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American vs Canadian Health Insurance – What’s the Difference?

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Last Updated on August 17, 2024 by Alaina

Welcome to your ultimate guide on American vs Canadian Health Insurance! Today, we will break down some of the key differences between healthcare services and insurance in the two countries so you have a better understanding of the funding and accessibility of healthcare across North America.

doctor holding stethoscope

We will look at funding for insurance, private insurance, and healthcare services, and what is covered in both countries. Then, we will explain why it is so essential to have some sort of healthcare insurance. Finally, we will look at different coverage around Canada and supplementary insurance options.

If you are not currently insured, or you would like to switch to a more comprehensive policy, have a look online for the best providers in your area.

American vs Canadian Health Insurance: The Differences

We will start our comparison of American vs Canadian Health Insurance by working through some key differences between the American and Canadian healthcare systems so you have a better understanding of each country’s health insurance and covered services.

You can check out this guide to some of the best health insurance companies in Canada if you would like more specific details about coverage. Remember that some providers are only available in certain provinces of Canada. A travel nurse will be familiar with the healthcare system of both countries, especially compact states nursing.

Funding for Health Insurance

In the US, individuals are required to fund their health insurance, with the exception of citizens who fall into certain income, age, or disability brackets. These individuals can access affordable health care through Medicaid, Medicare, and similar programs. A lot of people access health insurance through their employment, but this is not guaranteed and coverage varies from employer to employer.

Meanwhile, in Canada, the government provides financial support to provincial governments to fund health care insurance. This funding is dependent upon the provincial governments’ compliance with the Canada Health Act (1984). This funding allows all Canadian citizens to access health insurance through the national healthcare system.

Private Healthcare

In the US, both health insurance and healthcare services tend to be private enterprises. This results in competition between private insurance providers to get and retain clients. Private providers offer insurance packages to employers as part of benefits packages for employees, for instance. Healthcare providers compete for customers through areas of medical specialization, quality, and affordability.

In Canada, most healthcare service providers are private, not federal or provincial-funded providers. So, medical experts work independently or are employed by private hospitals to complete their healthcare services. They tend to be paid by billing government health insurance, rather than claims made through private insurers.

man and woman holding hands discussing American vs Canadian Health Insurance

What is Covered

In the US, what is covered by health insurance varies depending on the private insurance policy provided by an employer or that an individual can afford. However, since the Patient Protection and Affordable Care Act (2010), all Americans are required to have basic health insurance coverage. This can be privately provided or provided through an employer.

Moreover, issuers of health insurance must cover at least the essential health benefits, such as, but not limited to emergency services, hospitalization, ambulatory patient services, maternity and newborn care, mental health, and substance use services.

In Canada, the universal healthcare system that is available to all citizens covers services provided by hospitals and medical practitioners or surgical dental services provided in a hospital. Any service beyond this, such as prescriptions, vision care, home care, and long-term care, can be covered by the province, but may not be.

Why You Need to be Insured

It is essential that you have some sort of healthcare coverage regardless of whether you are in the US or Canada. As we have seen, it is a legal requirement to have basic coverage in the US. However, whenever possible, it is recommended to have additional coverage in case you fall ill in the US and need surgeries, medications, or other expensive treatments not covered by basic insurance.

If you are a US citizen and your spouse or parent (if you are under 26) has health insurance through their employer, you might be able to get coverage through them.

While Canadian citizens do have access to free basic healthcare, one of the biggest differences when it comes to American vs Canadian Health Insurance is that there are still many important care services not covered by Canadian insurance.

For instance, if you need special nursing, an ambulance service, a wheelchair, or other durable equipment, this is not covered by universal healthcare in Canada. Moreover, if you suffer a severe illness or injury, private or supplementary health insurance can supplement your income to help you cope with the loss of income and increased medical costs. 

Health Insurance Around Canada

Another difference when it comes to American vs Canadian Health Insurance is that when you sign up for private health insurance in Canada, it will be based in your province. There is an agreement between the provinces and territories of Canada to provide you with certain levels of basic coverage if you are traveling within the country. You should make sure you know what you are covered for if you are traveling within the country, as it will vary. For instance, Quebec participates in this agreement only for hospital fees.

You might want to consider buying travel health insurance in Canada, as well as any additional coverage for specific needs. There is also critical illness insurance that covers issues like Alzheimer’s, cancer, heart attacks, and strokes. Moreover, there is long-term care coverage for seniors or anyone who cannot look after themselves for a period of more than 90 days. Finally, you might require disability insurance.

FInal Thoughts on American vs Canadian Health Insurance

Hopefully, this quick but comprehensive guide to understanding the healthcare systems in the US and Canada has shed some light on the differences between the two countries. We have explored the differences in funding for healthcare in both countries, as well as differences with private healthcare and what is covered for citizens of both countries, depending on their level of coverage.

On top of that, you should now understand the importance of being insured, at least at a basic level to cover emergencies and essential care services. Lastly, we looked at the differences in coverage around Canada and what supplementary insurance you might need. Reach out to an insurance provider today to discuss your coverage if you want to increase it or start paying for private insurance.

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