Canada's publicly funded health care system is often considered a point of national pride. However, while it's true that provincial health care plans provide coverage for essential medical services, Canadians are often surprised to learn just how much these plans don't cover. This is especially true when it comes to routine, family-based care like dental visits, prescription drugs, mental health support, and vision care.
If you're raising a family in Canada, it's important to understand the provincial health care coverage. To help you make an informed decision, we'll go over these limits and the value of private health insurance for family medical coverage.
What Does Provincial Health Care Cover?
All provincial plans are required to meet the standards set by the Canada Health Act, which requires plans to cover all medically necessary services performed by doctors and hospitals. This means that most Canadian citizens are covered for things like:
- Visits to your family doctor or walk-in clinic
- Hospital stays and surgeries
- Emergency medical care
- Diagnostic tests like X-rays and bloodwork
Each province manages its own plan, and depending on where you live, you may receive additional benefits. In many cases, though, important health services such as preventive care, family wellness, and recovery will not be covered.
Common Gaps in Provincial Health Care Coverage
Provincial plans cover a lot of essential health care services, but it's important to be aware of the gaps. Here’s a breakdown of key health services that are either not covered or only partially covered by provincial plans:
1. Prescription Drugs
Unless you’re a senior, you're on social assistance, or you have a specific chronic condition, provincial plans typically offer little to no coverage for prescription medications. For families who have to purchase ongoing prescriptions like asthma inhalers and ADHD medications, this can quickly add up to significant out-of-pocket costs.
2. Dental Care
Routine dental care is typically not covered by provincial health care plans, meaning you'll have to pay out of pocket for services like cleanings and fillings. Emergency dental surgery in a hospital setting may be included, but that’s the exception rather than the rule. Since regular dental visits are especially important for children, families in Canada should strongly consider private dental insurance.
3. Vision Care
Vision care is another area where provincial health care coverage is lacking. Eye exams, prescription glasses, and contact lenses are usually only covered for children (up to a certain age) and seniors. Since kids with vision problems often need new glasses every year, not having thorough vision care coverage can quickly get expensive.
4. Mental Health Support
Society is catching up to the importance of mental health, but unfortunately, the insurance industry is still largely lagging behind when it comes to mental health care coverage. Provincial plans will often cover visits to a psychiatrist with a referral, but therapy from psychologists, social workers, or counsellors is rarely covered under the provincial system. This means that families dealing with stress, anxiety, ADHD, or grief often have to pay out of pocket for these important services.
5. Paramedical Services
Paramedical services such as chiropractic care, physiotherapy, massage therapy, and acupuncture can offer a lot of value. However, these services are only partially covered by provincial plans, if they are covered at all.
6. Medical Equipment and Supplies
Provinces typically do not cover items like crutches, wheelchairs, and hearing aids, and medical equipment such as this is often quite expensive. Some Canadians will qualify to have medical equipment and supplies covered under special programs, but most families worried about the potential expenses of medical equipment and supplies won't be able to count on this.
7. Out-of-Province and Emergency Travel Coverage
If you and your family are planning a trip outside of your home province, it's essential to realize that your provincial plan is likely to offer limited coverage for any expenses you incur during your trip. Since you never know when a medical emergency will strike, anyone planning an out-of-province trip should purchase either travel insurance or a private health insurance plan that includes comprehensive coverage for medical services in other provinces and countries.
Why You Should Consider a Private Health Insurance Plan
For families in Canada, the gaps in provincial health care coverage can often result in major expenses. The good news is that filling these gaps and preventing unexpected expenses is easy with an affordable private health insurance plan such as those offered by GMS.
In Canada, private health insurance plans are specifically designed to fill the gaps in provincial health care coverage. This means that health insurance plans for families are often more affordable than you might expect, while still offering comprehensive coverage for important services like dental care, vision care, prescription drugs, and mental health services.
The more people who live in your household, the more chances there are for unexpected medical expenses. Since many Canadians are unaware of the gaps in provincial health care coverage, these expenses far too often come as unpleasant surprises that have to be paid out of pocket. But with private health insurance for families from a trusted provider like GMS, you can protect your savings and ensure that all of your family's health care needs are covered.
Why Families Choose GMS
At GMS, we've been providing personalized private health insurance plans to Canadians since 1996. Our straightforward coverage, flexible options, and commitment to supporting the overall well-being of our customers are just a few of the biggest reasons why so many families in Canada trust GMS to fill the gaps that their provincial plan doesn't cover.
One big part of our commitment to overall well-being support is the GMS Care Network, which provides 24/7 access to virtual health care, therapy, and financial coaching services. We believe that our customers are at their happiest and healthiest when their physical, mental, and financial health are all supported, and the GMS Care Network is one key way we accomplish this.
We also understand that every Canadian family is unique, which is why we offer a range of flexible insurance plans that can be customized to meet your needs and budget. When it comes to private health insurance, there is no one-size-fits-all solution, and GMS gives you and your family the freedom to choose a plan that works for you.
Provincial Healthcare Coverage FAQs
- What does provincial health care cover?
Provincial health care plans cover the majority of essential health services, including hospital visits, medical testing, surgeries, and doctor visits. However, there are also many important services that these plans do not cover, making private insurance an important safety net for Canadian families.
- Do GMS plans cover pre-existing conditions?
Some GMS plans offer coverage for pre-existing conditions, depending on the plan type and your medical history. If you have a pre-existing condition you would like to be covered, it's best to speak with a GMS provider to find a plan that fits your situation.
- How much does private health insurance for families cost?
The cost of a private health insurance plan varies depending on a lot of different factors, including where you are located, the size of your family, and the level of coverage that you choose. Most providers, including GMS, will offer a free quote based on the information you provide.
- What does GMS health insurance cover?
GMS offers plans that include prescription drug coverage, dental, vision, extended health (like physiotherapy), mental health, and travel insurance. These plans are customizable, and you can choose the level of coverage that best suits your family’s needs.
Final Thoughts
Provincial health care plans are a strong foundation, but they're not a full safety net. For families in Canada, there are a lot of important health care services that simply aren't included in the public system.
Thankfully, a private plan from GMS can help you close those gaps and access a broader spectrum of care for you and your family. Check out our website to explore your options, or contact us to speak with a GMS advisor who can help you find the perfect plan for your family.