Check What Your Province Covers

Getting a Reliable Answer

Coverage rules change and often depend on who you are as much as where you live, so a few minutes of checking saves a surprise bill.

1. Choose the province or territory that issued your health card, rather than the one you are visiting.
2. Pick the service you want, as specifically as you can.
3. Read the result along with any note about age, income or referral, since those conditions often decide the answer.
4. Confirm the details with your provincial plan or the clinic before you book.
5. Check your workplace benefits for anything the province leaves to you.

Twenty-Three Days in Saskatchewan

Canadian medicare began with a fight. On July 1, 1962, Saskatchewan's Medical Care Insurance Act took effect, and most of the province's doctors went on strike the same day. The standoff lasted 23 days before the Saskatoon Agreement settled it, and within ten years the model had spread across the country.

The rules everyone now works from came in 1984. The Canada Health Act asks every provincial plan to meet five criteria, namely public administration, comprehensiveness, universality, portability and accessibility, and it requires every plan to cover hospital care, physician care and dental surgery in hospital. It sets no such requirement for anything else.

That is why the answer to "is it covered" so often depends on your postal code. Medically necessary hospital and physician services are covered everywhere. The rest is a provincial choice, made thirteen different ways.

What the Results Mean

The checker sorts every service into one of three answers.

Most results come with a condition attached. Age, income, a doctor's referral or a hospital setting often decides which of the three answers applies to you.

Words You Will Hear

Insured services. The hospital, physician and in-hospital dental surgery services the Canada Health Act requires every province to cover.

Medically necessary. A service a doctor judges you need, which is the test provinces use for what their plans pay.

Portability. The principle that keeps your coverage working for a time when you travel or move within Canada.

Wait period. The time before a new resident's coverage begins, which several provinces apply.

Supplementary benefits. Extra coverage some provinces offer certain groups, often based on income or age.

Extended health benefits. Private or workplace coverage for services the province does not pay for.

Same Service, Thirteen Different Answers

A few examples show how wide the gap runs. In Ontario, OHIP covers a yearly eye exam for anyone 19 and under, an exam every 18 months for people 65 and over, and yearly exams for adults with eligible conditions such as diabetes or glaucoma. Eye exam coverage by province varies, and adults outside those groups in Ontario pay for their own. OHIP does not cover dental care in a dentist's office, glasses or contact lenses, or prescriptions filled outside a hospital, which fall to separate provincial drug programs.

British Columbia shows the income angle. Its MSP supplementary benefits pay $23 a visit toward physiotherapy, massage therapy, chiropractic, acupuncture, naturopathy and non-surgical podiatry, for up to 10 visits a year combined, for eligible residents with lower incomes. So the answer to whether MSP covers massage therapy is yes for some people and no for most.

When the Checker Gets It Wrong

A quick answer cannot capture every rule, and these are the cases where it most often needs a second look.

• Age limits change the answer, especially for children, youth and people over 65.
• Income-tested programs cover some residents and not others in the same province.
• A service done in hospital may be covered when the same service in a clinic is not.
• A doctor's referral can turn a not-covered service into a covered one.
• Coverage rules change, so a result can go out of date between updates.
• First Nations and Inuit, veterans and some other groups have federal programs with their own rules.

Moving Between Provinces

Health coverage when moving provinces follows a simple rule that catches many people out. Your old plan usually keeps covering you while your new province's wait period runs. In British Columbia, for example, the wait period is the rest of the month you become a resident plus two more months, and the province tells people moving from elsewhere in Canada to keep their former plan until it ends.

Coverage outside Canada is much thinner, and Medimap's look at how a court case made OHIP's out-of-country coverage harder to get shows how narrow it can be. Travel insurance is worth having before any trip abroad.