When I first started talking about moving to Canada I’d hear a lot of blanket statements from Americans about how disappointed I would be with socialized health insurance. In fact, I also heard that from Canadians. Americans seemed to think that healthcare in Canada would be more expensive and of a lower quality than I was used to receiving in America. Some Canadians would warn me that I would wait forever to see a doctor and I would find that it provided less coverage than what I could get in America.

You might say I was skeptical of both sides of this argument from the start. For one, how many people have experienced healthcare in both American and Canada? Not many, it turns out. In 2013, only 10,624 people immigrated from America to Canada as permanent residents. That’s only 4.1% of the total number of immigrants to Canada that year. For another thing, Canadians have a longer life expectancy than Americans while also spending much less on healthcare than America. Finally, I worked at the same company in the US for 10 years and watched as the amount I paid for insurance went up each year. My annual deductible went up every year too, along with co-pays for doctor’s visits, medical procedures, and medications.

Just to be clear, I have a great job at a great company that offered great benefits. Watching costs go up every year was just normal. In the US you are pretty much guaranteed to have a totally different health plan any time you start a new job. Or, for that matter, every year when your plan renews at a continuing job. Since I transferred my job to Canada, I’m experiencing what supplemental coverage is like on the other side of the border..

Universal Health Care

It really is for all citizens and residents. Healthcare is managed through each province or territory, so your exact coverage will differ depending where in the country you live. In most provinces, you’re eligible for healthcare 3 months after immigrating as a permanent resident. Once you have your insurance card, you are eligible to use health services.

And what exactly is covered? Not everything, but a lot. Specific details vary by province, but the the general rule is that your health plan will cover most things so long as they are considered “medically necessary.” For example, you can’t count on the government to pay for cosmetic surgery unless it’s to fix a medical problem. You can count on your health care plan covering physician visits, medically necessary surgeries and procedures, diagnostics, and preventive care.

Since you’re not bound by a single plan, you can go to any doctor in the province. That means no looking around for an in-network provider. You’re also covered for emergency medical needs if you’re travelling within Canada, and can see doctors in other provinces if you first clear it with your provincial plan.

No matter where you live in Canada, you’re eligible for free emergency services, even if you don’t have a health card.

General Practitioner

You’ll have to find a family doctor or general practitioner (GP) in Canada to act as your gateway to prescriptions and specialists. This is similar to many kinds of insurance plans in America, where most insurance plans require referrals from your Primary Care Physician to access specialists. Just like in America, you may have to look around to find a GP that is accepting new patients. There are a few different ways to find a new GP. One trick is to look for new practices that aren’t already filled up with patients.

I was able to find a GP a few blocks from where I live that was accepting new patients. I got in to see her within a week. I can’t speak for everybody else, but I thought this was pretty impressive.

The hardest adjustment for me is not having ZocDoc anymore.

Supplemental Health Coverage

Many employers will offer supplemental health coverage plans which are often just called “insurance.” Unlike health insurance in the US, you can’t opt out of supplemental plans if they’re made available to you. Your spouse and/or dependents must sign up for any supplemental plan offered through your employer. The only exception to this is if your spouse is already signed up for a supplemental plan through their employer.

Supplemental plans aren’t universal, so they’ll be different depending on what your employer offers. Most cover all or part of costs related to vision, dental, physiotherapy, pharmaceuticals, and travel insurance. You can generally count on a supplemental plan to help with whatever isn’t covered by your provincial plan such as the costs of prescription drugs, physiotherapy, chiropractic visits, and dental work.

Most insurance plans will only cover the majority of costs of generic medications (for example, some cover 90% of the price and you’re left to pay for just 10%). Often times you’re on your own for brand names….sort of. There are some programs that will help pick up the difference between brand name and generic if your insurance plan won’t cover the (often super high) cost of brand names. For example, there’s one medication that I paid about $50/month for in the US. I found that the generic version didn’t work at all, and unfortunately my supplemental insurance plan didn’t cover the brand so I was looking at a $225 charge per month in Ontario. Lucky for me, the pharmacist told me about innoviCares, which helped to dropped the price down to $60 per month once I enrolled. Even when insurance plans fall through, there are still other things in place to help pick up the slack. Much like everything else, alternatives like innoviCares differ by province and even by pharmacy, so ask your local pharmacy about what sort of options they have that might help.

Taxes

If you had health insurance through your job in the US, you’re used to seeing two types deductions on your paychecks for taxes and health insurance. Tax deductions in the US include things like medicare, federal income tax, state income tax, city tax, disability, and social security. On top of that, you’d probably pay for health insurance, dental, vision, and long term disability. When I was living in New York, 34% of my paycheck went to taxes and health insurance.

Now that I’m working for my company in Ontario instead of New York, my paycheck still has two types of deductions for taxes (which includes healthcare) and supplemental insurance (dental, vision, life insurance, long term disability, prescription drugs, travel insurance). In Canada, 31% of my paycheck goes to taxes and supplemental insurance.

Costs

Here’s a high level overview of the approximate cost differences I’ve noticed so far:

America

  • 34% of income to taxes and health insurance PLUS…
  • $30 copays for all doctor visits
  • 20% copay required for in-network procedures and hospital visits (including things like surgeries, imaging, bloodwork, and ambulance rides)
  • 40% copay required for out-of-network procedures and hospital visits
  • $350 annual deductible I paid out-of-pocket before insurance kicked in
  • $2000 annual deductible for out-of-network coverage

Canada

  • 36% of income to taxes and supplemental health coverage
  • No copays for any doctor visit
  • No annual deductibles

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