Individual Health Insurance in Canada: Coverage, Costs & How It Works
What is individual health insurance?
Individual health insurance is private health coverage that you purchase on your own instead of through an employer or group plan. It helps cover healthcare costs that aren’t included in provincial health plans, such as:
- Prescription medication
- Dental care (check-ups, cleanings, fillings)
- Vision care (eye exams, glasses, contact lenses)
- Paramedical services (massage therapy, chiropractors, physiotherapy)
- Mental health services
Think of government health care as the foundation of your house, while individual health insurance is the furniture and finishes that make it livable. Just like furniture, your individual health insurance coverage can be sparse and practical or more elaborate and upscale—you choose what you’re most comfortable with.
“Paramedical benefits and mental health services are underused and overlooked in all of our individual health plans. PolicyMe has some of the best coverage in the industry for these services.” —Jeremy Burbano, Licensed Insurance Advisor
Individual health insurance vs. government health care
Canada’s universal healthcare coverage is funded by the federal government and administered through each provincial government, while individual health insurance is sold through private insurance companies. But the biggest difference between these two tiers of healthcare lies in what they do—and don’t—cover.
Some Canadians may qualify for government-provided income-based or age-based programs, like the Canadian Dental Care Plan (CDCP) or prescription drug coverage for seniors, low-income families, children, or those with certain medical conditions. But these programs have eligibility requirements that leave millions of Canadians without coverage, and those who do qualify won’t gain coverage for other medical services, like vision care, paramedical services, and mental health support.
That’s where individual health insurance comes in. Alongside essential care from government coverage and programs, private healthcare plans fill the gaps, offering more protection and flexibility for everyday healthcare needs.
What does individual health insurance cover?
Individual health insurance offers additional coverage for key healthcare costs that don’t fall under the umbrella of “medically necessary” services covered by government health care. Private individual health and dental plans offer similar coverage to a workplace-provided health benefits plan, but can be purchased through a private health and life insurance company.
Individual health insurance vs. group benefits
For many Canadian residents with full-time employment, employer-provided group benefits supplement public health care. As of 2024, the Canadian Life and Health Insurance Association reported that 91% of health insurance purchased in Canada was through a group plan.
PolicyMe’s 2025 Healthcare Access and Affordability Study found that while group healthcare plans account for the majority of health insurance premiums spent in Canada, only 40% of Canadian adults rely on a workplace plan for supplemental health insurance coverage. The remaining 60% have coverage through a spouse, partner, or parent—or no health insurance coverage at all beyond their provincial plan.
Employer-sponsored group health insurance plans typically cover the same extended health care benefits as private plans, such as:
- Prescription drugs
- Dental benefits
- Vision care
- Mental health services
- Paramedical and wellness services
- Medical equipment, home health care, hearing aids, and other extended health benefits
However, group plans come with drawbacks that can be significant depending on your healthcare needs.
The bottom line: Because group health insurance plans are designed for the average employee, they come with limited coverage options and may not meet the needs of those with ongoing health conditions.
Individual vs. family health insurance
The difference between an individual health insurance policy and a family plan is the number of people on the policy. For households with multiple people, a family plan is typically more cost-effective.
Who needs individual health insurance?
Individual health insurance can make a real difference for Canadians who don’t have access to workplace benefits and need insurance options for services not covered by provincial or federal programs. Key groups that may need individual health insurance include self-employed Canadians, retirees, part-time workers, unemployed individuals on or off the job market, or those with insufficient employer-sponsored coverage.
If you’re not sure whether you need individual health insurance, take a minute to:
- Review your current coverage: Do you have access to workplace health benefits—and if so, is your current level of coverage a good match for your actual healthcare needs?
- Assess your current healthcare usage: Do you take prescription drugs or access paramedical services (e.g. naturopaths, massage therapists, or chiropractors) regularly?
- Think about future usage: Do you have reason to expect major uncovered health or dental bills, such as for a root canal or tooth extraction, in the next few years?
Self-employed individuals
Running your own business or freelancing comes with a lot of perks, but unfortunately, health insurance isn’t usually one of them. If you’re self-employed, private health insurance can fill the gaps left by public plans, covering services like dental care, prescription drugs, and physiotherapy. It’s like adding a safety net under your entrepreneurial tightrope.
Retirees under 65
Retiring early is a dream for many, but it also means you might not yet qualify for senior health benefits. For those who hang up their work boots before turning 65, private health insurance can ensure continuous coverage. This way, you can enjoy your golden years without worrying about unexpected medical bills.
Canadians aged 55+ typically pay the most out-of-pocket for health coverages compared to other age groups. Averaging around $1,321 annually for coverage, retirees are one of the main groups that can financially benefit from a private plan.
Part-time workers
Working part-time has its advantages, but it often doesn’t include employer-sponsored health insurance. If you find yourself in this situation, private health insurance can be a smart move. It provides the peace of mind that comes with knowing you’re covered for the essentials, even if you’re not working full-time hours.
Unemployed individuals
Navigating unemployment is challenging enough without the added stress of potential medical expenses. If you’re currently between jobs, securing private health insurance can be crucial. It ensures you have access to necessary health services and can prevent financial strain from unexpected medical issues while you’re seeking your next opportunity.
The bottom line: Whether you’re self-employed, retired early, working part-time, or between jobs, private coverage can help protect both your health and your wallet.
When is individual health insurance not worth it?
Private health insurance can be a smart safety net, but it may not be necessary if you already have comprehensive coverage or don’t spend enough on health care to justify the cost of an individual plan. For some Canadians, the coverage they already get through work or their provincial plan is enough, and adding another policy means paying for benefits they may never use.
Knowing when insurance isn’t worth it can save you from spending on premiums that don’t actually improve your healthcare access.
- You already have strong workplace benefits: Some employers provide group benefits that cover prescription drugs, dental, vision, and paramedical services. You may not need additional healthcare coverage if your employer-sponsored benefits offer a good amount of coverage.
- You’re covered by extra public healthcare programs: Eligible seniors, children, and individuals from lower-income households may have access to enough prescription and dental coverage through provincial or federal programs. But keep in mind that you may miss out on other types of private healthcare benefits that aren’t covered by public programs (e.g., vision care, mental health services, paramedical care).
- You rarely use healthcare services: The cost of a policy may outweigh the benefits you’d actually use if you’re young, healthy, and don’t anticipate needing more than basic government-covered medical care. But some healthcare needs may be unexpected, so it’s best to consider your situation before making a decision.
Coverage may not seem urgent if you have minimal healthcare needs at the moment, but having individual health and dental insurance can help you stay prepared if circumstances change.
How much does individual health insurance cost in Canada?
The cost of health insurance for individuals in Canada varies widely based on factors such as age, health status, coverage level, and the insurer. On average, a well-rounded health insurance plan for an individual can cost between $100 to $200 per month.
But take note that this is just a ballpark range; the cost of your health insurance policy will depend on many factors. To give you a better idea of the cost of personal health insurance coverage, we’ve pulled monthly rates for PolicyMe’s Guaranteed Issue Classic health insurance plan for each province, for applicants in four different age groups.
What impacts your individual health insurance costs?
Understanding what influences the cost of individual health insurance in Canada can help you make more informed decisions when selecting a plan.
Several key factors play a part to determine the premiums you'll pay:
Age
- Younger individuals: Generally, younger people pay lower premiums because they are less likely to have significant health issues.
- Older individuals: Premiums increase with age as the likelihood of requiring medical care rises. You may only be eligible for guaranteed acceptance plans.
Coverage level
- Basic plans: These offer essential coverage and have lower premiums but may require higher out-of-pocket costs for services not covered.
- Comprehensive plans: Higher premiums, but they cover a broader range of services, including dental, vision, prescription drugs, and specialist treatments.
Province
- Programs and regulations: Public healthcare coverage varies from province to province, so your private insurance rates will depend on the amount of coverage you need to supplement your provincial health plan.
- Healthcare service costs: The cost of services like physiotherapy and dental services can vary by province. This means average claims can be more expensive in certain regions, resulting in higher premiums.
Insurance provider
- Reputation and market share: Larger, well-established health insurance companies might offer competitive rates due to their broad customer base and financial stability.
- Customer service and claims process: Insurers known for their excellent customer service and smooth claims process may charge slightly higher premiums for the added value they provide.
How to choose the best individual health insurance plan
To choose the best individual health insurance plan for your needs, take the following steps:
- Take stock of your current benefits: You may have access to health or dental insurance coverage through the province, the federal government, or your/your partner’s workplace that you’re not taking full advantage of. Review all eligible programs before moving towards an individual plan.
- Identify any predictable healthcare increases: Maybe you’re planning to start a family, or maybe you’ve been getting more frequent warnings from your dentist. If you feel it’s possible that your healthcare expenses will increase significantly in coming years, take that into account when comparing plans.
- Calculate your current coverage gap: Add up the total cost of routine out-of-pocket healthcare expenses you’ve incurred in the last year—anything from chiropractic visits to dental cleanings and eye exams—and divide the total by 12. That’s the maximum you should pay for any individual health insurance plan.
- Estimate the size of existing safety nets: How much do you currently have in savings—and how much could you comfortably pull out to deal with an unexpected healthcare bill that’s not covered by public health insurance?
- Compare plans: Each Canadian health insurance company has a range of individual and family healthcare plans, each with different coverage types, limits, reimbursement rates, exclusions, deductibles, out-of-pocket maximums, and more. Compare each plan with your analysis of your actual healthcare usage.
- Consider additional coverage: If you’re buying individual healthcare because you don’t have workplace benefits, take a moment to consider whether you also need common job benefits like critical illness insurance, disability insurance, or life insurance.
- Request quotes: Once you’ve found at least a few plans that meet your needs, request health insurance quotes from each company and compare the results.
You can conduct your health insurance needs assessment on your own or work with a licensed insurance advisor from PolicyMe for expert insights with no pressure to buy.
“One of the biggest mistakes someone can make when buying individual health insurance is moving forward with a plan they think will work best for them instead of reaching out to a PolicyMe advisor to check if they can get a more suitable plan at a better price.” —Jeremy Burbano, Licensed Insurance Advisor
FAQs: Individual health insurance in Canada
Helene Fleischer is Content Marketing Manager at PolicyMe, with 9 years in content marketing and 4 in Canada’s insurance industry. She works with skilled writers and licensed insurance advisors to create useful resources that help Canadians navigate insurance decisions with confidence and clarity.
Helene Fleischer is Content Marketing Manager at PolicyMe, with 9 years in content marketing and 4 in Canada’s insurance industry. She works with skilled writers and licensed insurance advisors to create useful resources that help Canadians navigate insurance decisions with confidence and clarity.
Prices listed on this page are based on information available as of March 2026. The prices shown are for general reference only and may vary based on factors like your age, location, and product selection.