What provincial plans cover and leave out, how private and government plans fill the gaps, and the rules in force in 2026.
Every province and territory runs a public health insurance plan under the Canada Health Act, but the Act only requires coverage of medically necessary hospital and physician services. Prescription drugs taken at home, dental care, vision care, physiotherapy, psychologists, ambulance fees and medical equipment fall outside that core, and each province fills the space differently. That is the gap private health insurance, employer benefits and newer federal programs try to close.
Start with the overview of private health insurance in Canada. It links to a guide on what provincial plans don't cover, the difference between group and individual plans, and what drives the price of an individual plan.
Three guides cover public programs that changed the picture recently: the federal Canadian Dental Care Plan, the pharmacare framework for contraception and diabetes medication, and the provincial drug programs that already exist. Quebec has its own mandatory prescription drug insurance, with rules that differ sharply from the rest of Canada.
Dollar amounts on this site are illustrative examples, not quotes or market rates. Rules are described as they stand in October 2026, with the official source to confirm them.
Coverage Gaps, Costs and 2026 Rules
CDCP eligibility explained: the $90,000 income limit, the no-access-to-dental-insurance rule, co-payment tiers, extra charges, renewal and when private dental cover is better.
Coverage Gaps, Costs and 2026 Rules
Employer group benefits versus individual health and dental plans in Canada: underwriting, maximums, premiums, taxes, Quebec rules and what happens when you leave a job.
Coverage Gaps, Costs and 2026 Rules
What sets the price of an individual health and dental plan in Canada: age band, province, plan level, underwriting, family size, taxes and why premiums rise at renewal.
Coverage Gaps, Costs and 2026 Rules
Where national pharmacare stands in 2026: the Pharmacare Act, first-phase coverage of contraception and diabetes drugs, provincial agreements and what it means for private plans.
Coverage Gaps, Costs and 2026 Rules
How private and group health insurance fits around provincial plans in Canada: the gaps it fills, how plans are priced, public programs to check first and how to decide.
Coverage Gaps, Costs and 2026 Rules
How public drug coverage works in each province: seniors' plans, income-based programs like Trillium and Fair PharmaCare, youth coverage, and how they work alongside private plans.
Coverage Gaps, Costs and 2026 Rules
How Quebec's mandatory prescription drug insurance works: private group plan obligation, RAMQ public plan, premium on the tax return, deductible and coinsurance, age 65 and taxes.
Coverage Gaps, Costs and 2026 Rules
The services Canadian provincial health plans leave to you, including drugs, dental, vision, therapy and ambulance fees, with the exceptions for children, seniors and low incomes.
