CANADIAN MEDICARE

The Canadian Medicare provides coverage to all Canadian citizens. It is publicly funded and administered on a provincial basis, based on guidelines outlined by the federal government. As a result, all Canadian provinces follow the same principles, but the level of cover may vary slightly from one to the other.

Canadians see their Medicare system as critical to their identity as it unites them across region, class, race, gender and age. To such an extent that they elected Tommy Douglas, the "father of Medicare," the Greatest Canadian of all time in a 2004 poll.

We will examine how the Canadian Medicare works, its origins and principles, and the options a Canadian citizen has when abroad.

THE CANADIAN MEDICARE

Principles
The Medicare is managed on a regional basis, and the government ensures the quality of care through a federal standard. Those standards can be traced back to 1948 and were revised in the 1984 Canada Health Act (CHA). The CHA is based on 5 criteria which each province has to comply with:

  1. Universality: All Canadian residents must have access to health care insurance on uniform terms and conditions;
  2. Accessibility: All residents must have reasonable access to health services, free of financial or other barriers;
  3. Comprehensiveness: All medically necessary services provided by hospitals and doctors must be covered;
  4. Portability: Health services shall be available to Canadian residents in all provinces – not just the one where the resident is paying his taxes;
  5. Public administration: It shall be administered on a non-profit basis, with public authorities accountable to their respective provincial government;
Provinces have an option to follow the CHA or not. As of today, none opted out.

Reimbursement
All Canadians hold a “health card”, also referred to as “care cards”, they enable them to visit their doctors and practitioners on a cashless basis. Although healthcare coverage for hospital services and physician services under the Canada Health Act are similar across the provinces and territories some slight differences in coverage do exist. This is related to the interpretation of what is "medically necessary".

  1. In-hospital treatment – Doctor's fees, ambulance fares, tests, and most of what happens in a hospital is covered, with the exceptions of cosmetic and experimental treatments;
  2. Out-of-hospital treatment – Once again doctor's fees and required tests are covered. Like in most public funded system, you will first be referred to a specialist by your general or family practitioner;
  3. Medicine – The cost of drugs prescribed within Canadian hospitals are insured and publicly funded. If prescribed outside of hospital, the burden falls on the provincial and territorial government and the level of cover can vary between provinces. There are however publicly funded programs for those most in need (elderly, poor etc.);
  4. Appliances, ophthalmic and dentistry – Most province do exclude dental, optical and appliances from their cover, with the same exceptions are here-above (elderly, poor etc.).

Funding
Canada's healthcare system is funded by both the federal government, and the provincial and territorial governments. Most of the revenue comes from taxation, both on personal and corporate incomes. Some provinces also opted for an annual healthcare premium based on annual income – still, these can be considered taxes as they are not attached to service use, or territorial health expenditures.

Canada spent approximately 10.0% of GDP on health care in 2006, 70% of it being paid by the government.

Private Insurance
Private insurance providers aim to fill the gap between the basics provided by the Medicare system and the extras patients may like to be covered for. Those extras usually include non-covered medical equipment, prescriptions, physical therapy or chiropractic care, dental, vision, and so on; Private or semi-private rooms also fall in this category of course. Thanks to the scope of the Medicare cover, the private insurances remains affordable, and many employers do offer them as benefits to their staff.

Medicare Abroad
If you leave your province to go to another province or territory and plan to return within 12 months, or leave for another country and plan to return within six months, you must retain your territorial Health Care Insurance Plan. If you are leaving for a longer period, you may apply for the following extensions of coverage:

  • four years if the absence is due to work, business or missionary service.
  • two years if the absence is due to personal travel, and other sabbatical .
  • the time period you are a full-time student at an accredited educational institute.

Should you fit in these categories, and continue to be classified as a ‘tax-resident’ of Canada; then you (1) will be covered as per your province level of cover; (2) will pay for the services provided and get reimbursed; (3) will need to cover the difference if the treatment received costs more than what your province covers. You should also be aware that transportation costs related to ambulance, evacuation and repatriation are not covered. It is therefore recommended to secure good travel insurance when traveling outside of Canada.

YOUR INSURANCE OPTIONS

As we saw here above, the Canadian system does offer some cover to their short term expatriates, which is more than what can be said about most public systems. Nevertheless, it comes up short in a few critical areas such as medical evacuation or repatriation costs), limited levels of cover when treated in private hospitals, and cashless facilities for serious emergencies.

As the level of cover and reimbursements provided by the Canadian Medicare match Canadian ones, your choice of hospital may be reduced to government ones and local private clinics if you wish to be reimbursed fully. Should you opt for a private hospital with international level of care, the cost of treatment will most likely be much higher than what the Canadian Medicare would cover you for.

The bottom line is that when traveling outside of Canada, a travel insurance is a minimum, and a private insurance is highly recommended for those traveling for long stretch of time; be it local or international.

If you wish to explore your options further, have questions, or need some guidance, give us a buzz.