Blue Cross Ontario Health Insurance Review

Canada’s best health insurance for:
Prescription drug coverage & dental care coverage

Blue Cross is a national brand originating in Manitoba in 1938, with many provincial franchises. Franchises include:

• Alberta Blue Cross
• Ontario Blue Cross
• Quebec Blue Cross
• Manitoba Blue Cross (Nunavut)
• Medavie Blue Cross (New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador)
• Pacific Blue Cross (BC and Yukon)
• Saskatchewan Blue Cross

Like the sound of “unlimited” benefits? Blue Cross offers unmatched prescription and dental coverage without limits. They also have coverage that allows you to keep your insurability for life. Diagnosed with an illness later in life? No worries with Blue Cross Assured Access coverage—once you have it, you have insurability for life. 

Blue Cross Ontario Health Insurance Pros:

• Assured access coverage
• Generational coverage
• Unlimited drugs
• Unlimited dental (excluding major)
• Capped out-of-pocket expenses for prescription drugs
• Highly customizable

Blue Cross Ontario Insurance Cons:

• No replacement plan
• No travel plans available for basic or mid-tier plans
• Unlimited drug pricing is not as competitive
• Major and orthodontic dental only available for enhanced plans

What other insurance coverage does Blue Cross offer?

• Group Insurance
• Travel Insurance
• Life Insurance

What are the types of private medical insurance available in Canada?

In general, there are three types of personal health insurance plan offered in Canada, including medically underwritten health insurance, guaranteed acceptance health insurance and replacement health insurance. Based on your unique circumstance and specific requirements, you can choose any of these plan for your healthcare emergencies.

1. Medically underwritten health insurance

Standard health insurance is medically underwritten. This means that during the application process, the insurance company will ask you about your health and lifestyle and use your answers to determine your eligibility and price for your insurance.

For this type of health insurance, insurers may exclude any pre-existing conditions. But you still have options for health insurance if you have a health issue.

2. Guaranteed acceptance health insurance

Guaranteed acceptance health insurance is usually a no-questions-asked kind of policy. There are no or very few medical questions or medical underwriting, and pre-existing conditions are generally covered.

Most companies will have the 3-tiered options — basic, standard, and enhanced — for medically underwritten policies, but just basic or standard options for guaranteed acceptance policies.

Key differences between standard vs guaranteed acceptance health plans

3. Replacement health insurance plans

The third most common type of personal health insurance in Canada is a replacement plan that’s meant for people who already had coverage through a group plan, such as through their work.

If you’re leaving your job or retiring, you can get health insurance without having to pass the usual medical requirements. But you must make the switch within 60-90 days of your work benefits ending.

Replacement plans can be especially useful for people who may have medical issues and may not get the best rates from a regular medically underwritten health policy, such as senior individuals.

What is the difference between public and private health insurance in Canada?

The main difference between public and private health insurance in Canada is what they cover — public health insurance generally handles the immediate, urgent care needs while private health insurance covers a portion of the costs related to recovery.

Public health insurance covers basic and emergency medical services such as hospitalization, surgeries, and doctor’s visits.

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.).

For example, if you had a car crash:

• Public health insurance will cover the ambulance services to get to the hospital and the cast for your broken leg.
• Private health insurance will provide physiotherapy coverage so you can walk and run normally again.

Canadians may coordinate this coverage so that all of their medical expenses are paid for under either their universal health plan, provincial health plan, private health insurance, or travel medical coverage.

What do public healthcare plans in Canada include?

Universal health insurance

The “Medicare” system in Canada is a universal health system that is publicly funded through taxpayer dollars. It allows all Canadians to access essential medical care such as hospital visits and emergency surgery.

The federal government also provides some national-level health care such as the Universal Dental Benefit, which provides children from low-income families access to regular dental treatments.

Provincial health insurance

Our universal healthcare system here in Canada is provincially administered. Each provincial or territorial health insurance will have different rules to qualify for “free” universal healthcare.

In order to access public coverage with the provincial plan, some provinces require you to be a permanent resident for at least three months, while others will require longer.

What do private healthcare plans in Canada include?

Private health care insurance

Many Canadians buy additional health insurance coverage through their employers or purchase private health insurance policies to cover gaps in the public healthcare system.

Private plans can vary in coverage and cost, depending on the provider, the specific policy, and your own health history.

Travel health insurance

Emergency travel medical insurance covers unexpected medical events and treatment when you’re traveling. You can buy it when you’re traveling outside of Canada or if you’re a visitor to Canada.

This is a form of private insurance, and those who buy it have many options for travel insurance providers.

Is it worth getting health insurance in Canada?

Yes, private health insurance is worth it in Canada. It can help you get the medical care you need without paying extremely high costs.

Even if you have access to provincial health care, it will not cover all the medical costs required for you to recover from an injury or illness. It doesn’t always pay for preventative healthcare. An extended healthcare policy supplements your public coverage so you get the treatment you need to stay healthy in the long term.

Just imagine trying to pay this medical bill below after a car accident, without private health insurance to cover you.

How to choose a health insurance plan?

To choose the health insurance plan that works best for you, start by thinking about your insurance needs. Ask yourself:

• Do I have health insurance coverage through my employer?
• Do I have health insurance coverage through my spouse’s employer?
• Do I have dependents who need more coverage?
• How much can I afford to spend on health insurance each month? 

The answers to these questions will help you determine which plan is the best for you and your family.

Which health insurance tier should I choose?

Still having trouble figuring out which personal health insurance plan is best for you? Here is a list of plan types and the scenarios in which they might be right for your insurance needs. 

Take a look at these health insurance tiers to choose from:

Basic Health Plan

• If you are on a tight budget
• If you are using it to supplement other plans (employer or group plans)

Mid-Tier Health Plan

• If you are looking for a primary plan with decent coverage
• If you want it for combined coverage with other plans (employer or group plans)

Enhanced Health Plan

• If you have no other health insurance through your work, through your spouse’s work, or other group benefits and you intend to use this as your primary plan
• If you want it for combined benefits with other plans (employer or group plans)
• If you are looking for your expenses to be 100% covered through the coordination of benefits
• If you want to coordinate benefits with other plans because your family has high medical costs (i.e. lots of kids with braces, glasses, medications)

Guaranteed Acceptance Health Plan

• If you have any pre-existing conditions or health issues
• If you don’t want to go through medical questionnaires

Replacement Health Plan

• If you are retiring and may have health issues that would prevent you from getting standard health insurance
• If you’re leaving a job with regular benefits

Who are the leading Canadian private health insurance providers?

There is no single “best” health insurance provider because everyone’s coverage needs are different. Each provider has something different to offer.

At PolicyAdvisor, we work with exceptional health insurance providers that all have great coverage options, depending on what kind of coverage you’re looking for.

We offer health insurance from the following providers:

• Blue Cross
• Canada Life
• Desjardins
• GMS
• GreenShield
• Manulife
• Sun Life
• And more!

Additionally, we offer guaranteed acceptance plans through Edge Benefits.

Apply for private health insurance

If you’re looking for a great price on , PolicyAdvisor can help! We have a team of licensed insurance experts to help you go through health plans from Canada’s best insurance providers.

Book a quick call with one of our advisors today and let us help determine your health insurance needs.

Frequently Asked Questions

What if you’re leaving your job with benefits?

If you have a job with benefits and you’re leaving that job, your private health coverage will likely come to an end.

But you can get replacement or guaranteed acceptance health plans with most insurance providers when you leave. This means that when you transition to your new plan, you don’t have to go through any medical questionnaires — your new individual policy is guaranteed to be accepted.

However, you must apply for the new coverage within the first 60-90 days of your employer benefits ending.

Isn’t health insurance in Canada free?

Some parts of healthcare are free in Canada. With universal healthcare, you don’t have to pay for basic medical expenses like seeing a doctor, surgery, non-private hospitalizations, etc.

But it does not cover costs associated with recovery, such as prescription medication, paramedical expenses, vision care, dental care, or medical equipment that may be needed to recover from injury or illness. Private insurance can cover these expenses and more.

Is private health insurance tax deductible in Canada?

In some cases, private health insurance can be tax deductible. For example, if you are self-employed or a business owner, it may be written off as a business expense.

Individuals may be able to include premiums as part of their medical expenses when calculating tax credits as well.

What if I’m covered under my spouse’s plan?

If you have private medical coverage through your spouse, that’s great! We’re glad that you have some sort of health insurance coverage to keep your financial wellness in check while you rest and recover. However, employer benefits may not have the most comprehensive plan.

You may consider buying your own individual plan to supplement your spouse’s employer’s plan to fit all your family’s needs. You can use both plans to get close to 100% coverage for your medical costs by coordinating your benefits. 

How does long-term care insurance work?

To qualify for benefits, policyholders typically need to demonstrate that they are unable to perform at least two out of six ADLs or have a cognitive impairment requiring supervision.

Here’s how LTCI generally works:

• Application process: Insurers assess health history, may review medical records, and sometimes require interviews before approval
• Premiums and coverage limits: After approval, policyholders pay regular premiums. Policies have a cap on daily payouts and a maximum lifetime benefit
• Reimbursement model: Most policies require individuals to pay for care upfront, and then submit receipts for reimbursement. Some plans, however, offer direct cash benefits

How to choose a long-term care insurance policy?

Choosing the right long-term care insurance (LTCI) includes considering factors like premium costs, waiting period, benefit duration, etc. 

When selecting a plan, consider the following factors:

• Premium costs: You need to determine how much you can afford to pay for premiums while balancing your budget and long-term financial goals
• Benefit amount: Then, estimate how much coverage you’ll need to afford quality care. Decide whether you prefer a fixed monthly benefit or coverage per service
• Waiting period: Most policies include a waiting period (also called an elimination period) before benefits begin. Common options range from 30 to 90 days, but some policies offer zero waiting periods at a higher premium
• Benefit duration: Coverage can last for a set period (e.g., 2, 5, or 10 years) or provide lifetime benefits. While longer coverage costs more, it ensures you won’t run out of benefits when you need them most
• Inflation protection: The cost of care rises over time. Choosing a policy with inflation protection helps ensure your benefits keep up with increasing expenses

Selecting the right plan can be complex, but our expert insurance advisors can help. Our knowledgeable team works with leading insurance providers to find the best LTCI coverage for your needs. A simple phone call can get you started on securing your long-term care plan.

What are the pros and cons of long-term care insurance?

LTCI provides coverage for long-term care when you need it most, ensuring you receive assistance without placing a financial burden on your loved ones. Many policies allow you to choose between in-home care or facility-based care, giving you flexibility in how you receive support.

However, there are also challenges to consider, such as age restrictions, exclusions related to pre-existing conditions, waiting periods, etc. Additionally, you may require assistance with a single Activity of Daily Living (ADL) but won’t qualify for benefits until you need help with at least two ADLs.

How much does long-term care insurance cost?

Long-term care insurance typically costs around $100 per month, but the actual price depends on several factors, including:

• Your age at the time of application: The younger you are when you apply, the lower your premiums will be
• Your health status: Pre-existing conditions or medical history may affect eligibility and pricing
• The type and amount of coverage: More comprehensive plans with higher benefit amounts cost more
• The waiting period: Policies with shorter waiting periods before benefits begin tend to have higher premiums

Remember, while paying for LTCI now may seem expensive, the cost of long-term care itself can be significantly higher. Retirement home expenses range from $900 to $8,000 per month, depending on the level of care and facility type. Over time, that could mean spending more than $60,000 per year to cover just essential support. 

What is the difference between long-term care insurance and life insurance?

Long-term care insurance (LTCI) and life insurance serve different financial purposes. Long-term care insurance covers the cost of care if you become unable to perform basic Activities of Daily Living (ADLs) such as feeding, bathing, or moving on your own. It helps pay for nurses, caregivers, and facilities required for your daily support.

Life insurance, on the other hand, provides a lump-sum payment to your beneficiaries after you pass away. Some policies include living benefits, allowing you to borrow against the policy’s value.

Certain insurers also offer long-term care riders, which let you use a portion of your death benefit to pay for care while you’re still alive.

What is a long-term care annuity?

A long-term care annuity is a financial product that combines investment growth with long-term care funding. You invest money into the annuity, and over time, it accumulates value. If you require long-term care due to aging or illness, you can use a portion of your annuity to cover those expenses.

However, withdrawing funds for care may reduce future payouts from the annuity. This option provides both a savings plan and a financial safety net for potential care needs.

When should you buy long-term care insurance?

The best time to purchase LTCI is as early as possible. The younger you are, the lower your premiums will be. Many insurers offer limited-pay plans, allowing you to pay for coverage upfront during your peak earning years. 

For example, you might pay premiums for 10, 15, or 20 years and then receive coverage for the rest of your life. This approach can help secure affordable coverage while avoiding high premiums later in life.

What is the oldest age for long-term care insurance?

The maximum age to purchase long-term care insurance varies by insurer, but most companies set the cutoff between 75 and 80 years old. Some policies may allow applications beyond this range, but premiums become significantly higher, and approval is more difficult due to health risks.

Which companies offer long-term care insurance?

At PolicyAdvisor, we work with over 30 of Canada’s top insurance providers. While we don’t offer LTCI directly, we can connect you with one of our licensed partners to find the best insurance company for your needs.

Some of the top insurers offering long-term care insurance include:

• Sun Life
• Canada Life
• Manulife
• GMS
• RBC

Speak to one of our licensed insurance advisors today to explore your options and determine if a long-term care policy aligns with your financial goals!

Does long-term care insurance cover pre-existing conditions?

Most LTCI policies do not cover pre-existing conditions immediately. Insurers may have a waiting period (e.g., 6 months to a year) before coverage applies to existing health issues. Some severe conditions may disqualify applicants altogether.

Can I buy long-term care insurance if I’m already retired?

Yes, you can apply for LTCI after retirement, but premiums will be higher, and approval may be harder if you have health conditions. Many insurers set age limits between 75 and 80 for new policies.

What happens if I never need long-term care?

Traditional LTCI is a use-it-or-lose-it policy, meaning you won’t get a payout if you never need care. However, some hybrid policies combine LTCI with life insurance or annuities, allowing you to use funds for care or pass them to your beneficiaries.

How long do long-term care insurance benefits last?

The duration of benefits depends on the policy. Some plans provide coverage for a set number of years (e.g., 2, 5, or 10 years), while others offer lifetime benefits. Longer benefit periods come with higher premiums.

Can I get long-term care insurance if I have a chronic illness?

Your eligibility while suffering from a chronic illness depends on the severity of the condition. Some insurers may still approve applicants with manageable chronic conditions, like controlled diabetes, but severe health issues (e.g., advanced Alzheimer’s or Parkinson’s) may lead to denial or higher premiums.

Determining what you can claim

Before submitting a claim, confirm which medical expenses your insurance covers. Check your insurer’s website or contact their customer support to clarify your benefits.

Most health insurance plans cover:

• Prescription drugs
• Dental care (cleanings, fillings, extractions, etc.)
• Vision care (eye exams, glasses, contact lenses)
• Paramedical services (chiropractic, physiotherapy, massage therapy, mental health therapy)
• Medical equipment (crutches, CPAP machines, glucose monitors)
• Emergency travel medical insurance

Checking whether your insurer uses direct billing or requires reimbursement

The way your claim is processed depends on whether your healthcare provider offers direct billing or if you need to pay upfront and submit a claim for reimbursement.

Direct billing

With direct billing, the healthcare provider submits the claim directly to your insurance company, and you only pay the remaining balance. To use direct billing, provide the provider with:

• Policyholder’s name
• Your name
• Policy number
• Member ID (if it’s a group plan)

Direct billing simplifies the claims process by eliminating the need for you to pay upfront. Some insurers require pre-authorization for direct billing, meaning you may need to complete a one-time setup with your insurer.

Reimbursement

If your provider doesn’t offer direct billing, you must pay out of pocket and file a claim for reimbursement. In this case, you will need to submit receipts and supporting documents to your insurance company.

If you have multiple insurance policies, you may need to pay first and then claim reimbursement through a coordination of benefits process.

Gathering the required documentation

Each insurer may require different documents depending on the type of service received. However, for most claims, you will need:

• Your policy number and/or member ID
• The name of the person receiving the service (you, spouse, dependent, etc.)
• An itemized receipt from the healthcare provider
• Proof of payment (if seeking reimbursement)

Completing the claim form

Once you have your documents, you will have to fill out the claim form. Depending on your insurer, you may submit claims online or via mail.

Online claims submission: Many insurers offer an online portal or mobile app where you can:

• Upload scanned copies of receipts and documents
• Fill out a digital claim form
• Receive real-time claim updates

Some insurers also allow claim submissions via email by completing a digital PDF form and attaching supporting documents.

Paper claims submission: If online claims aren’t available, print and mail your completed claim form along with any required documents. Some insurers require original receipts, so make copies before mailing them.

Submitting your claim

Once your claim is complete, you must submit it electronically or by mail.

• Online: Claims are typically reviewed faster, and you may receive an instant decision.
• Mail: Processing can take longer, but it’s an option if online submission isn’t available.

Your insurance provider will review the claim to determine the reimbursement amount. If additional information is needed, they will contact you.

Receiving your reimbursement

Once approved, your insurer will send an Explanation of Benefits (EOB) outlining:

• The total amount claimed
• The portion covered by insurance
• Any remaining balance you are responsible for

Reimbursement is typically issued via cheque or direct deposit, depending on your setup. Set up direct deposit with your insurer to receive claim payments directly into your bank account. You will need to provide:

• Bank institution number (3 digits)
• Branch transit number (5 digits)
• Bank account number (9+ digits)

Direct deposit speeds up the reimbursement process and eliminates waiting for a mailed cheque.

Keeping your records

Even if you submit your claim online, you must always keep copies of:

• Receipts and invoices
• Prescription details
• Referral notes (if applicable)

Your insurer may request these documents later, especially in case of a claim audit or appeal process if your claim is denied.

How to coordinate benefits with multiple insurance plans?

If you have more than one health insurance plan (e.g., through your employer and a spouse’s plan), you can coordinate benefits to maximize coverage.

1. File your claim with your primary insurer first. Wait for them to process the claim and issue an EOB
2. Submit the EOB and the remaining balance to your secondary insurer for additional reimbursement

On your claim form, select coordinating benefits and provide details of your primary insurance coverage. This ensures both insurers process your claim correctly.

How long do you have to submit a health insurance claim in Canada?

Most insurance companies require claims to be submitted within 90 days to 15 months from the date of service. Some group health plans may have shorter deadlines, while others offer more flexibility. Hence, we recommend checking your policy details or contacting your insurer to ensure you submit your claim on time.

How long does it take for an insurance company to pay out a claim in Canada?

An insurance company typically takes a few weeks to pay out a health insurance claim in Canada, however, the exact timeline depends on the insurer and the method of submission.

• Online claims: Typically processed within a few days, with reimbursement via direct deposit or cheque
• Paper claims (by mail): Can take several weeks, depending on processing times and mail delivery
• Large or complex claims: May take longer if additional documents or verification are required

What are some reasons a health insurance claim may be denied?

A health insurance claim may be denied for several reasons, including incomplete or incorrect information, ineligible expenses, or policy limits being exceeded. Your claim could also be rejected if your coverage has lapsed, if you didn’t get pre-authorization for a required service, or if key documents like receipts or medical referrals are missing. 

If this happens, you can file an appeal by submitting additional documentation, such as a doctor’s confirmation that the treatment was necessary. Most insurers provide an online appeal process or a claims department you can contact directly. If your appeal is denied and you believe the decision was unfair, you may escalate the issue to an ombudsman or, consider legal action.

Need help submitting your health insurance claim?

If you’re unsure how to file your health insurance claim, we’re here to help. We can connect you with the claims departments of our partner insurance companies based on your provider. 

Our expert insurance advisors can also review your coverage, guide you through the claims process, and help you explore other top insurance options if your current plan doesn’t meet your needs. For more details or to start your claim, visit your insurer’s website or reach out to us for personalized assistance.

What if my health insurance doesn’t cover all expenses?

If your health insurance doesn’t fully cover a medical expense, you have options. If you have dual coverage, you can submit the remaining balance to your secondary insurer for reimbursement. If you don’t have secondary coverage, you’ll need to pay the remaining amount out of pocket. If your current plan isn’t meeting your needs, our experts at PolicyAdvisor can help you explore better coverage options.

How long does it take for a health insurance claim to be processed?

Processing times vary by insurer. Online claims may be processed instantly, within 24 hours, or within a week, especially for smaller expenses. Some insurers use automated portals for faster processing. If you submit a paper claim by mail, it may take longer due to document handling and review times. Large claims or those flagged for additional review could also take more time before reimbursement is issued.

Is there a time limit to submit a health insurance claim?

Yes, insurers set deadlines for claim submissions, typically ranging from 9 to 15 months from the date of service. Even if your policy has expired, you can still submit a claim as long as the service was received while your policy was active. To avoid missing deadlines, check your insurer’s specific time limits.

What is a health insurance claim quote?

A health insurance claim quote allows you to estimate coverage before receiving a service. Your healthcare provider can request a pre-approval from your insurer, detailing how much will be covered and what you may need to pay out of pocket. This helps you make informed decisions before proceeding with treatment.

Where can I find my health insurance policy number?

Your policy number is on your health insurance member ID card, policy documents, or your insurer’s online portal. If you’ve misplaced it, contact your insurance company’s claims helpline for assistance.

Frequently Asked Questions

What are the best health insurance plans for seniors & retirees?

The best health plan will depend on your unique situation. In general, there are three types of health insurance available for seniors:

1. Personal health insurance
2. Replacement health insurance
3. Guaranteed acceptance health insurance

Compare health insurance policies for retirees and seniors

The perfect health policy for you will depend on your health and employment situation as a senior. The chart below outlines how the top-tier plans compare for personal health insurance, replacement health insurance, and guaranteed health insurance in terms of coverage and price. 

Types of health insurance for seniors and retirees

*Quote for a 65-year-old single person in Ontario with no pre-existing health conditions or dependents. 

Keep in mind, these are example plans with the top-tier coverages for all plans. Depending on your personal health history and company you’re applying for, not all coverages may be available. Additionally, not every plan will have a deductible amount, eligibility qualifications, waiting periods before you can claim coverage, and its own process for claims.

What are the different types of health plans?

Every person will have different health needs and require a different plan to meet their current and expected medical expenses.

You might choose the following options:

• If you are in good health
• If you are 69 years old or under
• If you want to coordinate benefits with other plans (employer, group, or spouse’s plan)
• If you are looking for your expenses to be 100% covered through the coordination of benefits
• If you want to coordinate benefits with other plans because you or your family has high medical costs (i.e. lots of kids with braces, glasses, medications)

• If you are retiring and may have health issues that would bar you from standard health insurance
• If you’re leaving a job with regular benefits
• If you need coverage within 30-90 days of your group benefits ending

• If you have any pre-existing conditions or health issues
• If you don’t want to go through medical questionnaires

Can I keep my employer’s health insurance when I retire?

Sometimes. Some employers will allow you to keep your group health insurance plan when you retire. Some will have age restrictions, depending on the contract they have with their group health insurance provider.

If you cannot keep your employer group health benefits when you retire, you can purchase your own personal health insurance, replacement plan, or guaranteed plan.

Your best bet is to shop around before you decide on any replacement or guaranteed plans. Guaranteed or instant approval plans can be expensive and group plans have restricted coverage, so they may not be best for you as you entire retirement age.

Individual plans allow you the flexibility to choose your own coverage options. They are underwritten based on your own personal lifestyle and health history, not an average of those in your group.

Options for your health plan when you retire: 

• Keep your employer’s group plan
• Transfer your group policy to an replacement policy
• Shop around for your own affordable health insurance plan

At PolicyAdvisor, we can help you look at your current plan details and see if it’s working for your needs either now or as you approach that golden 65th birthday retirement age. If not, we work with Canada’s best health and dental insurance providers and can find the perfect plan for you.

How much does personal health insurance for seniors cost?

You can expect to pay $150-300 per month for health insurance as a senior. The cost will depend on your age, health, and any pre-existing conditions. Personal health insurance plans are the most affordable health insurance for seniors.

Replacement health insurance has a mid-range cost but with lower benefit amounts. Guaranteed health insurance is the most expensive plan for seniors because there is little underwriting. 

Is health insurance worth it for retirees in Canada?

Yes. Health insurance is worht it for seniors and retirees. Just like the price of housing, food, and everything else, medical costs are going up by the day. While Canada’s publicly funded healthcare system provides essential medical services, it may not cover all the healthcare needs of seniors like mobility equipment and drug costs. Private health insurance helps alleviate the financial burden, making healthcare more accessible and affordable for seniors.

The reality is, that the older we get, the more likely it is that our health will deteriorate. Having an extended health insurance plan in place makes sure that you don’t have to stress about how you’re going to pay for your next medical treatment or medication.

Having health insurance means more than financial protection—it provides peace of mind. Your quality of life is directly linked to your health care. Having health insurance allows you to focus on your well-being without worrying about potential expenses. And that is priceless!

Can I get health insurance if I have a pre-existing condition?

Yes. It’s possible to get health insurance if you have a pre-existing condition. However, the extent of your coverage and the price will depend on your health history. Even if you’ve survived a serious health event like a heart attack, stroke, or cancer, or if you have a chronic health condition, you can still get health insurance. However, policies may have a particular waiting period after these events until they can provide coverage.

Guaranteed-issue plans are usually the go-to option if you have any kind of pre-existing medical condition that bars you from traditional health insurance plans. These plans are fast, easy, and convenient to apply for because they don’t ask many health questions. Some may limit your coverage for prescription drugs related to your pre-existing condition. Some may not have dental benefits or vision coverage. Additionally, they are more expensive than other plans.

What is the best health insurance company for seniors?

The “best” senior health insurance company really depends on your needs and budget. If you have existing health conditions or other complex health issues, you might consider guaranteed issue medical plans, which are only offered by some companies. However, if you’re in good health for your age, there are many coverage options. 

Here are our health insurance partners that have affordable health insurance plans for seniors in Canada: 

• Blue Cross: Offers personal and replacement plans. 
• Canada Life: Offers personal and guaranteed plans. 
• Desjardins: Offers personal and replacement plans. 
• GMS: Offers personal and guaranteed plans. 
• GreenShield: Offers personal, replacement, and guaranteed plans. 
• Manulife: Offers personal, replacement, and guaranteed coverage plans. 
• Sun Life: Offers personal and replacement plans.

What to consider when buying health insurance for seniors in Canada?

When buying health insurance for seniors in Canada, you need to consider several factors, such as:

• Health status: Your policy must address both ongoing and potential health concerns, such as heart disease, osteoporosis, and diabetes, which are more prevalent among seniors
• Types of services: Your insurance plan should cover services not included in provincial healthcare, such as prescription drugs, dental and vision care, and paramedical and travel expenses, to help reduce your overall healthcare costs
• Premiums: Health insurance premiums for seniors typically range from $150-300 monthly, depending on the applicant’s age, health status, and desired coverage. The ideal plan should balance affordability with coverage
• Additional benefits: Review optional add-ons offered by a provider. Many providers let you customize your coverage for specific needs, such as physiotherapy and chiropractic care

Get the best quote for seniors health insurance

We understand the unique healthcare needs of seniors and are committed to helping you find the perfect medical coverage that suits your requirements. Our easy-to-use platform provides access to a wide range of top-tier insurance providers, ensuring you have ample options to choose from.

With PolicyAdvisor.com, you can compare plans, benefits, and costs effortlessly, empowering you to make informed decisions that prioritize your health and financial well-being.

If you’re looking to talk to a real human advisor, we have those too! 

Book a call with one of our friendly expert insurance advisors today to chat about protecting your personal and financial health today!

Frequently asked questions (FAQs)

Is healthcare free for seniors in Canada?

In some provinces, there are programs for senior health care for those who need financial assistance. These programs may assist with the partial cost of prescription drugs and other healthcare services not covered by the standard government plan.

The eligibility requirements for these social assistance programs vary—some just require that you be over 65 while others have income thresholds. For more information about services for seniors, visit your provincial government’s website.

Do seniors get a discount on health insurance?

Some provincial healthcare programs help with out-of-pocket medical expenses, but private health insurance companies don’t offer discounts. This is because the rate of illness and injury among seniors can be high. That being said, health insurance is a competitive market and there are plans at various coverage and premium levels available to you depending on your budget.

What is the average cost of medical expenses in retirement?

Experts estimate at age 65, the annual spend on health care is $5,400 per person. This research is from a 2014 report and as inflation increases, retirees can expect to pay more. This estimate is also for a healthy individual. If you develop or are diagnosed with any type of serious illness, you can expect to pay more.

For example, 1 in 2 Canadians will be diagnosed with cancer once in their lifetime—with a greater chance of this as you age. Cancer medicine with 28-day treatment costs over $7,500 now accounts for more than half of all oncology sales in Canada.

What is long-term care insurance?

Long-term care insurance is a type of insurance policy designed to cover the costs associated with long-term care services for individuals who need assistance with daily living activities due to illness, disability, or aging.

These services typically include help with activities such as bathing, dressing, eating, and mobility, which may be required either in a nursing home, long-term care facility, assisted living facility, or even in the individual’s own home.

This is not the same as health insurance and is a separate insurance product. However, some health insurance plans have coverage for in-home care.

What is the best type of insurance for seniors?

The best type of health insurance for seniors involves a combination of provincial healthcare and private health insurance, tailored to specific needs. Provincial healthcare covers essential services, while private insurance takes care of prescription drugs, dental and vision care, and paramedical and travel expenses.

Some private insurance options are:

• Personal health plan: For those who are in good health and who want to combine the benefits of personal health insurance with other plans, such as employer, group, or spousal insurance
• Replacement health plan: For those who are retiring from their job and need to replace their group benefits within 30-90 days of their ending
• Guaranteed acceptance health plan: For individuals with pre-existing health conditions or those looking to avoid medical underwriting

Frequently asked questions

Can I switch providers or upgrade my family health insurance plan?

Yes, you can switch providers or upgrade your family health insurance plan in Canada, though it’s essential to review each provider’s specific terms. 

Most insurance plans allow adjustments during renewal periods or for certain life events, like a new family member. Be mindful of any waiting periods, coverage exclusions, or premium changes that may apply. 

Are there tax benefits for purchasing family health insurance in Canada?

Yes, there are tax benefits for purchasing family health insurance in Canada. Premiums paid for private health insurance can qualify as a medical expense, which may be eligible for the Medical Expense Tax Credit (METC) on your federal income tax return. 

If health insurance is provided through an employer, premiums are often tax-deductible for the employer. Employees may not need to pay tax on these benefits, depending on provincial rules.

Are pre-existing conditions covered under family health insurance?

Yes, pre-existing conditions are covered under some family health insurance. Coverage for pre-existing conditions under family health insurance in Canada varies by provider and plan. Some insurers may cover pre-existing conditions after a waiting period, while others exclude them entirely. 

Comprehensive plans are more likely to offer partial or conditional coverage, often requiring a medical assessment beforehand. It’s essential to review policy terms closely, as limitations or higher premiums may apply.

Is dental and vision coverage included in all family health insurance plans?

No, dental and vision coverage is not included in all family health insurance plans in Canada. While many comprehensive plans offer dental and vision as part of their package, basic or lower-tier plans may not cover these services. 

Some insurers provide optional riders for dental and vision care at an additional cost, allowing families to customize coverage.

Can I add or remove family members from my health insurance plan?

Yes, you can typically add or remove family members from your health insurance plan. New family members, such as newborns or spouses, can usually be added during a specific enrollment period or life event. 

Removing members is also allowed, often at the plan’s renewal. Be sure to check with your provider regarding timing and any changes in premiums or coverage when adjusting family members.

What does health insurance cover?

Private health insurance typically covers medical expenses not included in public or provincial health care plans. Common areas of coverage include:

1. Prescription medications – Costs for prescribed drugs not covered by provincial health plans
2. Dental care – Services like cleanings, fillings, and orthodontics
3. Vision care – Eye exams, prescription glasses, or contact lenses
4. Paramedical services – Coverage for physiotherapy, chiropractic care, massage therapy, and mental health counselling
5. Medical equipment – Expenses for crutches, wheelchairs, or hearing aids
6. Emergency medical coverage – Costs for medical treatment during travel or outside your home province or country

How can I get healthcare as an international student in Canada?

You can access private health insurance benefits through various sources, such as your parents’ work or group plan, their individually purchased extended health plan, your student union’s group health plan, or a private plan you’ve purchased yourself.

These student health insurance plans typically cover medical expenses like dental and vision care, mental health support, paramedical services, etc. that are not included in provincial insurance, providing additional protection up to specific coverage limits.

What to do if I’m not covered by my province’s health insurance plan?

If you are not eligible for healthcare under this plan, you need to look into private health insurance options to cover your healthcare needs. Your university may offer a student group health insurance plan and you should look into purchasing an emergency travel medical plan if you haven’t done so already. 

Student group health care plan

Your university or college would typically have a contract with a health insurance provider for group health insurance. The cost of participating in this program will be outlined in your student fees. If you are an international student, this program may be mandatory. 

Emergency travel medical plan 

Your student health plan may cover you during the semester, but it may have coverage restrictions if you travel outside of the province where your school is located or it may only cover you while classes are in session.

To make sure you’re fully protected as an international student, you should purchase emergency travel medical insurance for students. This insurance will pay for emergency medical care as well as prescriptions while you are away from your home country.

Do students get free healthcare in Canada?

In Canada, healthcare access for students varies depending on the province and the student’s residency status. Canadian citizens and permanent residents who are students generally receive provincial health coverage at no extra cost. 

However, international students often do not automatically qualify for free healthcare. Some provinces, like British Columbia and Saskatchewan, allow international students to enroll in their public healthcare plans, but they may still need to pay monthly premiums or enroll in private insurance for additional coverage. 

Other provinces, like Ontario, typically require international students to purchase private health insurance or enroll in a health plan provided through their school.

Does student health insurance cover mental health?

Yes, most student health insurance plans in Canada cover mental health services, though the extent of coverage varies by plan. Many include access to counseling, therapy, and mental health support programs either on-campus or through partnered providers. 

Coverage limits may apply, so students might need to pay a portion out-of-pocket or seek additional private insurance if they need extended care. Provincial health plans in some regions also cover basic mental health services for eligible students.

What can I do if I’m 25 and no longer covered under my parents?

Some health insurance plans allow you to stay on your parent’s plan even as an adult. Typically, you can remain covered until age 18 or 21, or up to age 25 if you’re a full-time student. However, eligibility may end if you get married. Once you’re no longer eligible for your parent’s coverage, you’ll need to set up your own health insurance.

For those with complex health needs, getting personal health insurance offers added protection. Fortunately, premiums for the student age group are generally affordable since young adults typically have fewer health expenses compared to older individuals.

Should I opt out of my student health plan?

Opting out of your student health plan depends on your existing coverage and health needs. If you’re already covered under a comprehensive private plan, such as your parents’ work or group insurance, you might consider opting out to save on fees. However, student health plans are often cost-effective and offer coverage for services like dental, vision, and paramedical care, which may not be included in other plans.

Before opting out, compare the benefits of your existing coverage with the student plan. If the student plan provides additional or complementary coverage, it might be worth keeping. Always evaluate your specific health needs and financial situation before making a decision.

You might opt out of your student health plan if:

• You are fully covered under your parent’s plan
• You are fully covered under a spouse’s plan 
• You are fully covered under your own private health insurance plan

Keep in mind that some student group plans may have specified enrollment dates, usually in the fall or spring. In the case that you’re relying on your parent’s coverage and you turn 25 halfway through the school year, you might be without coverage until the following enrollment period.

When should I not opt out of your student health plan?

Am I covered if I go to school out of province?

If you are a Canadian and go to school outside of your home province, your provincial coverage will extend for the usual emergency services. However, you may have to pay upfront and submit the receipt later on to get your money back.

Additionally, each province has a standard of what they will reimburse for each emergency service. For example, one province may have a $75 fee for ambulatory services, whereas another charges $300. 

If you have extended medical insurance, each company has different rules about out-of-province services. Your health insurance provider may decide: 

• You are NOT covered for any out-of-province medical procedures, services, or treatment. For example, your dental insurance wouldn’t be covered.
• You are covered for but only up to the limit dictated in your home province. For example, BC has a standard dental cleaning price, whereas Alberta dentist’s prices vary. If you are from BC and get your teeth cleaned in Alberta, your dental coverage limit will be the limit set for BC, meaning you could have to pay for the difference.

It’s always best to check your extended health insurance policy documents to see exactly what it covers and where. If you are not sure how to access that information, reach out to your broker or one of our agents.

What happens if I don’t have health insurance as a student?

If you don’t have health insurance as a student in Canada, you may face high out-of-pocket costs for medical care, as basic services like doctor visits, hospital stays, and emergency care can be expensive without coverage. 

Some provinces offer limited public health coverage for international students, but if you’re ineligible, private health insurance is essential. Additionally, many schools offer affordable student health plans that provide coverage for essential services, which can be especially helpful during unexpected medical needs.

How much does health insurance cost per month in Canada?

The cost of health insurance for students starts at $61 per month if you’re a healthy individual with no pre-existing conditions. However, if you’re unfortunately suffering from or diagnosed with an illness, you’d still be eligible for health insurance at slightly higher premiums.

For a student with pre-existing conditions, the cost of private health insurance starts at $99 and can extend to $300 per month or more depending on your specific plan details and coverage.

Am I covered if I go to school out of province?

Your province may cover some out-of-province doctor visits and emergency medical care, but they do not usually cover things like ambulance services.

You may have to front some of the cost and you may be reimbursed by your provincial health care plan at a later date. Your private, extended, or group plan may not cover you outside of your home province. 

Am I covered if I go to school outside of Canada?

If you are travelling outside of the country, your provincial or private health insurance will not cover your medical expenses. You must purchase travel medical insurance. This might be included in extended health insurance automatically, but not always. If it does not come included in your existing health insurance policy, we can help you shop for the best emergency travel medical insurance on the market! 

How do I file a health insurance claim?

Some health insurance plans pay the service provider (doctor, pharmacist, physiotherapist, etc.) directly, while others pay you back later. Imagine you need medicine from the pharmacy. If your insurance covers it directly, the pharmacy sends the bill to them. You pay only a part of the cost.

But if they don’t cover it directly, you pay the full price and then send the receipt to your insurance company. They give you some money back for the medicine. If you have to file a claim, contact your insurance company’s claims submission page.

Can I get health insurance with pre-existing conditions?

Yes, you can get health insurance with pre-existing conditions, but coverage may vary. Some plans cover pre-existing conditions immediately, while others impose waiting periods or exclude them entirely.

How much do contacts cost?

The cost of contacts can range from $125 – $1,000 a year, depending on your lens type. Some contacts are daily wear, while others are for more long-term use (making them more expensive). Additionally, your prescription type can affect the cost of your contacts. If you have a particularly strong or complicated prescription, it costs more to make.

How much do glasses cost?

On average, the cost for a single pair of glasses runs about $300. The cost of corrective eyewear has two different components: the frame cost and the lens cost. Frames can be relatively cheap—sometimes as low as $20 if you buy them online. The cost of the lens is the most expensive aspect of glasses cost. Single vision is the least expensive lens type.

This means there is only one type of prescription in the lens. Single-vision lenses can cost $75 – $300. If your prescription calls for dual vision or progressive lenses (meaning two different types of prescription in each lens) it can be more costly. Dual-vision lenses can cost $250 – $700.

How much do glasses cost?

On average, the cost for a single pair of glasses runs about $300. The cost of corrective eyewear has two different components: the frame cost and the lens cost. Frames can be relatively cheap—sometimes as low as $20 if you buy them online. The cost of the lens is the most expensive aspect of glasses cost. Single vision is the least expensive lens type.

This means there is only one type of prescription in the lens. Single-vision lenses can cost $75 – $300. If your prescription calls for dual vision or progressive lenses (meaning two different types of prescription in each lens) it can be more costly. Dual-vision lenses can cost $250 – $700.

Does insurance cover blue light glasses?

If the blue light glasses are prescribed by your optometrist, they may be covered under your health insurance plan. Especially if you work at a computer all day, your eye doctor may prescribe this type of blue-light-blocking lens. However, if you want to buy them on your own accord, they may not be covered by your plan—they usually are not unless specified.

How much does it cost for an eye exam?

The average cost for an eye exam can range from $90-$160. The cost will depend on your province and the eye care professional you see. In some provinces (like Alberta and Ontario), if you are under 18 or over 65, you can get yearly comprehensive eye exams for free. If you are between 19 and 64, you can get coverage for eye examinations through your private health insurance.

Should I opt out of vision insurance?

It depends on your circumstances. If you have medical insurance elsewhere, like through your parent’s plan, you may consider opting out of vision care if it’s offered under your student plan. If you’ve already done eye exams in the past and know you have decent vision, you might also consider opting out.

However, there may come a day when you need to see an eye doctor and find yourself paying hundreds in out-of-pocket expenses. Just like all insurance, vision insurance is there for your immediate needs and your “just-in-case” needs as well.

Frequently asked questions

Can you insure dentures or false teeth?

The cost of a dental appliance or prosthetic itself is usually covered under your dental insurance. However, if you have a particularly expensive set of dentures, false teeth, or other medical equipment, you may be able to cover that through your personal home insurance up to a specified limit.

For example, some home insurance providers have additional coverage for hearing aids, motorized mobility devices, and more.

How much does it cost to clean teeth?

The cost of teeth cleaning and scaling depends on your province. Some provinces have a “fair guideline” that dentists may have to adhere to for general dental services. For example, in Alberta, the guidelines state that polishing should be around $69, scaling should be $77, and a fluoride treatment should be $33, all of which are included in standard teeth cleaning.

Moreover, the approximate cost for just a cleaning may be around $180, depending on your province (not including the dentist consultation cost—just having the dentist examine your teeth will cost extra).

What is the most common type of dental insurance?

Many people have dental insurance provided through their employer benefits plan. For those that do not, they may opt for a basic plan as they are the least expensive.

Basic plans cover preventative care like teeth cleaning. Standard plans include orthodontics or restorative care like braces or teeth replacement.

What if I can’t afford dental insurance?

If you cannot afford dental insurance, you may be eligible for the Canada Dental Benefit. This is a taxpayer-funded program for families that earn less than $90,000/year and whose children are under 12.

Each province also may have dental care coverage available if you are a senior or are a family that needs income assistance.Visit the Government of Canada’s website or contact them to find out if you’re eligible.

Is there a waiting period for dental insurance?

Some plans may have a waiting period for dental insurance. This is usually the case with basic or low-cost plans. Having a waiting period with dental insurance means that you can’t claim anything once the policy comes into effect until the waiting period is over.

This is to prevent people from signing up for dental insurance when they already have pre-existing dental issues and then canceling the policy as soon as the treatment is done and paid for by insurance. Plans vary between 30-90 day waiting periods to no waiting at all.

What is a dental insurance predetermination?

An insurance predetermination is when your dental care provider requests a quote from your insurance provider to confirm which services and treatments will be covered by your plan. They will do this before the services are performed, to make sure that either the insurance fully covers it or that you can handle any remaining out-of-pocket expenses.

Do seniors get free dental coverage?

In some provinces, seniors with low or moderate incomes get financial assistance with basic dental care. However, that may not be the case in every province. By the end of 2023, the federal government is hoping to expand the Canada Dental Benefit to all individuals who are 18-years-old and under, seniors, and people living with disabilities.