Individual Health Insurance in Canada, Explained Simply (2025)

What is individual health insurance? 

Individual health insurance, also known as personal or private health insurance, is coverage you buy on your own rather than through a workplace or group plan. It's often a great choice for individuals who want coverage for health needs that aren’t supported by government healthcare, 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 healthcare as the strong, solid foundation of your house, while individual health insurance is the furniture and finishes that make it livable. You can choose a plan based on what matters most to you, whether that's affordability, benefits, or both. 

It’s no surprise that so many Canadians feel uneasy without health coverage. In fact, 49% would choose benefits over a pay bump. If you’re part-time, between jobs, or retired early, that gap in coverage can feel huge, and individual health insurance can help fill it. It's a flexible way to manage healthcare costs and stay protected when you don’t have group benefits.

“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 healthcare

Canada’s universal healthcare coverage is 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 goes beyond where they come from, and lies in what they cover.

Some Canadians may qualify for government-provided income-based or age-based programs, like the CDCP, or provincial drug coverage for seniors, low-income families, or children. But these programs have eligibility requirements that leave tons of people 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.

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Who needs individual health insurance in Canada? 

Not everyone in Canada has workplace benefits or qualifies for public programs, and that’s where individual health insurance can make a real difference.

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 $1321 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.

Whether you’re self-employed, retired early, working part-time, or between jobs, private coverage can help protect both your health and your wallet. But it’s not a one-size-fits-all decision, for example, even someone with workplace benefits might choose extra coverage if their plan doesn’t meet all their needs.

When is individual health insurance not worth it? 

Private health insurance can be a smart safety net, but it’s not always the best use of your money. 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.
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• 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.

Remember: Health needs can change

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, like losing workplace benefits or developing new medical concerns.

How much is health insurance for individuals?

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 basic health insurance plan for an individual can cost between $50 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 starting rates from PolicyMe’s Economic health insurance plans for each province, for applicants aged 21 to 44.

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.

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, which can result 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 save on individual health insurance

Individual health insurance can help you avoid out-of-pocket costs for planned and unplanned healthcare expenses, and you can save even more by choosing the right plan.

Here’s how to keep health insurance affordable, without sacrificing what matters:

1. Only pay for what you’ll actually use
When picking your individual healthcare coverage, stick to the core benefits you need and will actually use, whether that’s prescriptions, dental, vision, or paramedical coverage. You can adjust your coverage if your needs change, so it's best to simply start with what you need now.

2. Compare multiple plans side by side
Use comparison tools to review health insurance quotes and check what different providers include at each price point. Two $75 plans can have very different coverage, so comparing can help you find a plan with the most value.

3. Choose a higher deductible if you’re healthy
A higher out-of-pocket coverage limit usually means lower monthly premiums. This can be a smart trade-off if you rarely visit the doctor.

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Bottom line

The key is to balance cost with actual value. Paying less feels good, but make sure your plan covers what you truly need!

Questions to ask before buying individual health insurance

Before buying, you’ll want to be sure your health insurance plan meets your needs and fits within your budget. Here’s a practical checklist to help you make the best choice:
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• What coverage do I need and what does the plan cover? The plan should cover any healthcare needs that are currently unsupported, so be sure to assess your coverage needs and look for plans that meet them.
• Do I already have coverage for any of the plan’s benefits? You may already have coverage through group benefits, your spouse's plan, or from the government. Compare existing coverage side by side with the individual plan to avoid duplicates.
• Are there annual or lifetime maximums? Most insurance companies set coverage limits for each healthcare service, so it’s essential to confirm these limits and ensure they provide enough support. For example, if you estimate you’ll need around $1,000 per year in physiotherapy care, you’ll want a plan that has a similar paramedical coverage limit. 
• What are the waiting periods for claims? Some companies have waiting periods before certain benefits are available, which can range from 30 days to 12 months, depending on the type of service. Verify the waiting periods for all services to ensure you can file a claim for the care you need at the time you might need it.
• What out-of-pocket costs should I expect? Confirm the deductibles, co-pays, or coinsurance that apply before or after claim reimbursement.
• What’s the monthly premium? Your health insurance premium should align with your budget, so you may need to compare rates from different providers to find the right price point and coverage levels that suit your needs.
• Is the provider reputable and easy to work with? Take a look at customer reviews and research the provider’s support channels and claims process. Some companies, like PolicyMe, offer online policy access, customer service options and digital claims processing, which can be highly convenient when managing your policy.

“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 an PolicyMe advisor to check if they can get a more suitable plan at a better price.”  – Jeremy Burbano, Licensed Insurance Advisor

FAQs: Health insurance for individuals in Canada