What provincial plans actually leave uncovered

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Your provincial plan must pay for medically necessary hospital and doctor care, and very little else is required. Prescriptions you fill at a pharmacy, routine dental care, glasses, physiotherapy and ambulance fees are each left to your province, so what you pay out of pocket depends on where you live, your age and your income. This guide maps those gaps, what public programs fill part of them, and where a private health and dental plan fits.

Figures come from federal and provincial government pages, checked in September 2026. Programs change often, so confirm the current rules on your province's own page before you rely on them.

Each province and territory runs its own public plan, and the Canada Health Act sets the floor. Under the Act, public plans must cover medically necessary hospital, physician and certain surgical-dental services, and "patients pay for uninsured health services" (Health Canada).

Provinces decide which services count as insured, and they can add more on top. That is why two Canadians with the same prescription or the same sore back can pay very different amounts depending on the province they live in. Our glossary explains the terms that come up most.

In most provinces, some or all of the cost of these falls on you:

• Prescription drugs filled at a pharmacy, outside a hospital stay.
• Routine dental care such as cleanings, fillings and check-ups.
• Glasses, contact lenses and, for many adults, eye exams.
• Physiotherapy, chiropractic, massage therapy, psychology and similar services outside hospital.
• Ground ambulance fees.
• Private or semi-private hospital rooms.
• Many medical devices and supplies.

None of these are among the services the Canada Health Act requires. Some provinces cover parts of them for particular age groups, conditions or income levels, which is where the differences between provinces come from.

Drugs given to you during a hospital stay are covered; drugs you fill at a pharmacy depend on your province. In 2018 a House of Commons committee recommended amending the Canada Health Act to add prescription drugs dispensed outside hospitals to its insured services, which shows they are not part of it (Library of Parliament). Each province runs its own drug program instead, usually aimed at seniors, young people, low incomes or high drug costs.

• Ontario: the Ontario Drug Benefit covers people 65 and older, and people 24 and under who have no private plan, through OHIP+. The Trillium Drug Program is open to others with high drug costs: once you pay a deductible of usually about 4% of household income after taxes, you pay up to $2 per prescription (Government of Ontario).
• Quebec: drug coverage is mandatory. If you are under 65 and have access to a group plan, for example through work, you must join it; otherwise you are covered by the public plan run by RAMQ, which charges an income-based annual premium plus a deductible and coinsurance at the pharmacy (RAMQ).
• British Columbia: Fair PharmaCare sets an income-based deductible. After it, PharmaCare pays 70% of eligible costs (75% if a family member was born before 1940), then 100% once you reach your family maximum; 2026 coverage is based on 2024 income (Government of British Columbia).
• Alberta: Coverage for Seniors has no premium for people 65 and older, and Non-Group Coverage is open to residents under 65 for a monthly premium. Both charge a 30% co-payment to a maximum of $35 per prescription, effective April 1, 2026 (Government of Alberta).

Every program pays only for drugs on its own list, called a formulary, so a drug your doctor prescribes may not be covered even when you qualify. Check the formulary before assuming a prescription is paid for.

Only if you live in British Columbia, Manitoba, Prince Edward Island or Yukon, and only for certain contraception and diabetes medications. The Pharmacare Act came into force on October 10, 2024 (Health Canada), and Health Canada lists those four jurisdictions as the only ones with funding agreements in place (Health Canada).

In those places, the covered products are free at the pharmacy counter, though you may still pay other fees such as delivery or prescribing fees (Health Canada). British Columbia's version began March 1, 2026 and also covers menopausal hormone therapy (Government of British Columbia). Everywhere else, national pharmacare does not yet change what you pay.

Not by provincial plans, apart from certain dental surgery done in hospital. The federal Canadian Dental Care Plan now fills part of that gap for households that qualify (Government of Canada, updated September 22, 2026). To qualify, you must:

• Have no access to private dental insurance or coverage.
• Have filed your tax return in Canada, along with your spouse or common-law partner.
• Have an adjusted family net income under $90,000.
• Be a Canadian resident for tax purposes.

You pay nothing toward the plan's set fees if your adjusted family net income is under $70,000, 40% if it is $70,000 to $79,999, and 60% if it is $80,000 to $89,999 (Government of Canada). You may pay more if your dentist charges above those fees.

Here is the trade-off to weigh before you buy anything. Dental coverage you buy yourself, and a health spending account that pays dental costs, both count as access to private coverage, which makes you ineligible for the federal plan. For a household under $90,000, buying a dental plan can mean giving up coverage you would otherwise get.

Partly, and it varies a lot. Eye exams, physiotherapy and similar services sit outside the Canada Health Act, so provinces that cover them usually limit coverage to certain ages, conditions or income levels. Glasses and contact lenses are generally your cost. Check your province's current list before booking.

Ground ambulance is where the differences are easiest to see. Fees for an insured resident, as each government publishes them:

• Ontario: a $45 co-payment (Ontario Regulation 552).
• Quebec: $125 plus $1.75 per kilometre; for people 65 and older, the receiving hospital covers the cost, subject to physician approval (Government of Quebec, updated August 20, 2024).
• British Columbia: $80 per call (BC Laws).
• Alberta: $385 for assessment and transport, or $250 for assessment only; people 65 and older in Coverage for Seniors are not billed (Government of Alberta, September 1, 2026).
• Saskatchewan: a base fee of $245 to $325, which can rise with distance and waiting time; seniors 65 and older are capped at $135 per trip (Government of Saskatchewan).
• New Brunswick: $130.60 plus HST for an emergency call (Government of New Brunswick).

Devices work the same way. Ontario's Assistive Devices Program pays 75% of the approved cost of eligible devices (Government of Ontario), and for hearing aids it pays 75% up to $500 per ear (Government of Ontario).

First, check whether your province makes you wait. Ontario has had no OHIP waiting period since March 2020, though you must be in Ontario for 153 of your first 183 days (Government of Ontario). Our OHIP waiting period guide explains the rules.

Other provinces differ. In Quebec, coverage usually begins after a maximum of three months, a wait that does not apply to children under 18 (RAMQ). Alberta says people arriving from outside Canada might be covered from the date they establish residence, if they apply within three months (Government of Alberta), and Manitoba lets citizens and permanent residents apply for coverage from their date of arrival (Manitoba Health). Many newcomer guides still list three-month waits for several of these provinces, so trust the government page over the guide.

Second, the gaps above apply to newcomers too. Once your coverage starts, you face the same drug, dental and vision costs as anyone else, and without a workplace plan you have no private drug coverage unless you buy it. Our newcomers guide covers the first months in more detail. Family visiting from abroad are not covered by provincial plans at all; our Super Visa insurance guide explains what visitors need.

Refugee claimants and protected persons are covered differently, by the federal Interim Federal Health Program, which includes basic, supplemental and prescription drug benefits (IRCC, updated May 1, 2026). Since May 1, 2026, basic benefits remain free, but you pay $4 for each prescription and 30% of the eligible cost of other supplemental services (Medavie Blue Cross, program administrator).

The extras that provincial plans leave out: prescription drugs, dental care, vision care and paramedical services, usually with annual limits. The industry association describes extended health care insurance as coverage that pays "hospital and medical expenses not covered by your provincial health plan" (CLHIA).

Before looking at private plans, check the public ones. Ontario's Trillium program and Alberta's Non-Group Coverage both cover prescriptions for people without a workplace plan. For dental, the federal plan may cover you at little or no cost if your household qualifies.

Private plans generally come in two kinds. Some ask no medical questions but have lower limits and may exclude conditions you already have; others ask health questions and may offer more coverage, or may decline or limit it. If you are leaving a workplace plan, ask whether it offers a conversion option, which lets a departing member switch their group coverage to an individual policy (CLHIA). If you have both a group plan and an individual plan, the individual plan is generally treated as secondary, though the policy wording decides the order (CLHIA).

Start with your insurer's own complaint process. If the insurer has not responded within 90 days, or you are not satisfied with its final position, you can take the complaint to the OmbudService for Life and Health Insurance, which is free for consumers across Canada (OLHI). It aims to review and conclude most complaints within 120 days.

• List what you actually pay for today: prescriptions, dental, eye care, therapy.
• Check which public programs you qualify for, including your provincial drug program.
• If your household income is under $90,000, check the Canadian Dental Care Plan before buying dental coverage.
• For each prescription you take, check whether it is on the formulary of any plan you are considering.
• If you are new to your province, confirm whether a waiting period applies.

Coverage works differently again once you leave your province. To see how travel medical policies fill that gap, read our visitor and travel cover guide.

HealthRate.ca is educational. It makes no insurance referrals and does not offer or arrange quotes.