Pros and Cons of Private Insurance versus Medicare in Canada

Canada regularly takes the leading positions in the lists of countries with the highest quality of life, but the health system rarely occupies high positions in the ratings that evaluate the quality of medical services. For example, according to the international report on health systems in 2010, Canada was ranked the 30th – seven positions above the United States of America. Indeed, getting the treatment in Canada is almost two times cheaper than in the United States and significantly cheaper than in Germany or Switzerland.

The average lifetime of a Canadian resident is 82 years. According to the survey made by The Organization for Economic Cooperation and Development (OECD), 89% of Canadians said they are perfectly healthy and this is a record number. What makes Canadian healthcare system so popular?

Actually, when it comes to Canadian health system, residents have 3 options:

  • Private insurance plan;
  • Medicare – the governmental system that covers basic medical issues;
  • Family doctor – the most complicated pick for most people.

Pros and Cons of Medicare

Americans joke that Medicare – Canada’s affordable health insurance system – is like Obamacare, but for everyone. Yes, the main mission of the healthcare system is availability of medical services necessary for life and health for all groups of the population. The country’s territory counts 13 administrative units of Canada, there is a unified medical insurance. The state guarantees that its holders will not have to pay for treatment.

But everything is not so simple when it comes to Medicare. Surely, every citizen of Canada can come to a clinic at any time and receive a required treatment. There are also so-called “extra services” – including the services of a dentist, a vast list of prescription medications, physiotherapy and others. And every Canadian province or territory decides how to cover these basic services and whether to cover them at all. As a result, the 2/3 of Canadians prefer getting private insurance policies or receive insurance payments from an employer to heal a bad tooth or buy pills.

In Canada, there is a unified medical insurance – Medicare. However, each province and territory issues its own Health Card policy. Certain Health Cards can only be used within the borders of an administrative province.

Surely, medics of the province will not be refused a help to patients, but they will have to pay for the medical services fully, without any discount. The only exceptions are emergency cases with a direct threat to life – then healthcare specialists won’t even take money, including illegal residents or tourists.

However, Canadian Medicare has a few cons that must be taken into account:

  • Doctors are forced to limit the number of patients and working hours, because every province imposes restrictions on people who won’t pay for the services;
  • Frequently, the medical centers to increase profits (medical practice is a private business in Canada) use nurses instead of doctors, especially for examining patients. It’s quite legal but the quality of such diagnostics is questionable;
  • Very long queues for X-Ray and MRT procedures in clinics supporting the Medicare services;
  • In most provinces you can’t pay money to speed up medical procedures in governmental clinics – wait just like everybody else.

Private insurance: pros and cons

The largest private insurance company in Canada is Blue Cross. Her insurance plans include the cost of dental services, the purchase of medicines, glasses and lenses, as well as financial support in the event of a serious illness and temporary disability. Thanks to the Blue Cross insurance policy, you can safely travel around the country and not be afraid to go bankrupt, getting into a hospital in another province. As in the case of state insurance, the Blue Cross insurance plans cover a certain range of services in each province.

Sun Life Financial is another large Canadian company that issues insurance policies covering the costs of crutches, prostheses and wheelchairs, medicines for chronic diseases, and medical services that you have to resort to abroad.

The services of private insurance companies in Canada are quite diverse – you can take out an insurance for yourself and a group of people, you can buy a “package of services”. In this case, you may only cover dental treatment or something else that is not covered by Medicare.

The only drawback of private insurance plans is the cost that may easily go above $1000 per month for a whole family. The price ranges but it is surely never low.  According to, choosing the best plan should be largely based on how many family members are going to be covered by it, the age of people insured, their health condition and their access to affordable medications in their place of residence.

Private vs governmental insurance plans

Free medical insurance for Canadians covers almost all Medicare treatment services. Free receptions from specialists, in-patient treatment, any diagnostic tests as well as vaccinations. State Health Card insurance policy is available after 3 months of living in Canada – a small notification for tourists and immigrants. Drugstores are not complied with Medicare’s health plan and that’s why most prescription drugs are paid individually by every patient.

Yes, dental care is always paid. But you can get a sore tooth out for free. Each treatment is paid by a patient or he/she needs the additional insurance plan for dental services. Such services are claimed as Benefits in insurance plans.

Advantages of disadvantages of a having a family doctor in Canada

Canadian healthcare system is being criticized because of the time required for a patient to spend while waiting for a reception. You may wait up to a whole month before the doctor will be able to accept you.

Therefore, instead of waiting in queues in governmental hospitals and making an appointment for weeks, it is more convenient to have a family doctor. Finding a family doctor can be difficult, especially in some certain province they are not enough. On the other hand, it can be done in several ways:

  • Go to the nearest clinic and ask whether doctors are accepting patients for “family treatment”;
  • Search for a specialist through the universal database of doctors. For example, the province of Ontario has a website;
  • Ask your friends for the contacts of their family doctor.

Of course, this does not mean that the family doctor will go to the patient’s home. But the patient gets the opportunity to find out the doctor’s schedule, schedule meetings in advance and get an appointment more quickly, and the doctor with a long acquaintance with the patient can develop the most effective treatment plan.

Emergency treatment in Canada

Calling an ambulance in Canada with a delivery to the closest hospital will cost about 100 USD. Yes, the only paid service here is a convenient transportation to the hospital in an ambulance car. If a patient can walk safely, he or she will get an emergency treatment from the ambulance team free, right on the spot, upon their arrival.

But you must remember that just like in any other country calling an ambulance in Canada implies a threat to life and the task of healthcare professionals is to get you to a hospital as soon as possible. Calling an ambulance without a good reason will make you to pay a fine – about 250 – 300 CAD. Canadians prefer to get to the hospital on their own if it is possible. Unfortunately, Medicare or any individual private insurance plans do not cover the emergency ambulance services.

Jeffry Lee

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