Coverage Gaps, Costs and 2026 Rules
Quebec drug insurance: when you must join a private group plan and when RAMQ covers you
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.
In Quebec, prescription drug insurance is mandatory for everyone. Under the Act respecting prescription drug insurance (Loi sur l'assurance médicaments), in force since 1997, you must be covered either by a private group plan or by the public prescription drug insurance plan administered by the Régie de l'assurance maladie du Québec (RAMQ). The rule that decides which one applies is simple: if you are eligible for a private group plan that includes drug coverage, through your job, a professional order, an association or a spouse's or parent's plan, you must join it and cover your spouse and children unless they have other group coverage. Only people with no such access register with RAMQ, and they pay the public plan's premium through their Quebec income tax return. People aged 65 and over are automatically registered with the public plan, with options if they have private group access.
This guide is part of the private health insurance in Canada overview. Amounts that change every year are not stated as current figures; check RAMQ for the year that applies.
Who must be covered by a private group plan
You must join a private group plan with drug coverage if you have access to one:
- Through your employment or former employment (for example, some retiree plans)
- Through a professional order, association or union you belong to
- As the spouse or child of someone who has such access
If you are eligible, you must cover your spouse and dependent children as well, unless they already have private group coverage. Opting out of the drug portion of an employer plan is only allowed if you are covered by another private group plan, for example your spouse's.
Private plans must cover at least the drugs on the RAMQ List of Medications, and the amount you pay out of pocket under a private plan is limited by rules tied to the public plan's maximum annual contribution. Private plans may be more generous, for example by covering drugs not on the list.
Who is covered by the RAMQ public plan
- People with no access to a private group plan
- People aged 65 and over, who are registered automatically when they turn 65 (see below)
- Recipients of last-resort financial assistance
- Children of people covered by the public plan
You must register with RAMQ for the public drug plan if you have no group access; it is not automatic for people under 65. Losing group access, such as when a job ends, means registering with RAMQ promptly so you are not uninsured.
How the RAMQ public plan charges you
There are two parts:
- An annual premium, calculated on your Quebec income tax return (Schedule K) based on family income. Below a family income threshold you pay no premium; above it, the premium rises with income up to a maximum per adult ($789 for 1 July 2026 to 30 June 2027). The maximum is revised on 1 July each year.
- What you pay at the pharmacy: a monthly deductible and a coinsurance percentage of each prescription, up to a maximum monthly contribution and an equivalent yearly maximum. Once you reach the maximum, the rest of your covered prescriptions that period are paid by the plan.
Some people pay nothing at the pharmacy, including children of insured persons, full-time students aged 18 to 25 with no spouse who live with their parents, people receiving last-resort financial assistance, and people 65 and over receiving 94% to 100% of the maximum Guaranteed Income Supplement. Those receiving a smaller share of the GIS pay at a lower monthly maximum. RAMQ publishes the current premium maximum, deductible, coinsurance rate and maximum contribution for each period from 1 July.
Worked example (2026–2027 rates, illustrative person)
For 1 July 2026 to 30 June 2027 the public plan's figures are a monthly deductible of $21.25, coinsurance of 30% and a monthly maximum contribution of $105.25 (for adults and people 65+ without the GIS). A person registered with RAMQ fills prescriptions costing $180 in one month.
- Deductible: $21.25
- Coinsurance: 30% x ($180 - $21.25) = 30% x $158.75 = $47.63
- Total paid at pharmacy: $68.88 (under the $105.25 monthly maximum)
In a month with $500 of prescriptions, the calculation gives $21.25 + 30% x $478.75 = $164.88, but the monthly maximum caps it at $105.25. These figures change every 1 July, so check RAMQ's current ones for a real estimate. Add the annual premium from Schedule K to get the yearly cost.
Turning 65 in Quebec
At 65 you are automatically registered with the RAMQ public plan. If you also have access to a private group plan (through your job, a retiree plan or a spouse's plan), the options and obligations differ depending on your situation; for example, you may keep private group coverage for drugs or rely on RAMQ for basic drug coverage with a private plan as complementary coverage. Contact RAMQ and the private plan administrator a few months before your 65th birthday to understand which plan pays first and what premiums each will charge.
Tax differences in Quebec
- Employer contributions are taxable in Quebec. The share of group health and drug premiums your employer pays is a taxable benefit for Quebec income tax (shown on your RL-1), although not for federal tax.
- Medical expense credits. You can claim the federal medical expense tax credit and the Quebec tax credit for medical expenses. The Quebec credit uses a threshold based on family income, not the federal dollar threshold. Premiums you pay for private plans are eligible medical expenses. Check the CRA and Revenu Québec guides for how the RAMQ public plan premium is treated before claiming it.
Comparison: private group plan vs RAMQ public plan
| Feature | Private group plan | RAMQ public plan |
|---|---|---|
| Who | Mandatory if you have access | People without group access; most people 65+ |
| Premium | Payroll or association deduction; employer share taxable in Quebec | Paid on Quebec tax return, based on family income, up to a yearly maximum |
| What you pay at the pharmacy | Plan's deductible and coinsurance, within legal limits | Monthly deductible and coinsurance up to a maximum contribution |
| Drugs covered | At least the RAMQ list; may cover more | RAMQ List of Medications |
| Extras | Often dental, vision, paramedical in the same plan | Drugs only |
Mistakes to avoid
- Declining group drug coverage because RAMQ seems cheaper. If you have access, the law requires you to join.
- Forgetting to register with RAMQ after losing group access. You can owe the premium for the period regardless.
- Not covering your spouse and children when you join a group plan and they have no other group coverage.
- Ignoring the Quebec taxable benefit when comparing an employer plan's cost.
Frequently asked questions
I'm self-employed in Quebec with no group plan. What do I do?
Register with the RAMQ public plan and pay the premium through your Quebec tax return. You can buy an individual plan for dental, vision and paramedical care, but drug coverage comes from RAMQ unless you gain group access, for example through a professional order.
My spouse has a group plan. Must I join it?
If the plan allows you to be covered as a spouse and you have no group plan of your own, you are generally required to be covered by it.
Is RAMQ drug coverage valid outside Quebec?
The public plan covers prescriptions filled in Quebec. For prescriptions filled elsewhere, check RAMQ's rules before you travel or move.
Sources
- Régie de l'assurance maladie du Québec — public plan registration, premium, deductible and coinsurance for the current period
- Revenu Québec — Schedule K premium and the Quebec medical expense credit
- LégisQuébec — Act respecting prescription drug insurance
- Autorité des marchés financiers — regulator of insurers and representatives in Quebec
- Canada Revenue Agency — federal medical expense tax credit
