Ways to pay for health costs outside your provincial plan
Public programs, group and individual plans and self-funding compared by how they work, who they suit and their catches.
Each row is a way Canadians pay for prescriptions, dental, vision and therapy that the provincial health insurance plan does not cover. Most households combine several: a provincial drug program for seniors, an employer plan for dental, and the medical expense tax credit for what is left. Read the rows as types of coverage, not as products or prices. Eligibility, premiums and maximums differ by province and by plan, so check the official source or plan booklet before you rely on a row.
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| Option | How it works | Good for | Watch out for |
|---|---|---|---|
| Provincial health insurance plan (OHIP, MSP, AHCIP, RAMQ and others) | Pays medically necessary physician and hospital services; some provinces add limited eye care, physiotherapy or other services for certain ages or incomes | Everyone who meets residency rules | Waiting periods for some new residents; little or no drug, dental or vision coverage for working-age adults |
| Provincial drug program (OHIP+, Ontario Drug Benefit, Trillium, Fair PharmaCare, Alberta seniors' coverage and others) | Public coverage for prescriptions, often for seniors, young people or those with high drug costs relative to income | Seniors, people with high drug costs and those without a private plan | Formulary limits, deductibles and copayments; rules and amounts change, so check your province |
| Quebec public prescription drug insurance plan (RAMQ) | Mandatory coverage for Quebec residents with no access to a private group plan; premium paid through the Quebec tax return | Quebec residents without access to group coverage, and many people aged 65 and over | You cannot choose RAMQ if you are eligible for a private group plan; deductible and coinsurance apply |
| Employer or union group plan | Employer and employees share premiums; covers drugs, dental, paramedical and vision with set maximums | Employees and their families; often the best value per dollar of premium | Ends when the job ends; Quebec taxes the employer's contributions as income; maximums may be low |
| Individual plan, guaranteed issue | No medical questions if you apply within a set window after leaving a group plan, or for basic plans | People leaving a job, retiring or with health conditions | Lower maximums, higher premiums per dollar of benefit, deadlines to apply |
| Individual plan, medically underwritten | Health questionnaire decides acceptance and exclusions; usually richer benefits | Healthy self-employed people and families without group access | Pre-existing condition exclusions; misstatements can void coverage |
| Canadian Dental Care Plan | Federal dental coverage for residents with adjusted family net income under $90,000 and no access to private dental insurance | Uninsured lower and middle-income families, seniors and children | Any access to private dental coverage disqualifies you; co-payments above $70,000 income; providers may charge more than CDCP fees |
| Health spending account | Employer or your own corporation funds a set amount you draw on for eligible medical expenses | Business owners and employees who want flexibility | Must meet tax rules for private health services plans; unused credits may expire |
| Paying yourself plus the medical expense tax credit | You pay bills directly and claim the federal and provincial credits on amounts above the threshold | Low expected costs, or when premiums would exceed likely claims | No protection against a large bill; credit is non-refundable and modest |
Rows describe how each option generally works in October 2026. Provincial drug program names and rules differ, and amounts such as deductibles, copayments and income thresholds are revised regularly. Check your provincial ministry of health, Health Canada, the Canada Revenue Agency, the RAMQ for Quebec, and your plan booklet. For complaints about a private insurer, see the OmbudService for Life and Health Insurance. Use the plan comparison tool to test plans with your own numbers.