Health & Dental Insurance in Canada 2026: What Your Provincial Plan Doesn't Cover, and How to Fill the Gap

Provincial health plans cover doctors and hospitals - but not prescriptions, dental, vision, or physiotherapy. A complete guide to personal health and dental insurance, claims, and what happens if you lose workplace coverage.

What Your Provincial Health Card Doesn't Cover

Provincial health plans cover doctor visits and hospital care, and that's genuinely valuable - but it's easy to assume that means everything health-related is taken care of. It isn't. Provincial coverage generally excludes prescription medications, routine dental care, vision care, physiotherapy, and medical equipment - all of which can add up to significant out-of-pocket costs without a personal health and dental plan filling the gap.

Coverage for Pre-Existing Conditions

A common worry is that an existing health condition or prescription will be excluded from a new personal health plan. Depending on the plan, that's often not the case - many insurers offer "Guaranteed Issue" plans requiring no medical questions at all, which will cover existing prescriptions and conditions without exclusions.

What Happens If You Lose Your Workplace Benefits

Leaving a job doesn't have to mean losing health coverage entirely, at least not immediately. Most people have a 60 to 90-day grace period to apply for a "Follow-Me" or "Conversion" plan - a personal policy that continues coverage for your current health needs without requiring a new medical exam. Missing that window, however, can mean having to qualify medically for a new plan from scratch, so it's worth acting on promptly after a job change rather than assuming there's no rush.

How Claims Actually Work

Making a claim is generally simpler than people expect. Most providers issue a physical and digital benefits card - show it directly to your pharmacist or dentist for instant direct billing, with no upfront payment or reimbursement wait. For other expenses, like massage therapy or other paramedical services, you can typically photograph the receipt and upload it through a mobile app for quick reimbursement instead.

What's Typically Covered

• Prescription drugs not covered by your provincial plan
• Routine and major dental care (checkups, cleanings, fillings, and more depending on the plan)
• Vision care - eye exams, glasses, and contact lenses
• Physiotherapy and other paramedical services (massage therapy, chiropractic care, and similar)
• Medical equipment and supplies

• Don't assume provincial coverage means you're fully protected - check what it actually excludes
• Ask specifically about Guaranteed Issue options if you have an existing health condition or prescription
• Act within the 60-90 day window if you lose workplace benefits, to access Follow-Me/Conversion coverage without a new medical exam
• Keep your benefits card accessible for direct billing at the pharmacy or dentist
• Review your plan's specific coverage limits for dental and paramedical services before assuming everything is included