Medicare is a term that refers to Canada’s publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans.

Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket.

Roles and responsibilities for health care services are shared between provincial and territorial governments and the federal government.

The provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents.

The federal government is responsible for:

• setting and administering national standards for the health care system through the Canada Health Act
• providing funding support for provincial and territorial health care services
• supporting the delivery for health care services to specific groups
• providing other health-related functions

Canada Health Act

Provincial and territorial health care insurance plans must meet the standards described in the Canada Health Act. This is necessary to get their full payment under the Canada Health Transfer.

These standards include:

• public administration
• comprehensiveness
• universality
• portability
• accessibility

Public administration

The provincial and territorial plans must be administered and operated on a non-profit basis by a public authority.

Comprehensiveness

The provincial and territorial plans must insure all medically necessary services provided by:

• hospitals
• physicians
• dentists, when the service must be performed in a hospital

Medically necessary services are not defined in the Canada Health Act. The provincial and territorial health care insurance plans consult with their respective physician colleges or groups. Together, they decide which services are medically necessary for health care insurance purposes.

If a service is considered medically necessary, the full cost must be covered by the public health care insurance plan.

Universality

The provincial and territorial plans must cover all residents.

Portability

The provincial and territorial plans must cover all residents when they travel within Canada. Limited coverage is also required for travel outside the country.

When a resident moves to another province, they can continue to use their original health care insurance card for 3 months. This gives them enough time to register for the new plan and receive their new health insurance card.

Accessibility

The provincial and territorial plans must provide all residents reasonable* access to medically necessary services. Access must be based on medical need and not the ability to pay.

PLEASE NOTE: The Canadian Supreme Court has ruled that Canadian Medicare does not give timely access to Healthcare, IT ONLY GIVES ACCESS TO A WAITING LIST.

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*Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

*–Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html