Insurance Tips

Understanding Health Insurance Deductibles and Copayments in Canada

Getting health insurance is a vital aspect of ensuring financial security and access to healthcare services in Canada. Among the key components of health insurance policies are deductibles and copayments, which play crucial roles in determining how you share the costs of medical care with your insurance providers. Understanding the nuances of Canadian health insurance deductibles and copays is essential for making informed decisions about coverage options and managing healthcare expenses. In this article, we will delve into the intricacies of these health insurance components, providing all the information you need to choose the right insurance plan.

What Are Deductibles?

Health insurance deductibles are the amount of money you have to pay out of your own pocket for covered healthcare services before your insurance kicks in to cover the remaining costs. In simpler terms, it’s like a threshold or a starting point for your insurance coverage.

Let’s break it down with an example:

Imagine you have a health insurance plan with a $1,000 deductible. This means that you are responsible for paying the first $1,000 of your medical expenses before your insurance starts contributing.

You visit the doctor, you receive a bill for $200. Since you haven’t reached your deductible yet, you have to pay the full $200 out of your own pocket. Later, you need additional medical services, and the total cost is now $800. You still haven’t met your $1,000 deductible, so you pay the full $800.

Now, you’ve paid a total of $1,000 in medical expenses, which meets your deductible. The next time you need medical care, let’s say the cost is $500. Since you’ve already met your $1,000 deductible, your insurance will now start covering a portion of the expenses. The amount and percentage covered depend on your specific insurance plan.

So, in this scenario, if your insurance plan covers 80% of the cost after the deductible, you would pay $100 (20% of $500), and your insurance would cover the remaining $400.

Are There Health Insurance in Canada Without Deductibles?

Yes, there are zero-deductible plans that you can opt for if you so wish. With these no deductible health insurance Canada, you do not have to worry about reaching a threshold before your insurer comes in. The company contributes to medical expenses from the onset. However, these zero-deductible plans usually have higher premiums than plans with deductibles.

A premium is the amount of money you pay for your health insurance plan every month whether you use it or not. Typically, plans with higher deductibles have lower premiums while plans with lower deductibles have higher premiums. So, your premium becomes even higher for a zero-deductible plan. Although they may seem like an extra cost, the good thing with premiums in private health services is that they contribute to tax deduction for health insurance Canada.

What Is a Copayment?

A health insurance copayment, or copay, is a fixed amount of money that you pay for a covered healthcare service, and your insurance covers the rest. Unlike a deductible, a copayment is a set fee rather than a percentage of the total cost.

Let’s go through an example to illustrate how copayments work:

Let’s say your health insurance plan has a $30 copayment for doctor visits. You go to the doctor, and the total cost of the visit is $150. Since you have a $30 copayment, you pay $30 out of your own pocket at the time of the visit. Your insurance plan covers the remaining cost after your copayment. In this case, the insurance covers $120 (the remaining $150 – $30). So, with a copayment, you know exactly how much you’ll need to pay for specific services, making it more predictable than a deductible.

It’s important to note that copayments often vary depending on the type of service. For example, your plan might have different copayments for doctor visits, prescription medications, or specialist consultations.

Copayment Vs. Coinsurance

Unlike copayment, coinsurance is the percentage you pay for your health insurance after you have completed your deductible. Assuming you are on an “80/20” plan, it means that your coinsurance is 20% while the insurance company covers 80%. So, if your medical bill is $500, you will pay $100 while the insurer will pay the rest.

While coinsurance has a fixed percentage which may cause you to pay varied amounts depending on the healthcare service you need, copay has fixed amounts for different healthcare services, ensuring predictability.

At the end of the day, Canadian health insurance deductibles and copays as well as coinsurance all count towards your out-of-pocket max Canada. Out-of-pocket max or maximum is the maximum amount of medical expenses you will pay out of your pocket in one year. Once you reach this amount, the insurance company pays 100% of the bills. Keep in mind that premiums do not count towards the out-of-pocket maximum.

Differences Between Deductibles and Copayments in Canada


Deductible: The deductible is the amount you must pay out of your own pocket for covered healthcare services before your insurance starts contributing. It’s usually an annual amount.
Copayment: A copayment is a fixed amount you pay for a specific healthcare service, and your insurance covers the remaining cost. Copayments are set fees, not tied to an annual threshold.

Timing of Payments

Deductible: You pay the deductible first before your insurance starts covering a portion of the costs.
Copayment: You pay the copayment at the time of the healthcare service, and your insurance covers the rest.

Payment Structure

Deductible: It’s often a percentage of the total cost, and you pay the full cost of services until the deductible is met.
Copayment: It’s a fixed amount for specific services, providing more predictability for the individual.

Similarities Between Deductibles and Copayments in Canada


Both deductibles and copayments are mechanisms for sharing the costs of healthcare services between the individual and the insurance provider.

Insurance Coverage Kicks In

In both cases, once you’ve met your deductible or paid the copayment, your insurance starts covering a portion of the costs according to the terms of your plan.

Applicability to Covered Services

Deductibles and copayments apply to covered healthcare services specified in your insurance plan.

Annual Reset

Both Canadian health insurance deductibles and copays are often reset on an annual basis, usually at the beginning of the calendar year.

Frequently Asked Questions (FAQs)

1. Do all health insurance plans in Canada have deductibles?

No, not all plans have deductibles. Some plans may have deductibles for specific services, while others may have none. It’s essential to carefully review the details of your specific insurance policy.

2. Can I choose the amount of my deductible in Canada?

The amount of your deductible is often determined by the specific health insurance plan you choose. Some plans may offer different deductible options, allowing you to select one that aligns with your preferences and budget.

3. Are preventive services subject to deductibles in Canada?

It depends on the insurance plan. Some plans may cover preventive services without requiring you to meet the deductible, while others may include preventive care as part of the deductible. You can compare health insurance plans Canada to find the one that offers what you want.

4. Can I negotiate the terms of deductibles or copayments with my insurance provider in Canada?

Generally, the terms of deductibles and copayments are set by the insurance provider and outlined in the policy. However, it’s advisable to communicate with your insurer and explore available options, especially if you are facing financial challenges.

5. Are copayments common in Canadian health insurance plans?

Yes, copayments are common in Canada, especially for prescription medications, specialist visits, and certain healthcare services. They provide a clear and predictable structure for out-of-pocket costs.

6. How often do deductibles and copayments reset in Canada?

Deductibles and copayments typically reset on an annual basis, usually at the beginning of the calendar year. It’s important to be aware of these reset periods when planning for healthcare expenses.

7. How much is health insurance in Canada?

The cost of health insurance in Canada can vary based on several factors, including the type of coverage, age, location, and the number of individuals covered. Private health insurance in Canada costs about $756 annually or about $63 per month on average. While private or supplemental health insurance for families can average around $4,000 CAD per year.


Understanding the Canadian health insurance deductibles and copays is fundamental for dealing with the broad healthcare coverage system. Informed decision-making empowers you to make the most of your insurance plans. As healthcare needs and financial circumstances vary, the knowledge you gain about deductibles and copayments enables you to select insurance policies that align with your priorities, fostering a balance between affordability and comprehensive coverage.


Sophie is a creative content writer. She loves knitting words together, you can call it writing. She is also a certified Anatomist who is passionate about health and healthy living. She's on this project to share lifestyle tips with our readers.

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