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National Health Services for Expats in Canada

Submitted: September 2013

Canada has a comprehensive national health system which covers medically necessary treatment on a subsidised basis. This is commonly referred to as “Medicare” (“assurance-maladie” in French). Technically speaking, it is a universal health insurance system whereby entitlement to healthcare benefits is based on social citizenship. Accordingly, healthcare in Canada is not free unless you are an insured person.

Canada doesn’t run any socialised health insurance programme at federal level, though there are a few exceptions. Instead, each province or territory has its own public health insurance programme. Provinces have considerable autonomy, but provincial programmes are harmonised by the Canada Health Act (see excluded services below).

It is advisable to take some time to check the extent of your provincial health insurance programme. An overview of the Canadian national health insurance system is available here.

Provincial health insurance

Funding

Canadian Medicare programmes are primarily funded through general tax revenue rather than social insurance contributions. Additional health taxes (e.g. payroll taxes) or monthly premiums may be imposed by provincial governments.

Medicare in Canada may appear less generous than its foreign tax-funded equivalents (e.g. in the UK or Scandinavia). Therefore, expatriates should be prepared to contribute towards certain out-of-pocket costs or private health insurance.

Eligibility

In theory, Medicare is a residence-based system. You are eligible for Medicare only if you establish residency in one specific province or territory. In practice, this system is not really designed to encourage mobility.

Many Canadians do not qualify for Medicare coverage because they do not meet strict provincial residency rules, or because they are unable to show appropriate documentation, such as utility bills. This may happen, for example, if you frequently move within Canada or if you are homeless. As a consequence, you should check the residency requirements in your province or territory and plan accordingly.

Generally speaking, a province may require that you spend a waiting period there before you can qualify for the provincial Medicare programme. By law, this cannot exceed three months. Thanks to portability rules under section 11 of the Canada Health Act, you may remain enrolled in the Medicare programme of your previous province during the waiting period.

Your immigration status is also taken into account. All Canadian citizens and permanent residents automatically pass the immigration status test. Certain refugees and newcomers to Canada may also qualify for temporary coverage from the Federal Government.

When you are eligible for a provincial Medicare programme, you should apply for a provincial health insurance card as soon as possible. These cards are strictly personal, and you may face criminal charges if you share them.

Here is an example for illustrative purposes:

Example

Danny is a US citizen with permanent residence status who lives in Alberta. He then moves to Ontario to live there.

According to the rules applicable in Ontario, Danny cannot claim Medicare benefits under the Ontario provincial programme (OHIP) during his first three months of residence in Ontario. However, Danny may stay enrolled in the Alberta provincial programme (AHCIP) during this waiting period to the extent that the rules in Alberta allow it.

If something happens to Danny 15 days after he moves to Ontario, he may use his AHCIP card in Ontario to get subsidised healthcare there.

If, for any reason, Danny is no longer covered by AHCIP but not yet enrolled for OHIP, he should pay his healthcare bills out-of-pocket or have private health insurance.

Practical use

Once you are enrolled for a provincial Medicare plan, you simply need to show your provincial health insurance card to your doctor. If your treatment is covered, you may have nothing to pay at all. This is because your doctor then applies for payment directly from your provincial Government.

Portability within Canada

The general rule in Canada is that you should seek healthcare treatment in your province of residence, even if you are temporarily absent. However, your provincial health insurance plan may pay your healthcare costs if you need urgent treatment whilst you are visiting another Canadian province. Aside from emergency cases, you are generally expected to seek prior approval from your provincial health insurance plan.

Under reciprocal billing agreements between different Canadian provinces, you may also show up your provincial health insurance card outside of your province of residence. The downside is that your provincial programme may exclude many treatments obtained outside of the province, even if they are clinically necessary (e.g. medicines or ambulances).

Be aware that Quebec does not have reciprocity agreements with other Canadian provinces or territories. Therefore, Quebec cardholders have to pay upfront when they use healthcare services outside Quebec. They may then apply for reimbursement from the Quebec Government. Likewise, holders of provincial Medicare cards issued outside Quebec must pay for treatment delivered in Quebec, even if they may have their costs reimbursed by their province of residence.

Portability outside Canada

Portability is also available if you travel temporarily outside Canada. International travel is different from travel within Canada in that:

  • reciprocal billing agreements are not available, i.e. you must pay your overseas doctor for yourself and then apply for a refund in Canada, and
  • the refund you are entitled to is determined by the applicable rate in your home province. This is bad news if you go to an expensive country, such as the US.

Excluded services

Provincial health insurance programmes attract federal funding only to the extent that they cover medically necessary services as defined by the Canada Health Act. Accordingly some healthcare services may be outside of the scope of the Canada Health Act. These include, but are not limited to:

  • outpatient dentistry
  • eye care
  • ambulances
  • medicines
  • cosmetic surgery
  • treatment of work-related injuries or illnesses
  • production of most medical certificates
  • preferred hospital accommodation, unless prescribed by a doctor

A provincial Government may decide to include certain services in its health insurance programme, even if they are not eligible for federal funding. Therefore, it is best to check what you are entitled to in your individual case.

An excluded service for provincial health insurance purposes (e.g. dentistry) may qualify for tax benefits. For more information on health tax benefits, see below.

Medical tax benefits

In addition to provincial health insurance, many out-of-pocket healthcare costs incurred by Canadian residents attract tax benefits.

You should keep your receipts to avoid denial of tax benefits.

Medical expense tax credit

You may claim tax relief in respect of your eligible medical costs on any amount in excess of 3% of your annual income or CAD2,152 (whichever is lower) over a 12-month-period ending in the relevant tax year. Your amount is then multiplied by 15% for federal income tax purposes.

Example

Ben is resident in Vancouver and he earns CAD200,000 a year. His eligible medical expenses are CAD3,000 between 1 June 2012 and 31 May 2013.

For the 2013 tax year, Ben will be entitled to tax relief on 3,000-2,152 = $848. His tax credit will be 848*0.15  = $127.2 for federal income tax purposes and 848*0.0506 = $42.9 for British Columbia tax purposes.

A list of eligible medical expenses is available here. Most healthcare costs are eligible, even if they are incurred outside Canada. However, medical expenses are ineligible if they have a purely cosmetic purpose. A list of ineligible expenses is available here.

Medical expense tax credits are non-refundable.

Medical expense supplement

Low-income households are entitled to a refundable medical expense supplement. To qualify, you must:

  • be resident in Canada throughout the relevant tax year
  • be at least 18 at the end of the tax year
  • earn at least CAD3,333 from labour sources (whether employment, self-employment or business income)
  • have been entitled to claim a medical expense tax credit, and
  • file a tax return for the relevant tax year.

The maximum you can get each year is the lower of:

  • CAD1,142, and
  • The sum of 25% of your eligible medical expenses for medical expense tax credit purposes and 25% of any disability supports deduction.

If your annual income exceeds CAD25,278, your medical expense supplement is reduced by 5% of your income in excess of CAD25,278.

Tax authority guidance

For more information on medical tax benefits, you can read the manual from the Canadian Revenue Agency (CRA).

 

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