Earlier this year, I wrote about our early retirement healthcare options in Canada, specifically options for extended health care in early retirement. The research behind that article took a while and I thought the data was quite interesting.
If you’re like me, you probably haven’t really thought about healthcare in early retirement until you get closer to this major milestone, because you just assume that, as a Canadian, universal healthcare is there to cover everything.
But that’s not the reality. Although our universal healthcare covers big expenses like doctor visits, surgery, hospital stays, specialized treatments, it doesn’t cover things like dental, prescription, physio, and vision. These “extra” treatments are usually covered by extended healthcare, which I discussed in my previous article on early retirement options.
Despite having universal healthcare, I believe it’s still important to keep in mind all the different provincial rules and benefits. My previous article primarily focused on BC, so I want to compare early retirement healthcare options in each province. Furthermore, I want to explore options like moving provinces to lower your cost of living, and what if you decided to live abroad most of the year… What happens to your healthcare coverage?
Let’s find out.
Many years ago, it was true that you paid for provincial health coverage. But fast-forward to today, that’s no longer true in most provinces.
Here in BC, the government eliminated the MSP (medical service plan) premium back on January 1, 2020. The BC provincial healthcare is now funded through tax revenues. Similarly, Alberta got rid of the health premium in 2009. If you look across Canada, most provinces have removed the provincial healthcare premiums and provincial healthcare is now funded through general tax revenues.
But the two big Canadian provinces still charge premiums.
Ontario charges an Ontario Health Premium, collected through your income tax return and it is based on your income. If your taxable income is under $20,000, you do not have to pay anything. The premium scales up $0 to a maximum of $900 per year for high-income earners.
Quebec doesn’t charge a health premium, but it does have a mandatory prescription drug arrangement. The fee is collected at tax time if you don’t have private drug coverage.
So yes, for the most part, you don’t have to pay the monthly provincial health premiums anymore. Instead, you are paying via provincial income tax or other provincial taxes.
The gaps that universal healthcare doesn’t cover
The universal healthcare we have in Canada covers many things, especially the big expenses, but it doesn’t cover everything. Our universal healthcare falls short on the following:
- Prescription drugs
- Dental care
- Vison
- Paramedical services like physio, massage, chiropractor, counselling, etc
- Out-of-country medical care
For these expenses, early retirees typically rely on either private extended healthcare plans, self-insurance for these expenses, or some level of government assistance.
Government-assisted plans for dental & prescription
Prescription drugs can be quite costly, but two provinces have programs to help with that.
Here in BC, the Fair PharmaCare program covers prescription drugs with a deductible based on your family’s net income from two years ago. You have to pay a deductible first, then Fair PharmaCare covers 70% (or 75% if someone in your family was born before 1940). Once you hit the family maximum, Fair PharmaCare pays 100% of the eligible costs for the rest of the year. You can find the family deductible amount here. For early retirees in BC who need prescription drugs, the Fair PharmaCare program can be a good option.
In Quebec, prescription drug insurance is mandatory. So if you have access to a private plan, you must take it. If you don’t have a private plan, you are automatically enrolled and covered by the public plan. This public plan has a premium that’s income-based via your tax return. Interestingly, Quebec is the only Canadian province that legally requires you to have prescription drug insurance.
Outside of BC and Quebec, prescription drug coverage for early retirees is limited. The provincial prescription drug coverage is typically aimed at seniors and people with specific conditions. Below is the summary for the different provinces:
- BC: Fair PharmaCare. Your deductible and family maximum are calculated from your net income. Lower-income households (including many seniors) have low or zero deductibles.
- Alberta: Albertans 65+ have premium-free coverage for prescription drugs on the Alberta Drug Benefit list, administered by Alberta Blue Cross. The copayment is 30% to a maximum of $35. Outpatient cancer therapy and palliative-care patients have separate, copay-free or specialized coverage.
- Saskatchewan: eligible seniors 65 and older pay $25 per prescription under the Seniors’ Drug Plan. To qualify, your net income must be $79,487 or less on your 2024 income tax return to be eligible for 2026. There is also coverage for palliative-care drugs and long term disability and illnesses.
- Manitoba: Manitoba Pharmacare provides drug assistance to eligible Manitobans via an income-based deductible. Once your spending hits the deductible, the program covers eligible drugs. The Manitoba Enhanced Pharmacare Program covers most medications for residents with certain conditions who aren’t covered through other public programs.
- Ontario: 65+ Ontario residents automatically qualify for the Ontario Drug Benefit program. Lower-income seniors can apply for the Seniors Co-Payment program, under which recipients pay no annual deductible and co-payment of $2 or less. The Trillium Drug Program supports lower and modest-income people by covering about 5,000 drugs plus about 1,000 more drugs through the Exceptional Access Program. You pay up to $2 per prescription. The deductible is capped at roughly 4% of household income. (Note, my additional research showed it may actually be more complicated. There’s a $100 annual deductible (Aug-Aug) after which most drugs on Trillium are covered fully, except for the $4.11 dispensing fee).
- Quebec: universal/mandatory. Seniors automatically register for the public plan at 65, and many low-income seniors pay a reduced or zero premium.
- Nova Scotia: the seniors’ Pharmacare program is open to residents 65+ with a valid health card who don’t have other drug coverage. Members pay an income-based annual premium plus an annual copayment, both with maximums, with the province covering the rest. Separate coverage exists for cancer patients and palliative care.
- New Brunswick: The Prescription Drug Program covers low-income families and seniors.
- Prince Edward Island: all eligible residents are automatically enrolled in the seniors’ drug plan the month they turn 65. The Family Health Benefit Drug Program and Financial Assistance Drug Program are available for low-income residents and families.
- Newfoundland & Labrador: the 65Plus Plan covers residents 65 and older who receive Old Age Security and the Guaranteed Income Supplement. The Foundation Plan and the Access Plan cover low-income individuals and families.
So if you’re an early retiree and not yet 65 or older, you probably need to self-cover prescription drugs.
Dental care can be another big expense for families. Fortunately, as of 2026, the Canadian Dental Care Plan (CDCP) is available to eligible Canadian residents regardless of age, as long as your adjusted family net income is under $90,000 and you don’t have access to private dental insurance. For households under $70,000 net income, you will get full coverage with no co-pay. Between $70k and $90k, you get partial coverage. Therefore, for an early retiree without a group plan and a modest reported income, the CDCP may be able to cover dental care.
Out-of-country coverage: very important to consider
Many retirees will want to travel for an extended period, sometimes outside Canada. This begs the question: What should you do for out-of-country health coverage?
The provincial plan does cover emergency medical care outside Canada, but only at the rates it would pay in your home province. This may sound reasonable, but the reality is that many healthcare costs are way more expensive than in Canada (i.e. the US). I have heard someone not wanting to go to the emergency room in the US and driving back to Canada to get treatment, because of the outrageous US cost (and they didn’t have travel health insurance).
This is why, if you are travelling outside of Canada, it is critical to get travel insurance, regardless of your health conditions. It’s better to be safe than sorry.
Fortunately, many premium credit cards have travel insurance benefits. For example, TD Infinite Visa has a $2 million travel medical insurance for the first 21 days for holders 65 and under. Unfortunately, if you’re 65 or older, these credit card travel insurance benefits drop significantly. In TD Infinite Visa’s case, the coverage drops to four days. Based on my research, if you are 65+, the best credit cards for travel insurance are the National Bank World Elite Mastercard and Desjardin Odyssey Visa Infinite Privilege (15 days up for seniors aged 65-75). The Scotiabank Platinum American Express and Scotiabank Gold American Express cards also offer 10 days of travel insurance for seniors 65 and older.
Since many early retirees go for extended trips longer than 21 days, it is better not to completely rely on credit card coverage and get travel insurance. The cost of the travel medical insurance will depend on your age, duration, coverage tier, pre-existing conditions and deductible. For the most part, these travel insurances are quite cost-effective (anywhere from $70 to $500 based on my research).
Keep in mind the three-month gap
If you decide to move to another province to reduce your cost of living, you need to keep in mind the three-month requirement.
Provinces typically have a waiting period of up to three months before the “new” provincial health coverage kicks in. During that window, you will need to rely on your “old” province to continue to cover you. Basically, you need to make sure you register promptly once you settle in the new province so you don’t end up with no health coverage for a brief period.
Similarly, if you go out of the country for an extended time (i.e. more than six months), you are no longer eligible for provincial health coverage, so you will need to cover yourself via health insurance.
A province-by-province health coverage snapshot for early retirees
Here’s a simplified comparison of health coverage for the different provinces.
| Province | Health Premium | Adult drug coverage | Important notes for drug coverage |
| BC | None | Fair PharmaCare, income based deductible | Low income = low deductible. Beneficial for early retirees |
| Alberta | None | Limited for <65 | Need to plan to self cover drug/dental |
| Saskatchewan | None | Limted for <65, some income based help | Need to plan to self cover drug/dental |
| Manitoba | None | Income based Pharmacare deductible | Deducible scales with income. Beneficial for early retirees |
| Ontario | Income-based (max $900/yr premium) | Limited for <65 | Premium is low/zero with low/modest income |
| Quebec | None (has drug premium) | Mandatory drug coverage, public or private | Must have coverage legally |
| Atlantic provinces | None | Varies, typically limited for <65 | Please double check for provincial specifics |
How should you plan for healthcare as an early retiree?
As a Canadian, I’m very grateful that planning for healthcare in early retirement is not as difficult as in the US. But just because it’s easier, it doesn’t mean you shouldn’t have any plans.
If you’re planning for early retirement, I believe these are the steps you should take (something we’re doing as well):
- Keep track of your annual health expenses. This includes prescriptions, dental care cost, vision exams, glasses & contacts, and paramedical like physio, massage, chiropractors, acupuncture, and counselling.
- Categorize these annual health expenses. Which ones are recurring or regular expenses and which ones are one-time expenses? This will give you an idea of what kind of health expenses you may have in retirement.
- Estimate and simulate your retirement income, then check whether you qualify for the provincial prescription drug program (i.e. Fair PharmaCare) and the Canadian Dental Care Plan.
- If you don’t, consider budgeting money to self-insure these health expenses. Alternatively, you may want to buy private health plans. Since healthcare varies person to person, there’s no right or wrong answer here. Private healthcare plans may be more expensive in the long run but do offer predictability and peace of mind. On the other hand, self-funding is often cheaper in the long run if you’re reasonably healthy.
If you’re travelling out of the country for an extended period, it is always highly recommended to get travel insurance beforehand.
I hope this article provides some insight into early retirement healthcare in Canada and your options in the different provinces. What’s encouraging is that if your net income is low or modest in early retirement, you can qualify for provincial or federal assisted health programs, making healthcare planning in early retirement easier.
I’d love to hear from you on your thoughts. Have you looked into what your province covers? For those of you who are already retired or close to it, are you using private health insurance? Or are you self-covering? Let me know in the comments section.
