dental care, and prescription drugs, to avoid out-of-pocket expenses.

• Include coverage for dental care and prescription drugs, which the public health plan, due to its limitations, doesn’t cover 
• Consider private health plans that cover healthcare services, such as prescription drugs, dental care, etc.
• Compare coverage from Canadian insurers like Manulife, Sun Life, and Blue Cross 

Is private health insurance worth it in Canada?

Whether an individual should buy a private health insurance plan in Canada depends on their needs and circumstances. Provincial health insurance in Canada provides essential medical coverage, such as a doctor’s visit, diagnostic tests, surgeries, and hospital visits. However, having public health insurance may not be sufficient due to the lack of coverage for medical services such as dental care, vision, mental health benefits, and prescription drugs. 

Group health insurance may cover gaps in a provincial coverage plan, and in that case, an individual may not be required to opt for private health insurance in Canada. It is important to evaluate the benefits offered under a group plan and identify gaps in coverage, based on which one can decide whether a private health plan is needed or not. 

We recommend that individuals with dependents, retired seniors, and those with regular prescription needs buy a private health plan to cover the rising cost of different medical care.

Our advisors at PolicyAdvisor offer guidance for comparing different health insurance quotes and help Canadians determine the best coverage option according to their needs.

How to apply for health insurance in Canada?

The health insurance application process in Canada is straightforward. Each province in Canada oversees its own healthcare programs, and the applicant needs to submit their residency and identity documents, either online or offline, to obtain public health coverage.

Canadians and newcomers looking for private medical insurance must first compare different health coverage options, choose a plan, and apply online. The online process is convenient, as it helps an individual find an affordable plan that can be tailored to fill the gaps in their public healthcare coverage. 

Directly get in touch with our licensed advisors at PolicyAdvisor at no cost to compare different health insurance quotes and buy the most affordable plan.

• Our experts at PolicyAdvisor provide free comparison tools and offer guidance for comparing various medical insurance quotes
• Evaluate each plan’s benefits and limitations, including the policy term and premium rates, before buying
• Fill in the application form and submit it along with the relevant documents
• Ensure the supporting documents, such as identity and residency proofs, are in order 
• After submitting the application form, it will be reviewed by the insurer or the government office. Processing time differs by insurers and provinces
• Once the application is approved, you will receive your health card
• When the need arises, complete the claim-filing process. Submit the necessary documents, along with the claim form, after which the insurer will verify them. If all the documents are in order, the claim will be paid

Dental care is expensive for many Canadians. In 2022, 25.9% residents skipped dental check-ups, and of those, 47.4% people without insurance delayed oral care due to high costs (Statistics Canada, 2024). CDCP aims to lessen this burden.

The Canadian government sponsors the Canadian Dental Care Plan (CDCP), which makes basic dental coverage affordable for eligible families. However, not all dental services are covered. In this guide, you will learn what is covered, excluded, and what to do if you do not meet the eligibility requirements or lose coverage.

How to choose the cheapest personal dental insurance plan?

Choosing the right personal dental insurance plan is essential for having access to a broad range of dental benefits at an affordable cost. Various insurers in Canada provide dental care plans that cater to different dental needs. Before buying private dental coverage, compare different dental insurance quotes to buy a suitable plan.

You can also get in touch with our advisors at PolicyAdvisor, who will help you compare various insurance quotes and buy the most suitable dental plan based on your budget.

Understanding the key factors when looking for dental coverage can help you make an informed decision.

Things to consider when looking to buy private dental coverage in Canada

Before buying private dental insurance, consider factors such as cost, provider networks, services included, waiting period, and other benefits to ensure you have access to a cost-effective dental plan.

• Coverage type: Dental insurance typically covers three categories – basic, preventive, and major. Basic covers common dental services such as root canals and cavities, while preventive services include teeth cleaning and routine check-ups. Under major services, complex dental treatments that are typically expensive are covered
• Annual limits and maximums: Most of these plans have an annual limit ranging between $1,000 and $2,000. Once you exceed the limit, any additional expenses are to be paid out of your own pocket
• Network providers: Several Canadian insurance plans cover visits to a licensed dentist. Though the premiums remain fixed, the reimbursement can be lower if choosing an out-of-network dentist
• Waiting period: Several dental care plans include a waiting period on certain services, ranging from a few months to a year. Knowing the waiting period can help you decide the type of dental coverage you require
• Additional benefits: Look for dental plans that offer additional coverage for services such as wellness programs, telehealth dental consultations, etc. You can also bundle your dental coverage with vision and/or drug coverage to maximize your benefits at an affordable cost

How to get the best dental insurance in Canada?

Evaluate your dental care needs and budget before looking for a new dental plan in Canada. You can contact our experts at PolicyAdvisor, who will help you compare various dental insurance quotes and buy the most suitable coverage.

Knowing the step-by-step process can help in making an informed decision and buying a comprehensive private dental insurance plan in Canada.

• Assess your dental care needs, including those of your family members. This will help you know the benefits you need and your budget
• Our experts at PolicyAdvisor can help you compare different dental insurance quotes and guide you to buy a comprehensive dental care plan. Our advisors are also available to help even after you have bought the coverage and have insurance-related queries
• Compare premiums, deductibles, and co-payments to get a better understanding of what coverage is suitable according to your budget
• Check provider networks to see whether the dental plan includes your preferred dentist or not
• Choose a plan with a low waiting period, especially if you need immediate dental services
• Our experts provide you with access to different online tools and calculators to help you buy a comprehensive coverage plan. Check out customer reviews to have a better understanding of what a dental plan would offer
• Fill out the application form and submit it along with the necessary documents for verification

In 2025, Canada’s health insurance market is estimated to be about $73.6 billion, and expected to touch $121.53 billion by 2030 (Mordor Intelligence), expanding at a CAGR of 10.55% annually. 

Two-thirds of Canadians have private supplemental health coverage, often through group plans, despite Canada’s universal healthcare system covering essential medical services. Private health insurance in Canada often covers services not included under provincial plans, such as dental care, prescription drugs, mental health, vision care, and private hospital rooms.

The guide explores the value of health insurance in Canada and why buying it is necessary despite being covered by a provincial health insurance plan. In this guide, you will learn:

• What is covered under Canadian health insurance
• How to buy health insurance, and the top insurance companies in Canada to consider
• Factors that determine the cost and coverage of a health insurance plan 

Factors influencing cost and coverage for health insurance in Canada

Factors influencing health insurance costs in Canada include the level of coverage, benefits, deductibles, copayments, and your personal risk profile. Understanding these will help you choose a plan that balances affordability and protection.

• Status of health and age: Your age and health status play a primary role in determining the cost of health insurance. A young individual with no medical condition will need to pay lower premiums for health insurance compared to an older person with a pre-existing medical condition. Canadian insurers assess your health risk to determine the coverage and the premium

• Level and type of coverage: Health insurance costs in Canada are dependent on the extent of coverage you seek. For example, buying health insurance offering coverage for mental health benefits, dental care, prescription drugs, vision, and paramedical treatment, the premiums will be higher compared to a basic plan with limited coverage, for which the premiums will be lower

• Province determines cost: Public healthcare coverage differs by province, which influences demand for private coverage. For example, residents in some provinces may rely more on private insurance for prescription drugs or mental health services, affecting the cost of supplemental plans in those regions. For example, residents of Ontario and British Columbia may have a higher demand for mental health coverage, the premiums for which would be higher. Premiums, however, vary by insurer and coverage

• Occupation and lifestyle: Your lifestyle and occupation decide the cost of health coverage. Smokers and people in high-risk jobs generally pay more for coverage. Healthy non-smokers may qualify for lower premiums or discounts, as they are considered lower risk. Similarly, healthy individuals who do not smoke may get rewards such as discounts on premiums from their insurer since they are considered low risk

• Copayments and deductibles: Plans with lower deductibles and copayments tend to have higher premiums, since the insurer covers more costs upfront. Annual benefit maximums (e.g., vision or dental limits) also affect pricing and coverage levels
• Individual plans vs. group plans: Group health insurance is often more affordable due to risk pooling and employer contributions. Personal medical plans, while typically more expensive, allow greater flexibility in tailoring coverage to personal needs

Tips for choosing the best health insurance plan

Buying health insurance in Canada requires careful planning. The process goes beyond comparing health insurance quotes, and you need to compare policies, check the benefits offered, and determine the healthcare plan that meets both your health and financial requirements. We have laid down the tips for choosing the best health insurance plan so that you can get maximum protection at a good value for your money.

• Reading the policy fineprint: Read the fine print when buying coverage for health insurance in Canada. Know about the exclusions and other limitations so that you do not incur additional expenses. Acquaint yourself with important terms related to insurance in Canada, such as lifetime maximums, pre-existing conditions, etc., to ensure you buy a suitable health insurance plan. You can visit PolicyAdvisor, where you can learn everything you need to know about buying private health insurance in Canada

• Getting the most out of your coverage: Read the benefits, inclusions, and the claim process mentioned in the policy document to get the most out of your insurance plan. Keep track of your medical expenses and file claims in a timely manner. To maximize the benefits of your health insurance, make use of all the preventive care covered, and inspect paramedical services, wellness initiatives, and other benefits

• Support and resources: Simplify the process of buying and managing health insurance by having access to reliable resources. Canadian health insurance advisors provide a professional guide to buying appropriate health insurance and ensure your queries are cleared. You can also refer to government manuals to know more about health insurance options and understand the benefits offered by provincial health insurance and private health insurance, respectively
• Work with PolicyAdvisor: Instead of navigating dozens of insurers on your own, let PolicyAdvisor experts do the work for you. We compare plans from Canada’s top health insurance providers side by side, explain the fine print in plain language, and guide you to a plan that fits your unique needs and budget. Best of all, our advice is free, and our recommendations are based on the coverage you choose

• Review your renewal terms: Some health insurance plans allow the renewal option, during which you can make changes to your existing coverage, policy terms, and other benefits. You must check the terms associated with the policy renewal regularly

• Inquire about add-on plans: Private medical plans offer different add-on plans like critical illness, travel insurance, etc. You must inquire which plan offers what add-on options to help you determine the coverage and the benefits required

• Confirm insurer network: While most plans cover care from licensed providers, some may have spending limits, and only cover services from preferred networks  

• Assess the waiting period: Under certain insurance policies, there can be a waiting period before the benefits offered are activated. Check the policy for the waiting period to decide whether to buy it or not
• Look for flexibility: Buy health insurance plans that offer the flexibility to change your coverage as per the changes in your health and financial needs

Being self-employed has a lot of upsides. You get to be your own boss, set your own hours, and plan your professional life on your own terms. The downside? No group health insurance. Whether it’s prescription medication, vision care, dental visits, or other preventative care, the costs can be substantial. 

Health insurance plans for self-employed individuals help cover the costs of medical expenses that provincial coverage does not cover. 

Read on to find out how to choose the best health insurance plans for self-employed people and more expert tips.

What does health insurance for self-employed individuals mean?

Health insurance for self-employed individuals in Canada refers to health coverage plans that are specifically tailored for those who run their own businesses or work as freelancers. Such individuals do not have employer-provided benefits and need a health insurance plan that covers medical expenses such as doctor visits, hospital stays, medications, and more.

Self-employed individuals often purchase these plans through private insurers, government exchanges, or association health plans. They have the flexibility to choose from a variety of coverage options, though premiums, deductibles, and out-of-pocket costs can vary depending on the plan chosen. Additionally, self-employed individuals may be eligible for tax deductions on their health insurance premiums, making it more affordable.

Private vs. government healthcare

Government healthcare in Canada has limited coverage. It generally only covers emergency care that requires urgent intervention such as doctor’s visits, emergency surgeries, hospitalization due to a severe illness, etc. 

Private health insurance covers health care services and other medical expenses such as prescription medication, paramedical services (chiropractic services, physiotherapy, massage), and other medical equipment (CPAP machines, crutches, nebulizers, etc.).

As someone who is self-employed, you are entitled to provincial health insurance. But it may not be enough. Think of it this way: public health insurance handles immediate care of injury and illness, while private health insurance covers the costs needed to fully recover.

Provincial/territorial healthcare coverage

Provincial and territorial healthcare systems in Canada, known as universal healthcare, provide coverage for essential medical services deemed medically necessary.

This includes emergency services, doctor visits, specialist referrals, hospital stays in standard rooms, primary mental health care, palliative and end-of-life care, maternity care, and some prescription drugs.

Self-employed individuals should get private health insurance to supplement their provincial coverage. 

What are the advantages of personal health plans for self employed individuals in Canada?

The main advantages of private health insurance for self employed Canadians are the flexibility it brings with customizable options, tax benefits, portability, and more. Let’s look at these in detail:

• Flexibility: A self-employed person gets to choose their individual plan, rather than being stuck with a group plan that may not fit their unique needs
• Customizable options: Similarly, they can tailor their health insurance coverage to make sure their plan works best for them
• Independence: Having your own individual plan plan for health coverage means you’re not reliant on anyone for financial protection
• Portability: Health coverage through an employer will end if you leave the job or retire, but private insurance moves with you
• Tax benefits: You can get a tax deduction for health insurance premiums you pay for a private health plan. We’ll talk more about this below

Why do self-employed individuals need private health insurance?

Self-employed people need private health insurance to fill the gaps in provincial or government coverage. Private health insurance offers financial protection and tax benefits, both of which are important for self-employed individuals. 

Let’s take a detailed look at why self-employed individuals need private health insurance:

• Provincial health plans cover emergency medical care. Other essential services such as dental care, vision care, mental health related therapies, massages and chiropractors, are all covered under private health insurance. Without private health insurance, the costs for these services can be substantial
• Unexpected medical bills on top of running a business is not a good combo. Private health insurance helps ease the financial burden that a sudden illness can cause
• The premiums for private health insurance can often be deducted from a self-employed individual’s taxable income. This makes private health insurance affordable and financially advantageous

Having private health insurance coverage can help you stay healthy and focused on your work. It means you won’t have to worry about unexpected medical bills that could hurt your personal and business finances.

What does private healthcare insurance cover?

Private healthcare insurance in Canada supplements provincial healthcare by offering coverage for services not fully covered by the public system.

This typically includes:

• Dental care
• Vision care (including eyeglasses and contact lenses)
• Prescription drugs (often with more comprehensive options)
• Semi-private or private hospital rooms
• Certain medical services not covered by provincial plans (such as chiropractic care, physiotherapy, and massage therapy)
• Enhanced coverage for ambulance services, medical equipment, and treatments abroad

What kind of health benefits can I get if I’m self employed?

Self-employed Canadians can get health insurance that only covers costs related to health, like prescription drugs, paramedical services, or nontraditional therapies. Or, they can also get a plan with supplemental coverage, which can help cover costs for things like dental and vision care.

Let’s look at the different types of coverage the self-employed can access in Canada below.

Traditional health insurance

Personal health insurance plans come in tiers, depending on the coverage level that you’re looking for. In general, these health insurance packages come in basic, standard, or enhanced. The more the plan covers, the more it will cost.

Cost and coverage tier for traditional health insurance

*Quote for a 35-year-old person in Ontario with no pre-existing health conditions.

Supplemental health insurance

Aside from the health insurance coverage we noted above, self-employed people can also get supplemental health insurance to cover vision and dental care needs.

Dental insurance for self employed

To get dental costs covered, self-employed people can get private health benefits. Most private health insurance plans have dental built right into the plan cost, but some may only have it for standard or enhanced tiers of coverage.

Vision care insurance for self-employed

Many individual health coverage plans also have vision care built into their packages. Usually, basic packages will cover you for an eye exam at least once every two years. Some also cover some costs for glasses, but plans can include other services too.

Critical illness insurance for self-employed

Critical illness insurance can be especially valuable for self-employed individuals, providing a tax-free lump sum if you’re diagnosed with a serious illness. Without employer benefits to fall back on, this coverage helps protect your income and keep your business running during recovery.

How much does health insurance cost per month for a self-employed person?

The average costs of private health insurance costs around $80 to hundreds in monthly premiums for self-employed Canadians. The cost of health insurance depends on your age, where you live, what kind of plan you buy, and more. The chart below shows some sample quotes for private health coverage for self employed individuals.

Health insurance cost per month for a self employed individual

*Quotes based on single-person coverage (for yourself only) for a 35-year-old resident of Ontario in normal health.

Are there deductible options for self-employed health cover in Canada?

Yes, private health insurance has several options for deductibles. This is how much you have to pay out of pocket before insurance starts helping with the costs. The deductible makes a difference in your premium rates. Higher deductibles mean lower monthly premiums, but you also have to pay more upfront if you have a claim.

Is health insurance tax deductible for self-employed in Canada?

Yes, self-employed Canadians can deduct their health insurance on their yearly income tax return under the Medical Expense Tax Credit. You can qualify as long as:

• You are the sole proprietor of your business
• Your business income is your primary source of income

You may be able to claim medical expenses on behalf of your dependents too. Just be sure to consult a tax professional to make sure you’re filing properly.

What insurance is best for the self-employed?

The best health insurance for self-employed individuals depends on their unique requirements and circumstances. If you are young, generally healthy, and with no dependents, a standard private health insurance plan might work for you. If you have a family and are a smoker, an enhanced plan might work better for you. For those with a pre-existing health condition, a guaranteed acceptance plan will work best. 

To get you started in thinking about which plan would work best for you, check out some of our self-employed friends below and see what plan worked best for them.

We suggest… 

A standard plan.

Why?

Her spouse’s plan has fairly decent coverage for prescription drugs and dental insurance. That would cover most of Solange’s needs, and her own basic plan will make up the rest. If things change in the future and they have kids, we would suggest a more comprehensive supplementary plan. But for now, basic coverage is perfectly fine.

We suggest…

An standard plan.

Why?

While she has great coverage through her husband’s federal employee benefits plan, Cindy’s income in inconsistent and she doesn’t always have extra income to cover the remaining 20-30% of the medical service bills. Plus, her three boys all need braces. Her husband’s plan will cover about 70% of that, and her standard plan could make up the rest.

We suggest…

An enhanced plan.

Why?

His daughter has coverage through his ex-wife’s work plan, but Danish doesn’t have any coverage at all. As a self-employed business owner and single dad who is pre-diabetic, he needs to take his health seriously — and every penny counts. An enhanced plan can help him budget his healthcare costs so he can provide for his daughter and protect himself.

What are the best health and dental insurance companies for the self-employed?

These are the companies our experts recommend for the best self-employed health insurance plans:

• Blue Cross (Ontario) — unmatched prescription and dental coverage without limits
• Canada Life — comprehensive coverage options and flexible plans
• Manulife CoverMe — great options for flexibility and add-ons like dental-only, vision-only, or prescription drugs-only
• Sun Life — offers health coverage as one of its flagship products
• GreenShield (Sure Health) — offers guaranteed acceptance coverage for those with pre-existing conditions or who cannot qualify for other plans
• Desjardins — offers a SOLO healthcare product specifically for health and dental
• GMS — also has guaranteed acceptance plans plus no waiting periods and a LifeWorks digital wellness program to promote physical and mental well-being

How to get the best health insurance for self-employed individuals?

If you’re looking for advice on how to apply for the best self-employed health insurance options, just follow these 5 tips below:

Figure out what you need

The key to getting the best coverage is knowing and understanding what essential health benefits you need to cover and how the cost compares to the advantages.

Shop around

Comparing health insurance quotes can be easily done online through PolicyAdvisor. Look at different options to find the package that gives the most bang for your buck.

Apply online

Time is money and you can save both when you submit your application online with one of our friendly, licensed advisors. Getting medical insurance for self employed people is fast and easy with us

Compare companies closely

The health insurance provider you choose makes a difference. Compare quotes for health insurance from top companies to find who can give you the best deal. Or speak with our licensed advisors and let us do it for you!

Check with associations you’re part of

If you’re a part of any organization, check and see if they offer insurance coverage or discounts. Many of them offer exclusive insurance plans or deals.

What to avoid when looking for the best medical insurance for self employed in Canada?

When looking to get the best self-employed health insurance coverage, you should also avoid these faux-pas:

• Not comparing quotes — There’s no shame in window-shopping. Shop around before you buy, or contact us and let our agents help you find the best health plans for self-employed Canadians
• Skipping reviews — See what real customers have to say before you choose to buy from an insurance company
• Waiting too late — The sooner you buy, the lower your premiums will be and the better your plan options will be
• Cutting corners — You don’t have to get the most expensive plan, but don’t leave yourself without enough coverage either. Insurance isn’t something to skimp on
• Short-term thinking — Think about yourself and your business long-term to get a plan that will cover you now and in the future
• Not reading your policy — Understanding your coverage details is important to make the most out of your coverage, and your policy will tell all. Be sure to read it carefully!

Get affordable health insurance for self-employed individuals in Canada

If you’re a self-employed individual looking to find the right health insurance coverage that fits your diverse needs, you may need a little help! While you may be aware of your needs, it can be difficult to go through all the plans on your own!

This is where health insurance advisors like our experts at PolicyAdvisor come in! Not only can we help you pick the right plan, but we can also help you get the best possible riders and customization to ensure all your needs are taken care of. With the help of PolicyAdvisor, you can focus on your business while we keep you financially protected in case of a medical emergency.

Health insurance comes with cost-sharing elements like co-pays and deductibles that determine how much you pay out of pocket before your plan kicks in. While a co-pay requires you to pay out of pocket when you visit a medical practitioner or a pharmacy, deductibles are charged upfront when you’re purchasing your health insurance policy.

Knowing how co-pays and deductibles work can save you money and help you choose the right health insurance plan. Let’s break it down so you can make smarter healthcare choices.

What does cost-sharing in health insurance mean?

Cost-sharing refers to splitting up the cost of your healthcare needs between you and your insurance provider. There will be a portion of healthcare expenses you’re responsible for paying, even with insurance. Here’s what it includes:

• Co-pays: Fixed fees you pay for services like doctor visits or prescriptions
• Deductibles: The amount you must pay before insurance starts covering costs
• Co-insurance: A percentage of costs you share with your insurer after meeting your deductible
• Out-of-pocket maximum: The most you’ll have to pay in a year before your insurer covers 100% of expenses

What is co-pay in health insurance?

When you visit a doctor or pick up a prescription, you might have to pay a small, set fee at the time of service. This is called a co-pay (copayment)—a fixed amount you’re responsible for paying, regardless of the total cost of the medical service. 

Co-pay helps with splitting the cost between you and your insurance provider for your medical care and makes it easier to budget routine medical care.

When do you pay a co-pay?

Co-pays are typically due at the time of service, whether at a doctor’s office, pharmacy, or urgent care clinic. However, some insurance plans require you to meet your deductible first before co-pays apply.

This means you might have to cover the full cost of services until you’ve spent a certain amount of money out of your own pocket.

Which medical services usually have a co-pay?

Generally, healthcare services such as doctor visits, pharmacy runs, visiting specialized practitioners, or even emergency care. A few examples of how much you might have to pay for availing these services are:

• $30 for a primary care doctor visit
• $50 for a specialist consultation
• $10 for a generic prescription, $30+ for brand-name drugs
• $75 for an urgent care visit, and $250 for an emergency room visit
• $25-$40 for mental health therapy sessions

What does deductible mean in health insurance?

A deductible is the amount you must pay out of pocket before your insurance starts covering the cost of your healthcare. It is like a financial deposit wherein you pay for certain medical expenses first, and once you hit a specific amount, your insurance kicks in.

For example, if your plan has a $1,500 deductible, you must first pay $1,500 for covered medical services before your insurer starts sharing the costs. After reaching this amount, your insurance will cover a percentage of your medical bills, often through coinsurance (e.g., 80% covered by insurance, 20% by you).

How do deductibles work?

Deductibles don’t apply to all healthcare expenses equally. Some services like hospital stays, diagnostic tests, and pharmacy visits require you to pay the full cost until your deductible is met, while other services like preventive care and prenatal checkups, are covered right away. Here’s how it typically works:

Medical expenses that count toward your deductible

These are services you must pay for out of pocket until you reach your deductible limit:

• Hospital stays, surgeries, and specialist visits: Major medical treatments and procedures usually contribute toward your deductible
• Diagnostic tests: Expensive tests like MRIs, CT scans, and lab work are often applied to your deductible before insurance kicks in
• Certain prescription medications – Some plans require you to meet your deductible before covering higher-tier drugs

Services covered before the deductible limit is met

Some healthcare services are covered immediately, without requiring you to meet your deductible limit:

• Preventive care: Most health insurance plans cover annual check-ups, screenings, and vaccinations at no cost
• Routine prenatal care: Many health insurance plans provide maternity-related check-ups without applying costs to the deductible

Choosing between a high and low-deductible plan

When selecting a deductible health insurance plan, it’s important to weigh the trade-off between monthly premiums and out-of-pocket costs. Choosing the right plan depends on your medical needs, budget, and how much financial risk you’re willing to take. 

If you rarely visit the doctor, an HDHP may save you money, but if you need frequent care, a low-deductible plan might be a better option.

High Deductible Health Plans (HDHPs)

High deductible health insurance plans require higher upfront payments for medical care but come with lower monthly premiums. They are best for those who don’t expect frequent healthcare expenses. Some of the features of high deductible health plans are:

• Lower monthly premiums, making them cost-effective for people with minimal healthcare needs
• Higher out-of-pocket costs until the deductible is met, which can be challenging in case of unexpected medical expenses
• Often paired with a Health Savings Account (HSA), which allows tax-free savings for qualified medical expenses
• Works well for young, healthy individuals or those with emergency savings to cover sudden costs

Low Deductible Health Plans

Low deductible health insurance plans come with higher monthly premiums but offer lower out-of-pocket costs, making healthcare expenses more predictable. Some of the features of a low deductible health plan are:

• Higher monthly premiums, but they help reduce financial strain when seeking medical care
• Lower deductibles, meaning insurance starts covering costs sooner
• Ideal for individuals with chronic conditions, ongoing prescriptions, or frequent doctor visits
• Offers peace of mind with more predictable healthcare expenses

How do co-pays and deductibles affect your healthcare costs?

Understanding how co-pays and deductibles work together can help you manage healthcare expenses more effectively. While co-pays are fixed costs per visit, deductibles determine how much you must pay before insurance starts covering a portion of your bills.

For instance, let’s say your health plan has a $1,500 deductible and a $30 co-pay for doctor visits. Here’s how it impacts your costs:

• Before meeting your deductible: You pay the full cost of medical services (e.g., a $150 doctor visit). Co-pays typically don’t apply here
• After meeting your deductible: Your insurance starts covering part of your medical bills, and you only pay the $30 co-pay per visit instead of the full price

This balance between deductibles and co-pays affects how much you’ll pay out-of-pocket annually, influencing your budgeting and healthcare decisions.

How will choosing a higher deductible or co-pay impact premium costs?

Opting for a higher deductible or co-pay will lower your monthly health insurance premiums. A higher deductible means you’ll need to cover more out-of-pocket costs before your insurance starts paying for services, while a higher co-pay increases the amount you pay for doctor visits, prescriptions, or specialist appointments. 

Since these plans shift more costs to the policyholder, insurers reduce the monthly premium. However, while these plans help save on monthly expenses, they come with a trade-off—higher upfront costs when medical care is needed. 

If you have chronic conditions or unexpected medical emergencies, a high-deductible plan may result in significant out-of-pocket expenses. That’s why it’s important to assess your health needs and financial situation before choosing a plan.

Where can you get affordable health insurance quotes in Canada?

If you’re looking to get the best health insurance quotes in Canada, PolicyAdvisor is your one-stop solution!

At PolicyAdvisor, we work with 30+ insurance providers to compare rates, build customized plans and provide you with the best quotes well-suited to your needs. Our team of licensed insurance advisors provides personalized support, making the insurance-buying experience both transparent and human-centered.

Our AI-powered customer experience tools can assist clients in assessing their insurance requirements, determining appropriate coverage amounts, and submitting applications efficiently.

Schedule a call with us today and get the most affordable health insurance quotes for your healthcare needs.

The average cost of personal health insurance in Canada varies based on age, family size, and coverage type. For individuals, premiums start as low as $61.32/month for a 25-year-old (e.g., Sun Life) and can range up to $348.40/month for a 75-year-old (e.g., Manulife). 

Families of four pay between $167.24 and $818.30/month and plans with pre-existing conditions typically begin at $99.10/month for a 25-year-old, and can go up to $304.34/month for older individuals aged 75 years.

While Canada’s public healthcare system covers many medical expenses, private health insurance is often necessary for services like dental, vision, and prescription drugs. In this article, we’ll explore what these costs are, what influences them, how these costs vary across provinces, and more.

How much does private health insurance cost in Ontario?

The cost of private health insurance in Ontario varies based on the type and level of coverage. Basic plans start at approximately $100 per month, offering essential medical coverage with minimal extras. Comprehensive plans, which can range from $250 to $300 per month, provide broader benefits such as vision, dental, and prescription drug coverage. 

How much does health insurance in Alberta cost?

Personal health insurance in Alberta is generally more affordable compared to other provinces, with costs varying based on the level of coverage. Basic plans range from $50 to $180 per month, providing essential health services, while comprehensive plans can cost up to $234 per month. 

For example, a basic Sun Life plan for a 33-year-old may cost approximately $59.48 per month, whereas a more extensive plan could be priced around $145.54 per month, offering broader benefits.

What is the cost of health insurance in British Columbia?

In British Columbia (BC), private health insurance costs vary based on the plan’s scope and benefits. Basic coverage starts at approximately $70 per month, providing essential health services, while comprehensive plans covering drug, dental, and vision care, can go up to $200 per month.  

How can I get health insurance with pre-existing conditions?

Most insurers offer guaranteed or assured acceptance plans, and replacement plans for individuals with pre-existing conditions. Guaranteed health insurance plans provide coverage for individuals with pre-existing conditions, ensuring approval regardless of medical history. 

These plans do not require any medical underwriting, meaning you don’t need a health assessment to qualify. Coverage typically starts immediately or after a short waiting period, offering quick access to benefits. However, the premiums are higher to account for the increased risk of covering pre-existing conditions.

Replacement plans are designed for individuals transitioning between insurance policies, such as after losing group medical coverage or switching providers. These plans may cover pre-existing conditions if continuous coverage has been maintained, ensuring seamless protection. 

While they often come with higher premiums due to the inclusion of pre-existing conditions, replacement plans typically provide more comprehensive benefits than guaranteed plans, offering broader networks and additional services.

For individuals with pre-existing conditions, monthly premiums vary by age and gender. For instance, a 25-year-old male can expect costs ranging from $99.10 to $293.20, while a 55-year-old male may pay between $129.90 to $299.23. 

Cost of guaranteed health insurance plans 

*Average premiums for sample plans. Higher coverage will lead to higher costs. 

How are dental and vision coverages included in personal health insurance plans?

Many personal health insurance plans in Canada offer dental and vision benefits as part of their extended health coverage. These benefits help individuals manage routine and unexpected healthcare expenses not covered by provincial plans.

Dental coverage: Most plans provide reimbursement for preventive care (cleanings, exams, and X-rays), basic procedures (fillings, extractions), and major services (crowns, bridges, root canals). Some also cover orthodontics, typically with a lifetime maximum.  

Vision coverage: This typically includes partial reimbursement for eye exams, prescription glasses, and contact lenses, with coverage limits renewing every one to two years. Some plans also contribute to corrective laser eye surgery.

These benefits are especially valuable for individuals without employer-sponsored coverage. They ensure continued access to essential care while managing out-of-pocket costs.

How do pre-existing conditions affect the cost of health insurance in Canada?

Pre-existing conditions can significantly impact the cost and coverage options for private health insurance in Canada, often leading to higher premiums or limitations in coverage.

• Higher premiums: Individuals with pre-existing conditions often face higher premiums as insurers consider them higher risk due to ongoing medical needs
• Rated policies: Insurers may issue a “rated” policy, where the premium is increased to reflect the additional risk posed by the applicant’s medical history
• Coverage limitations: Some policies may exclude treatments related to pre-existing conditions or impose waiting periods before coverage for these conditions takes effect
• Disclosure requirements: When applying for private health insurance, applicants must fully disclose any pre-existing conditions. Failure to do so could result in policy denial or claim rejection
• Types of coverage available: Canadians with pre-existing conditions can access guaranteed acceptance plans, comprehensive plans, or supplemental insurance, though these options may come with higher premiums or waiting periods

Choosing the best health insurance in Canada can feel overwhelming, but finding the right plan for you is essential.

Our expert reviews of top providers like Manulife, Blue Cross, and Sun Life help you compare health insurance plans, from affordable options to the best health and dental insurance Canada has to offer.

Designed for families, individuals, and newcomers, these plans ensure comprehensive coverage, including medical, dental, and vision care. So, get a health insurance quote today to find the perfect coverage for your health.

What is private health insurance?

Private health insurance in Canada works alongside the publicly funded healthcare system to provide additional coverage for services not covered by the government.

Coverage includes prescription medication, medical equipment, paramedical services, dental care, vision care, emergency medical travel insurance, and other medical expenses.

What are the best health insurance companies in Canada?

After reviewing Canada’s top health insurance companies, our team of experts has picked Blue Cross, Canada Life, and Manulife as having the best health coverage in Canada.

But, not every health insurance company is the same. Some have the best dental coverage, while others have top-rated coverage for vision care. Check out our list of the best health coverage in Canada.

Canada Life Health Insurance Review

Canada’s best health insurance for:
Vision care coverage

Canada Life, one of the country’s largest life insurers, is a subsidiary of Great-West Lifeco Inc. and a member of the Power Financial Corporation group of companies. With $396 billion in assets and a financial strength rating of A+ from A.M. Best, Canada Life is one of the most stable life insurers in the country.

Canada Life offers health insurance that speaks to the saying “you get what you pay for.” What we mean is, you’ll get good coverage, but it won’t be the cheapest policy on the market.

Canada Life offers great vision insurance coverage for those who need glasses or contacts—they’ll cover up to 100%! While the pricing is a bit on the expensive side, Canada Life makes up for this by providing comprehensive coverage for both prescription drugs and health practitioner services.

Canada Life Health Insurance Pros:

• 100% vision coverage
• Good prescription drug coverage
• Good paramedical coverage
• Replacement plans
• Guaranteed plans for those with pre-existing conditions

Canada Life Health Insurance Cons:

• Pricing not as competitive
• Replacement plans are expensive

What other insurance coverage does Canada Life offer?

• Life insurance
• Critical illness insurance
• Disability insurance
• Travel insurance
• Creditor insurance
• Investment products

Desjardins Health Insurance Review

Canada’s best health insurance for:
Bundling with other products

Desjardins is one of Canada’s largest financial institutions and is frequently ranked among the world’s 50 safest banks and financiers.

Love a good twofer? Desjardins is known for their great combo deals. Combine life insurance, disability insurance, critical illness insurance, and health insurance and you’ll get a financial security team that will fully protect your financial future—and for a few bucks less than if you bought them all separately. 

These plans are best for younger individuals—those in the sunset years need not apply (especially those looking for a retirement replacement health plan).

Desjardins Health Insurance Pros:

• Can be bundled with other products (life insurance, disability insurance, critical illness insurance) for a discount
• “Best Doctor” program (get a second opinion for you and/or extended family)

Desjardins Health Insurance Cons:

• Limited term options
• Plans only cover to age 64
• No replacement or guaranteed plans

What other insurance coverage does Desjardins offer?

• Home and Auto Insurance
• Pet Insurance
• RV Insurance
• Life and Savings – Life Insurance
• Group Insurance
• Credit Insurance
• Travel Insurance

GMS Health Insurance Review

Canada’s best health insurance for:
Multiple plan options

While their name is less known, there’s no denying that GMS offers great coverage for those looking to customize their plan. They also offer great coverage for those with pre-existing conditions—they’ll cover your medication prescribed for that condition, whereas other private plans may not at all. They also have a unique (to Canada) co-pay setup where you pay a set deductible rather than just the remaining percentage of the total cost of the bill.

If you’re someone who likes to plug and play with different package add-ons to meet your needs, GMS health insurance may have a plan for you.

GMS Health Insurance Pros:

• Enhanced drug plan includes prescriptions for pre-existing conditions up to $800 a year  
• Flat deducible (co-pay) rather than a percentage-based coverage ($6 co-pay vs. “70% of coverage listed”)
• Customizable add-ons
• Replacement plans available

GMS Health Insurance Cons:

• Limited base plan options

What other insurance coverage does GMS offer?

• Travel Insurance
• Immigrants’ and Visitors’ Insurance
• Group Insurance

GreenShield Health Insurance Review

Canada’s best health insurance plan for:
Paramedical coverage (chiro, physio, massage, etc.)

GreenShield (aka SureHealth) has the biggest market share in the health insurance industry—that means they’re the big dogs. They specialize in health and dental insurance (hence the huge market share), and you may know them if you’ve had an employer health insurance plan.

Greenshield offers multiple plan options so you can customize your health insurance to meet your needs. The biggest bonus is its high coverage limits for services like massage, chiropractic, physiotherapy, psychotherapy, etc.—all those necessary health maintenance services that are important to keep on top of. While not the most competitive in price, Greenshield may have an extended health plan to meet your unique health expense needs.

GreenShield Health Insurance Pros:

• Multiple plan options
• Guaranteed options
• Travel coverage: $5 million 
• Higher limits for paramedical health services

GreenShield Health Insurance Cons:

• Pricing is not as competitive 
• Dental insurance is not automatically in basic plans

What type of health insurance does GreenShield offer?

• Group health insurance
• Guaranteed acceptance health insurance

Manulife Health Insurance Review

Canada’s best health insurance for:
Customization

Life changes and your needs change. That’s why it’s good to have options. Manulife offers many health insurance product lines to meet you where you’re at. Whether you’re a fitness-tracking maniac already, a new retiree looking for replacement coverage for your work policy, or just need to look after your teeth, they’ve got you covered.

Manulife is our top choice for health insurance providers simply because of the variety of products they sell—the price isn’t bad either! With all their options available, we’ll bet you can find a plan that best suits your needs!

Manulife Health Insurance Pros:

• Telehealth (virtual doctor) access 
• Vitality program
• FollowMe program has great replacement coverage
• Comprehensive paramedical coverage
• Option to choose dental only 
• Combo plans available
• Guaranteed plans available
• Travel coverage: $5 million for first 9 days (additional days extra charge)

Manulife Health Insurance Cons:

• Hospital benefits not included
• Travel insurance has a $100 deductible 
• It can be expensive due to the comprehensive coverage

What other insurance coverage does Manulife offer?

• Life Insurance
• Travel Insurance
• Mortgage Protection Insurance
• Critical Illness
• Disability Insurance

You’ve probably heard that Canada has a free national health insurance program. We do have many healthcare costs that are publicly funded by taxpayers. However, this “free” health care doesn’t cover everything you might require to fully recover from an injury or illness.

To cover those expenses, many Canadians use private health insurance. In this article, we go over the different types of health insurance available in Canada, how to apply for it, and how to choose the best provider for you.

What is private health insurance?

Private health insurance, also called personal health insurance, is an insurance plan that covers medical expenses that aren’t covered by provincial health plans, such as OHIP in Ontario. It helps to pay a portion of those additional costs so that you don’t have to.

You may also see private health insurance called:

• Personal health insurance
• Private medical insurance
• Extended health insurance

Most Canadians get private health insurance either through their employer benefits, through a family member’s plan, or by buying it on their own.

Different health insurance providers have several tiers of coverage that you can use to supplement other plans and make your coverage as comprehensive as you need it to be.

What does personal health insurance cover?

Private health insurance covers the medical expenses that government healthcare does not.

Extended health insurance can cover: 

• Prescription drugs 
• Dental care
• Vision care 
• Paramedical expenses (chiropractic services, physiotherapy, massage, therapy, mental health services, etc.) 
• Medical equipment (blood sugar meters, crutches, CPAP machines, etc.) 
• Emergency travel medical insurance

What you’re covered for and how much costs the insurance company will pay (coverage amount) depend on your provider and what tier of coverage you select.

Additionally, insurance companies have a price list of what they think is a “reasonable amount” for any service, equipment, or medication within your particular province. So, keep in mind that they may only cover costs based on that.

For example, under your prescription drug coverage, your plan may feel that name-brand medication like Ozempic is overpriced, and will only approve coverage for a generic alternative with the same ingredients.

Does personal health insurance cover dental care?

Yes, personal health insurance often covers a varying range of dental services. Most providers include preventative coverage for all of their dental plans — usually covering 60%-80% of costs for things like oral exams, cleanings, etc.

Enhanced or top-tier plans may also cover major dental work like root canals, crowns, or other orthodontic procedures.

Some providers may not automatically include dental care with their base plans, but instead may offer a dental care add-on for an additional fee.

Personal health insurance can cover dental services such as:

• Teeth cleaning and scaling
• Dentist’s diagnostics
• X-rays
• Whitening
• Orthodontic services (braces, Invisalign, etc.)

Does private medical insurance cover vision care?

Yes, personal health insurance usually covers vision care. Most plans cover one visit to an optometrist every 24 months and some money for corrective lenses, frames, or contacts.

More comprehensive plans may include coverage for corrective eye surgery. And, like dental coverage, some providers may not automatically include vision care with their base plans, but may offer a vision coverage add-on for an additional fee.

Personal health insurance can cover eye care costs such as:

• Eye exams
• Prescription eyeglasses
• Prescription sunglasses 
• Contacts 
• Laser eye surgery

Does health insurance cover mental health services?

Yes, private health insurance usually includes some form of mental health services, although the extent of coverage can vary widely depending on the plan you choose.

You may be able to receive some mental health support by seeing a family doctor (which would be covered by provincial health care), but private health insurance can help you further on your mental health journey by providing additional support.

Personal health insurance can cover mental health resources such as:

• Clinical counsellors
• Therapists
• Psychologists
• Psychotherapists
• Social Workers
• Family therapy
• Virtual mental health resources
• Coverage for prescription medication and other mental health treatments

Can you purchase private health insurance in Canada?

Yes, you can purchase private health insurance in Canada. While the government provides universal healthcare covering essential medical services, private insurance covers services not included, such as dental care, vision, prescription medications, and specialized treatments.

It is especially useful for those seeking additional benefits, faster access to certain services, or coverage during waiting periods for public healthcare. You can get private health insurance through individual plans or as a benefit provided by your employer.

How much does private health insurance cost in Canada?

In general, you can expect to pay anywhere from $60 to $200 a month for private health insurance in Canada. The monthly cost of medical coverage depends on your health as well as the plan you select.

Your health insurance premiums are determined by details such as:

• If you have any existing health conditions
• Your age
• Where you live
• What tier of coverage you have
• The waiting period (how long you have to wait before getting medical services)
• Your deductible amount (how much you pay before insurance coverage kicks in)

If you are in poor health, it may be difficult to get standard health insurance coverage, but there are other options for you.

Some private health plan providers, like Manulife, GreenShield, Canada Life, and Blue Cross, offer something called a guaranteed acceptance healthcare coverage plan. This lets you get a plan without answering too many medical questions.

However, these plans are likely to be much more expensive and offer less coverage than standard plans. It’s best to speak with one of our licensed insurance agents and let us help you find the right coverage for your needs.

What are the different private medical insurance plan tiers?

Supplemental health care is usually put into a tiered system, with each tier increasing its coverage at higher costs. The plans are usually separated into basic, standard, and enhanced tiers. Coverage tiers and costs for each of these tiers may look like the following:

Private medical insurance tiers

*Quote for a 35-year-old person in Ontario with no pre-existing health conditions. 

Every tier of plan will also have:

• Different deductible amounts
• A set waiting period before you can claim coverage
• Its own process for claims

As people age, the need for long-term care insurance increases due to chronic conditions, disabilities, or cognitive disorders. The cost of care, whether at home, in an assisted living facility, or in a nursing home, can be overwhelming. 

Long-term care insurance (LTCI) helps cover these expenses to ensure that individuals receive the necessary care without depleting their savings. In this article, we’ll take you through what long-term insurance is, who needs it, and how it differs from other insurance products.

What is the meaning of long-term care insurance?

Long-term care insurance is a type of health insurance policy that helps pay for the costs of extended care when you can no longer perform daily activities independently. It provides a set daily or monthly benefit to cover services such as home care, nursing home stays, or assisted living.

As we age, the need for assistance with daily activities becomes more likely. Common reasons for requiring long-term care include:

• Degenerative diseases (e.g., Parkinson’s, ALS)
• Cognitive impairments (e.g., dementia, brain injuries)
• Serious illnesses (e.g., stroke, cancer)
• Physical disabilities caused by accidents or aging

While these situations may seem distant, planning ahead can help secure your future and protect your family from unexpected financial burdens.

What are activities of daily living?

Activities of Daily Living (ADLs) are any self-care activities including feeding yourself, dressing yourself, bathing yourself, using the restroom, moving independently (e.g., getting in and out of bed or a chair), and maintaining continence. 

Most long-term care policies require that you need assistance with at least two or more ADLs before you can make a claim. However, eligibility requirements vary by insurer, so it’s important to review the specific terms to understand what qualifies as “dependent” living.

Why do people need long-term care insurance?

Long-term care insurance can be a critical financial planning tool, helping individuals and families manage the rising costs of extended care. Many people avoid thinking about the possibility of needing long-term care, but ignoring the issue doesn’t make it go away.

Nearly 74% of Canadians admit they have no financial plan to cover long-term care costs (Leger Marketing survey, CLHIA).

By getting LTCI insurance, you:

• Protect your savings from the high costs of care
• Ensure you have access to quality support when needed
• Reduce the financial and emotional burden on your loved ones

A health insurance claim is your formal request to an insurance provider for coverage or reimbursement of medical expenses. Whether it’s a routine check-up or an emergency procedure, knowing how to file a claim lets you access your policy’s benefits anytime you require it. 

However, the process can be confusing, especially during stressful times. In this article, we’ll simplify the steps so you can file your health insurance claim confidently.

What does a health insurance plan cover?

Your health insurance plan should typically cover doctor visits and specialist consultations, prescription medications, diagnostic tests and lab work, hospital stays, surgeries, and paramedical services like physiotherapy, and chiropractic care.

How are health insurance claims processed?

Health insurance claims are processed in two ways: direct billing or reimbursement.

• Direct billing: Your healthcare provider submits the claim directly to your insurer. You only pay the remaining balance, if applicable. To use this option, provide your policy number, member ID (for group plans), and the policyholder’s name
• Reimbursement: You pay for medical services upfront and then submit a claim to get reimbursed. This method requires you to keep all receipts and medical documentation

What are the steps to file a health insurance claim?

Filing a health insurance claim in Canada can feel overwhelming, especially when dealing with medical expenses. Whether you’re using direct billing or paying upfront for reimbursement, understanding your policy and the claims process is essential. 

Knowing what expenses are covered, what documents you need, and how to submit your claim can help you avoid delays and maximize your benefits.

Here are the steps to file a health insurance claim in Canada:

• Determine what you can claim
• Check if your provider offers direct billing 
• Gather required documents 
• Fill out the claim form  
• Submit your claim 
• Receive your reimbursement  
• Keep records of your documents