The cost of having a baby in Canada: what is not covered

Money out, not money in

Our Canada financial help guide covers the Canada Child Benefit, provincial child benefits and Quebec's Family Allowance, the money that arrives after your tax return. This page is the reverse: what a Canadian birth costs the family, what the provincial health plan absorbs, and the gaps that are genuinely out of pocket. The gaps are smaller than in the United States and larger than most Canadians expect.

Why the birth itself is not billed

The Canada Health Act sets the conditions a province must meet to receive its full federal cash contribution, and those conditions are what make maternity care free at the point of use. Section 9 requires comprehensiveness: a provincial plan must insure all insured health services provided by hospitals, medical practitioners or dentists. Section 10 requires universality: one hundred per cent of insured persons must be entitled to those services on uniform terms and conditions.

Section 12 requires accessibility, and it is worded to close the obvious loophole. A plan must provide insured health services on a basis that does not impede or preclude, directly or indirectly, whether by charges made to insured persons or otherwise, reasonable access to those services. Extra-billing and user charges by physicians for insured services are treated as a breach and trigger deductions from federal transfers.

The practical result: prenatal visits, ultrasounds, the obstetrician or family physician, the labour and delivery, an epidural, a caesarean and your ward stay are covered by your provincial plan. You will not receive a bill for the birth.

The three-month wait is legal

Section 11 of the Act allows a province to impose a residency or waiting period of up to three months before residents are eligible for insured health services. Provinces exercise this differently. If you have recently moved to Canada, or between provinces, and you are pregnant, find out your coverage start date immediately and buy private interim coverage if there is a gap, because an uninsured birth in Canada is expensive.

What your province does not pay for

Ontario's published list of what OHIP covers is a useful worked example, and the exclusions in it are typical of the country.

Prescriptions after you go home

Ontario states it directly: medications are covered for in-patients, but once a patient is discharged, prescribed medications are not covered. Painkillers after a caesarean, antibiotics for mastitis, iron for postpartum anaemia and any medication your baby needs at home are yours to pay for unless you have workplace drug coverage or qualify for a provincial drug programme.

Accommodation above the standard

Standard ward accommodation is insured. A semi-private or private room is an upgrade you pay for, either directly or through private insurance, and maternity wards are exactly where people choose to pay it.

Care from providers your province does not fund

Midwifery is publicly funded in most provinces but the model, the availability and the scope differ. Doulas are almost universally a private cost. Lactation consultants may be free through public health in one province and privately billed in another. Ambulance services carry a co-payment in several provinces.

Dental, vision and paramedical

The Canada Health Act's guarantee is about hospitals and physicians. Dental care outside hospital, routine vision care, physiotherapy, psychology and lactation consultancy are outside the insured basket in most provinces and are paid for privately or through workplace benefits. Pregnancy raises the odds of needing dental treatment, and postpartum pelvic floor physiotherapy is one of the most commonly recommended and least commonly funded services in the country.

Adding the baby to your benefits

If you have workplace health and drug coverage, your newborn is usually not added automatically. Most plans require you to enrol a dependant within a set window after the birth, often 30 or 31 days, and missing it can mean waiting until the next enrolment period. Put it on the list of things to do in the first fortnight, alongside registering the birth and applying for the baby's health card and social insurance number.

Thirteen systems, not one

This is the part that cannot be generalised. Health care delivery is provincial and territorial, and the list of what is insured beyond the Canada Health Act floor differs in every one of the thirteen. Quebec in particular runs a distinct system, including its own public prescription drug insurance plan that everyone not covered by a private plan must join. Look up your own province's ministry of health page for what is covered, rather than assuming a friend's experience in another province transfers.

The costs outside the health system

A car seat is mandatory for the drive home and is regulated by federal safety standards, so buy new or from a source you can verify has never been in a collision and is not expired. Beyond that, budget for a sleep space, feeding equipment, nappies and clothing.

The largest cost, as in most countries, is income. Employment Insurance replaces a percentage of insurable earnings up to a maximum, and choosing extended parental benefits spreads the same total money across more weeks, which lowers the weekly amount considerably. Run that calculation before electing, because the election is difficult to reverse.

What to do, and in what order

Confirm your provincial health coverage is active and, if you have moved recently, find out exactly when it starts. Check whether you have workplace drug and dental coverage and whether the baby is automatically added. Ask your hospital what a semi-private or private room costs before you are asked to decide in labour. Find out how midwifery is funded in your province. Then model your Employment Insurance income before choosing between standard and extended parental benefits.