People new to self-employment are often surprised by how much of routine healthcare they now pay for directly. Provincial plans cover physician and hospital care — a great deal — but a substantial category of everyday costs sits outside them.
What provincial coverage leaves out
- Prescription medication outside hospital, for most adults under 65
- Dental care, from cleanings to major work
- Vision — eye exams for many adults, and glasses or contacts
- Paramedical services — physiotherapy, chiropractic, massage, psychology
- Ambulance fees, in many provinces
- Medical devices — braces, hearing aids, mobility equipment
- Private or semi-private hospital rooms
For a healthy single person these may total little. For a family with children, orthodontics, prescriptions and a couple of physio courses a year, they add up to real money.
How individual plans work
Individual health and dental plans are structured differently from group coverage, and the differences matter.
Annual maximums per category — a dental maximum, a paramedical maximum per practitioner type, a vision allowance every two years. These are typically lower than comparable group plans.
Co-insurance — plans often cover a percentage rather than the full cost, commonly 70–80% for basic services and less for major dental.
Waiting periods — particularly for major dental. It is common to wait a year before crowns or orthodontics are covered, which prevents people buying a plan the week before expensive work.
Underwriting — some plans ask health questions and may exclude pre-existing conditions. Others are guaranteed-issue with lower limits. If you have ongoing prescription needs, read this section carefully, because a plan that excludes your existing medication is of limited use.
The honest question: is it worth it?
I will not pretend the answer is always yes.
Individual health and dental plans are priced so the insurer expects to collect more than it pays out — that is how insurance works. For someone with predictable, modest costs, self-insuring by setting money aside can be the better financial choice.
The case for a plan is stronger when:
- You have ongoing prescription costs, which can be substantial and recurring
- You have children, particularly with orthodontics ahead
- You use paramedical services regularly for a chronic issue
- You want budget predictability rather than lumpy annual costs
- You are concerned about a high-cost drug, where catastrophic coverage matters
The case is weaker for a healthy single person with no regular prescriptions, no dental problems and a decent emergency fund. For them, a dedicated savings buffer may genuinely be better value.
Most provinces have programmes covering high drug costs relative to income, or specific coverage for seniors and certain conditions. These are not always well publicised. Confirm what you already qualify for before buying private coverage to fill a gap that may be partly filled already.
The incorporated business option
If you operate through a corporation, ask your accountant about a Health Spending Account. Rather than buying an insurance plan, the corporation reimburses eligible medical expenses, generally as a deductible business expense, and the benefit is typically non-taxable to you.
For an incorporated business owner with predictable medical costs, this is often more efficient than a traditional plan, because you are converting after-tax personal spending into a deductible business expense rather than paying premiums for pooled risk. It suits routine costs better than catastrophic ones — some owners pair a Health Spending Account with a high-deductible plan for the large, unlikely events.
What to compare
Do not compare on premium alone. Look at the annual maximum per category against what you actually spend, the co-insurance percentage, the waiting periods for anything you need soon, whether existing conditions and current prescriptions are covered, and whether there is meaningful protection for catastrophic drug costs.
A cheap plan that excludes your prescriptions and caps dental at a low figure may cost more than it returns.
If you want help working out whether a plan makes sense for your actual spending — including the honest answer that it might not — that is a conversation worth having.
