⚕️ Healthcare & Insurance

Navigating U.S. Healthcare, The Canadian Way.

Healthcare & Insurance Guide for Canadians

Critical Point

US healthcare costs without insurance can be financially catastrophic. A simple ER visit can cost $3,000-15,000+. Coverage is an important consideration.


The Fundamental Difference


Canada

Universal healthcare funded through taxes - most services are "free" at point of care


United States

Private insurance-based system - you pay premiums, deductibles, and co-pays

Employer-Sponsored Insurance (Most Common)
  • How it works: Your employer pays part of the premium, you pay the rest through payroll deduction
  • Typical employee contribution: $200-600/month for individual, $500-1,500/month for family
  • Open enrollment: Usually once per year (often October-December)
  • Coverage starts: Typically first day of employment or after 30-90 day waiting period
Individual/Family Plans (ACA Marketplace)
  • When you need it: Self-employed, unemployed, employer doesn't offer insurance
  • Where to buy: Healthcare.gov or your state's marketplace
  • Open enrollment: November 1 - January 15 (with some state exceptions)
  • Subsidies available: Based on income (up to 400% of federal poverty level)
Short-Term Plans
  • Duration: 3-12 months (some states allow longer)
  • Pros: Cheaper, can start quickly
  • Cons: Limited coverage, don't cover pre-existing conditions
  • Best for: Temporary gaps between other coverage

Term What It Means Typical Amount
Premium Monthly cost to have insurance $300-800/month individual
Deductible Amount you pay before insurance kicks in $1,000-8,000/year
Co-pay Fixed fee for specific services $25-50 doctor visit
Co-insurance Percentage you pay after deductible 10-30% of costs
Out-of-pocket maximum Most you'll pay in a year $3,000-15,000
Example: How It All Works Together
  • Monthly premium: $400
  • Annual deductible: $3,000
  • Doctor visit co-pay: $35
  • Co-insurance: 20%
  • Out-of-pocket max: $8,000

Scenario: You need surgery costing $20,000

  1. You pay the first $3,000 (deductible)
  2. Insurance pays 80% of remaining $17,000 = $13,600
  3. You pay 20% of remaining $17,000 = $3,400
  4. Total you pay: $6,400 + your monthly premiums

Don't Rely on Provincial Coverage Alone

While some provincial plans provide emergency coverage in the US, it's often limited and may not cover the full cost of US healthcare. You could still face thousands in out-of-pocket expenses.


Travel Insurance Options
Single Trip Insurance
  • Cost: $50-200 depending on age, length of stay
  • Coverage: $1-5 million medical emergency
  • Best for: Vacations, short business trips

Annual Multi-Trip
  • Cost: $200-800/year
  • Coverage: Multiple trips up to certain days each
  • Best for: Frequent travelers, snowbirds

For Snowbirds (Long-term Visitors)
  • Extended stay policies: Coverage for 6+ months in the US
  • Provincial requirements: Check your province's rules on maintaining coverage while away
  • Pre-existing conditions: Declare all conditions - coverage may be excluded if not disclosed
  • Tip: Buy insurance before leaving Canada, not after you arrive in the US

What Travel Insurance Typically Covers
Usually Covered
  • Emergency room visits
  • Hospitalization
  • Emergency surgery
  • Ambulance services
  • Emergency prescription drugs
  • Emergency dental (limited)
  • Medical evacuation to Canada

Usually NOT Covered
  • Pre-existing conditions (unless stable)
  • Routine check-ups
  • Pregnancy-related care
  • Mental health treatment
  • High-risk activities
  • Treatment you traveled to receive
  • Prescription refills for chronic conditions

Before You Travel
  1. Contact your provincial health plan to understand your coverage limits
  2. Get travel insurance quotes from multiple providers (CAA, Blue Cross, etc.)
  3. Bring medication in original containers with prescriptions
  4. Carry both cards: Provincial health card AND travel insurance card
  5. Know your policy details: Coverage limits, deductibles, claim procedures

If You Need Medical Care While Visiting
Step-by-Step Process:
  1. For emergencies: Go to ER immediately, worry about payment later
  2. Call your insurance company: Many have 24/7 hotlines for pre-approval
  3. Show both cards: Provincial health card and travel insurance
  4. Keep all receipts: You may need to pay upfront and get reimbursed
  5. Get documentation: Medical reports, itemized bills for claims
Understanding Costs as a Visitor
Service Typical US Cost What You Might Pay
ER Visit (minor) $1,500-3,000 $0-500 (with insurance)
Urgent Care $300-800 $0-200 (with insurance)
Ambulance $1,000-2,000 Usually covered
Hospital Stay (per day) $3,000-10,000 Usually covered
Prescription (brand name) $200-500+ $20-100 (with insurance)
Money-Saving Tips for Visitors
  • Urgent Care vs ER: Use urgent care for non-life-threatening issues
  • Walk-in clinics: Often found in pharmacies (CVS, Walgreens)
  • Telemedicine: Some travel insurance covers virtual consultations
  • Generic drugs: Ask for generic versions of prescriptions
  • GoodRx: Use this app for prescription discounts if paying out-of-pocket

Network Coverage
  • In-network: Doctors/hospitals contracted with your insurance (cheaper)
  • Out-of-network: Higher costs, sometimes not covered at all
  • Tip: Check if your preferred doctors accept the plan before enrolling
Plan Types
  • HMO: Cheaper, need referrals for specialists, limited to network
  • PPO: More expensive, more flexibility, can see out-of-network providers
  • HDHP: High-deductible plans, often paired with Health Savings Accounts (HSAs)
Prescription Drug Coverage
  • Formulary: List of covered medications
  • Tiers: Generic (cheapest) to specialty drugs (most expensive)
  • Prior authorization: Some drugs need insurance approval first

Before You Need Care
  1. Get insurance immediately - don't wait
  2. Find a primary care doctor within your network
  3. Understand your benefits - read the summary of benefits
  4. Download your insurance app for digital ID cards
When You Need Care
  1. Always show insurance card first
  2. Ask about costs upfront - it's normal and expected
  3. Get referrals when required (HMO plans)
  4. Keep all receipts for tax deductions/HSA reimbursements
Common Mistakes to Avoid
  • Going to out-of-network providers without checking costs
  • Not getting pre-authorization for procedures when required
  • Assuming "urgent care" is the same as Canadian walk-in clinics
  • Not understanding that ambulance rides can cost $1,000+

Medical Emergency
  1. Call 911 - don't worry about cost in life-threatening situations
  2. Go to nearest ER - they must treat you regardless of insurance
  3. Bring insurance card and ID
  4. Contact insurance company within 24-48 hours
Lost in the US Healthcare System
  • Patient advocate: Many hospitals have them to help navigate
  • Insurance customer service: Use the number on your card
  • Billing department: Can often set up payment plans
If You Can't Afford Care
  • Community health centers: Federally qualified centers with sliding scale fees
  • Hospital charity care: Most hospitals required to offer financial assistance
  • Prescription assistance: Many drug companies offer patient assistance programs
  • GoodRx: App for prescription drug discounts
Important Disclaimer: Healthcare and insurance regulations change frequently and vary by state. This guide provides general information only. Always verify current requirements and consult with qualified professionals for advice specific to your situation and location.