A Guide to Supplemental Health Benefits in Canada
Many Canadians are feeling the financial pressure of rising healthcare costs, and it’s changing how often people seek care. Recent data shows that 56% of Canadians have delayed or skipped a medical appointment because of cost, with dental visits leading the list. Even those with coverage are struggling: 52% of insured Canadians say they still put off care due to out-of-pocket expenses.
Supplemental health benefits provide extra coverage for services that provincial plans don’t fully cover, including dental care, prescriptions, paramedical services, mental health care, and more. Here’s what supplemental insurance actually covers, how it works, and how to decide if it’s worth it for your budget.
What are supplemental health benefits?
Supplemental health benefits are insurance plans that cover medical care that is not covered, or only partially covered, by provincial healthcare insurance. They’re designed to reduce costs for everyday healthcare needs.
Supplemental health benefits vary by eligibility, province, and enrolment rules. Coverage levels depend on what the insurer considers eligible expenses, which may include eyeglasses, contact lenses, dental treatment, and other medical services not covered under provincial medicare. Some plans include services from specialists, like podiatrists, and for services like prostheses and mobility aids. Many plans include a co-payment or coinsurance—especially for prescriptions and paramedical care.
With more than half of Canadians delaying care due to cost, supplemental coverage is increasingly important in helping households manage rising medical expenses.
What gaps do provincial and employer plans leave?
Even with Canada’s universal healthcare system, many essential health services fall outside of provincial coverage. That leaves Canadians and their loved ones paying out of pocket unless they have supplemental insurance.
Provincial plan limitations
Most public plans cover medically necessary doctor visits and hospital care, but very little beyond that. The biggest gaps include:
- Dental care
- Prescription drug
- Vision care
- Paramedical services
- Medical equipment
These gaps contribute to the rising personal cost burden, with 29% of Canadians spending more than $1,000 out of pocket for these types of services last year.
Employer plan limitations
Employee benefits programs vary depending on the plan coverage. For some people, employer benefits plans simply aren’t sufficient to cover needed health expenses:
- Low annual maximums: Many work plans cap dental, vision, or paramedical coverage at just a few hundred dollars per year, which can get used up quickly.
- Exclusions and waiting periods: Plans may exclude major dental services, limit mental health coverage (if any), or restrict the number of visits per year for certain types of care.
- Non-portability: Your benefits plan will end if you change jobs, get laid off, or retire.
What do supplemental health benefits typically cover?
Coverage varies by the plan tier you choose, but most supplemental health plans include dental prescriptions, vision, paramedical care, and medical supplies. Here’s a breakdown:
Who needs supplemental health benefits?
Supplemental health benefits are especially useful for Canadians who don’t have stable workplace coverage or who face recurring out-of-pocket healthcare costs. You may want to consider a plan if you fall into one of these groups:
- Retirees losing employer coverage and suddenly responsible for dental, vision, and prescriptions out of pocket
- Gen Z aging off parental plans, often becoming uninsured at a time when costs are rising
- Families with regular dental, vision, or prescription needs, who face predictable annual expenses
- Gig workers, freelancers, and self-employed Canadians without access to workplace benefits
- People expecting major dental or health expenses, such as orthodontics, crowns, glasses, or physiotherapy
Supplemental coverage helps reduce these costs and provides more predictable healthcare spending for households that would otherwise pay entirely out of pocket.
How much do supplemental health benefits cost?
The cost of supplemental health benefits varies widely depending on your age, province, health care services needs, and the level of coverage you choose. Canadians can expect plans to range from basic, affordable coverage focused on essentials (such as prescription medications or vision care) to more comprehensive plans that offer dental benefits and paramedical services and have higher maximums.
Here are PolicyMe’s average costs for Canadians aged 21-44 across the country:
*Prices may vary
Premiums vs. payouts: what you’re actually paying for
Premiums represent your fixed monthly cost, while payouts depend on how often you use your plan. If you have recurring expenses, like prescriptions, a mid- or high-tier plan may pay for itself quickly. For users with fewer care needs, a basic or prescription-only plan may be more than enough.
Understanding coinsurance, deductibles, and annual maximums
- Coinsurance: The percentage that your plan covers (for example, 80% of a dental cleaning).
- Deductible: The actual amount you’ll pay out of pocket before coverage starts.
- Annual maximums: The maximum amount your plan will pay for. These are usually categorical, for example, $500 per year for massage therapy. Your plan will have more than one annual maximum to look out for.
Together, these mechanics determine how much financial value you actually get out of your plan, even if your premiums look low.
How to choose a good health insurance plan without overspending
The biggest thing to keep in mind is your real healthcare usage. The highest-tier plans may look nice, but are you actually going to need the services they offer? A cost-effective plan is one where the benefits you expect to claim each year are equal to or greater than your annual premium.
Consider:
- Your typical yearly dental, vision, and prescription spending
- Whether you need major dental services, or expect to need them in the next year
- How often you use paramedical services like massage therapy, physiotherapy, chiropractic, acupuncture, etc.
- Whether a lower premium with smaller maximums fits your needs
Choosing the right plan means balancing coverage and cost, so you’re protected without paying for services you won’t use.
Is supplemental health insurance worth it?
Deciding whether supplemental health insurance is worth it comes down to comparing your likely out-of-pocket costs against the cost of coverage. Will you get value out of your plan, or will the costs of the plan outweigh your costs for health and dental care?
The data shows that many Canadians face significant financial and access gaps in health care. For example, 56% of Canadians have delayed or skipped a health appointment due to cost, and 29% of Canadians spent over $1,000 out of pocket on health or dental services in the past year.
When you expect regular or major health expenses, supplemental insurance can deliver clear value.
Alex, a 34-year-old who gets regular dental care and occasional paramedical treatments, is considering a standard health plan at $80/month. Alex’s normal yearly health care spending looks like this:
- Two dental cleanings and a filling: $800
- New glasses every couple of years: $250/year
- A handful of massage therapy sessions: $400
Total annual spend: $1,450
With a plan that reimburses 80% of these services, Alex would get $1,160 in claim payouts. His annual premiums total $960.
Alex’s plan covers more than it costs for the services he uses regularly, and he’s protected from bigger bills if something unexpected happens (like a crown or physio after an injury).
How to choose the right supplemental coverage
A good plan should reduce predictable expenses and protect you from major costs, without loading you with premiums for services you’ll never use. Consider this:
- Start with your current spending: List what you typically pay for each year. If those costs add up to a few hundred dollars or more, a plan with dental and vision may be worth it.
- Factor in future needs: Consider expenses over the next 1–3 years. Planning ahead helps you choose the right tier, avoiding the need to upgrade later at a higher cost.
- Routine vs. “just in case” coverage: Are you looking at plans for regular use, or for protection in emergencies? Routine users may get more value out of a higher-tier plan.
- Evaluate plan limitations: Look at what the plan doesn’t cover or where limits apply. Are you covered where you need it?
From there, it’s just a matter of making sure your coverage aligns with your actual use. If you rarely visit the dentist or don’t need vision or paramedical support, you may not need a higher-tier plan. If you have dependable, recurring expenses, higher-tier plans may save you money.
FAQs
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 October 2025. The prices shown are for general reference only and may vary based on factors like your age, location, and product selection.