The government-run Canadian health insurance is called Medicare. Every Canadian is covered by Medicare. There are no copays, deductibles, or premiums. Access to care is based on medical need–not ability to pay. The plan covers all “medically necessary hospital and physician services.” There are five major categories of services not covered by Canada’s Medicare.
- dental care
- vision care
- prescription drugs
- in-home care
- ambulance services
Supplemental coverage is provided to cover the cost of services not covered by Medicare for children, seniors, and those receiving social assistance.
Medicare isn’t managed by the federal government; instead, there are 13 provincial and territorial health plans. A Canadian province is like a state in America. Local governments are charged with administering a public health care plan for their citizens that complies with the requirements of the Canada Health Act. Each provincial and territorial insurance plan is free to determine which services it deems medically necessary. If a service is deemed medically necessary, the entire cost of that service is paid by the plan. The plans must cover someone throughout Canada and must offer some coverage outside of the country as well.
The federal government provides funding to the provinces and territories through the Canada Health Transfer (CHT). Payments made through the CHT are made on an equal per capita basis. This means that each health insurance plan is given the same amount of federal dollars for each person enrolled in its plan. Beginning in 2017, payments made through the CHT are guaranteed to grow by at least three percent annually.
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