Factors That Influence the Cost of Health Insurance

Factors That Influence the Cost of Health Insurance in Canada
Although the government provides Canadian residents with health insurance, most provincial plans cover only a handful of basic services, leaving individuals with gaps in their coverage. As a result, many people purchase individual health insurance to bridge the gaps. Individual health insurance in Canada typically pays a percentage of the costs associated with covered services. But rates for health insurance vary greatly based on a number of factors.

The factors that influence the cost of health insurance in Canada generally fall into one of two categories – the risk you pose to the insurance provider and the type of plan you choose. Below you will find additional information about the factors that could impact the cost of your health insurance plan.

Medical History

Some health insurance plans offer guaranteed acceptance, which means anyone who applies will be covered under the plan. However, other plans require applicants to complete a health questionnaire and/or get a medical exam before determining whether or not someone is eligible for coverage. In these cases, your medical history could influence the cost of your health insurance plan.

If you have a history of certain medical conditions, you may be required to pay a higher premium than someone without a history of those conditions. Your pre-existing condition may not be covered, and in some cases, you may not qualify for coverage at all. If you already have group health insurance but are losing coverage soon, you may be eligible for some policies without a medical exam or health questionnaire. If this is the case, you must apply for health insurance benefits within 60 days of losing your existing coverage.


The role that your location plays in the cost of your health insurance plan is twofold. First, the cost of medical services varies from province to province. If you live in a place where medical costs are higher than average, your premium will likely be higher, and if you live in a place where costs are lower than average, your premium will be lower. The list of services that are covered in your province of residence will also affect your overall cost of health insurance.

Level of Coverage

While all health and dental insurance plans pay for a portion of the cost associated with covered services, the services that are covered, such as specialist visits, prescriptions, vision care and dental care, and the amount the provider pays, vary greatly from plan to plan. Plans that offer broader coverage have higher premiums than plans that cover fewer services.

Pay close attention to what services will be covered under a plan you choose. Comprehensive coverage that seems more expensive up front may actually be a better value if you end up paying out of pocket for services that are not covered under the seemingly more affordable plan.

Insurance Deductibles and Co-Payments

Most people are familiar with the concept of an insurance deductible as it applies to their auto insurance. You pay a portion of the cost of your services, and your insurance provider picks up the costs that are over and above that amount.

Factors That Influence the Cost of Health Insurance in Canada

A co-payment is the amount you are required to pay for each visit to a healthcare service provider after you have met your deductible. As with deductibles, health insurance plans with higher co-payments tend to have lower premiums, while those with low co-payments have higher premiums.

An Insurance Broker Can Help

If you are having trouble evaluating insurance policies to determine which one best suits the needs of your family, you are not alone. Sometimes it’s a challenge to make an “apples to apples” comparison to find the best value. An insurance broker can help you make sense of it all, and help to ensure you only pay for the coverage you need.

The first step towards choosing the right insurance coverage for the needs of you and your family is a no-obligation quote. You can review all of the available options and clearly see the difference one type of policy or level of coverage can make. Contact us today to get started.


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