With Medicare approaching a fiscal cliff, American retirees set sights on Canadian health insurance
With federal funding for Medicare under pressure, some American retirees have found solace in a backup plan: health insurance publicly funded by the Canadian government.
Today, millions of Americans qualify for Canadian citizenship by descent, in the wake of the removal of the generational limit to inheriting Canadian citizenship.
Under the new citizenship law, any American with Canadian ancestry has the right to Canadian citizenship, provided they were born before December 15, 2025.
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These Americans, now legally recognized as U.S.-Canadian dual citizens under Canadian law, have the same rights to publicly-funded healthcare as citizens born in Canada.
They’re not all packing their bags for Canada today—but many are planning ahead for the future, so they can, in fact, obtain Canadian public healthcare coverage, in the event that they need to, just in case.
Let’s look at how.
How to get Canadian healthcare coverage as a U.S.-Canadian dual citizen by descent
U.S.-Canadian dual citizens qualify for Canadian healthcare in the same way as any other Canadian citizen: by meeting the requirements of their Canadian province or territory of residence.
If you’re an American who is eligible for Canadian citizenship by descent, you can get Canadian healthcare coverage by following a two-step process.
Step 1: Apply for proof of Canadian citizenship.
Step 2: Meet the requirements of a provincial or territorial health insurance plan.
If you are in urgent need of health care, you can request that Canada’s citizenship department fast-track your application.
Applying for proof of Canadian citizenship
If you descend from even one Canadian ancestor, even if that’s your great-great-great-grandparent or elder, you’re eligible for Canadian citizenship by descent, provided you were born before December 15, 2025.
If your parent was born in Canada, the process is more straightforward, as described in our article.
Otherwise, once you’ve identified your Canadian ancestor and confirmed that they were a Canadian citizen at the time that their child, from whom you descend, was born, the next step is to gather the supporting documents needed to support your proof of citizenship application.
Your application must include compliant copies of accepted official documents proving your continuous line of descent from a Canadian ancestor.
An example of a typical case, for instance, would be a copy of your great-grandfather’s birth certificate, showing that he was born in Canada, plus copies of the birth certificates and marriage certificates of each connecting generation (your grandparents’ birth certificates and marriage certificate, your parents’ birth certificates and marriage certificate), terminating with the copy of your own birth certificate.
If you don’t have originals sitting in your filing cabinet, you’d typically obtain copies of these documents by requesting them from the appropriate vital statistics offices and/or archives, depending on the time and location of the birth and marriage of each ancestor. Many American applicants will need to request some records from institutions in Canada, and other records from offices in the U.S.
With compliant copies of the accepted official documents in hand, you’d complete the paper form, CIT 0001, along with the rest of the application package in accordance with the government’s application guide, pay the application fee online, and submit your proof of payment along with the completed application package by mail or courier to Canada’s citizenship department.
You can prepare and submit your application yourself, or you can have a representative handle the application on your behalf, for example, by hiring a professional legally authorized by the Canadian government, such as an immigration lawyer licensed by a provincial or territorial law society.
Whoever prepares the application should exercise considerable diligence, as even minor errors can result in rejection.
If you use a representative, you must declare your use of a representative and include the corresponding form in your application package. Failure to declare a representative, whether paid or unpaid, is misrepresentation and can result in the refusal of your application.
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After your application has been submitted, you or your representative should keep an eye out for any questions or follow-up correspondence from the officer reviewing your application. If you fail to respond to an inquiry in the required time frame, the officer may reject your application.
Canada’s citizenship department typically sends follow-up inquiries through email to the contact person designated on the application.
As of the time of writing, an American applying for proof of Canadian citizenship can expect their application to be processed within about 12 months, if all goes smoothly.
If, along with your complete application, you apply for and are granted urgent processing—for example, on account of needing access to healthcare—Canada’s citizenship department will expedite your application.
There are reports online of expedited applications for proof of Canadian citizenship being processed in as little as two weeks, although Canada’s citizenship department provides no guarantee for the timeline, even if your request for expedited processing is approved.
When your application has been successfully processed, the officer reviewing your file will issue you your proof of Canadian citizenship certificate, either in the form of a paper certificate or an e-certificate, depending on which you requested.
This is the official document that confirms the Canadian government’s recognition of your legal status as a Canadian citizen under Canada’s Citizenship Act.
As a Canadian citizen, you have the right to enter Canada, to settle anywhere you wish in Canada, and to remain in Canada for as long as you wish.
To facilitate entry into Canada, it’s helpful to have a Canadian passport. You can apply for a Canadian passport after having received your proof of Canadian citizenship certificate.
As of the time of writing, applications for Canadian passports are typically processed within 10-20 business days, not including mailing time.
Obtaining a proof of Canadian citizenship certificate as an American does not expose you to any additional tax obligations; unlike the U.S., Canada does not apply a worldwide tax on its citizens.
Qualifying for Canadian public health insurance as a U.S.-Canadian dual citizen
As a U.S.-Canadian dual citizen, you have the same access to healthcare as any other Canadian citizen.
But that doesn’t mean you can simply waltz across the border and get government-funded surgery.
Canadian citizens access the lion’s share of their publicly funded healthcare by qualifying for provincial or territorial health insurance plans: for example, Ontario residents get coverage through the Ontario Health Insurance Plan (OHIP), while residents of British Columbia get coverage through BC’s Medical Services Plan (MSP).
The requirements vary based on the province or territory, but all typically have some sort of residency requirement, meaning that you’d need to establish residency in a Canadian province or territory in order to get health insurance coverage.
Some plans have a waiting period for coverage, meaning that a citizen who first moves to that province or territory must reside there for a minimum time period, such as 90 days, prior to qualifying.
Other plans have no waiting period, meaning that Canadian citizens who first move to that region can qualify for coverage immediately upon establishing residency.
Establishing residency in a province or territory doesn’t mean you can’t go back to the United States. For many provincial plans, a resident can maintain health insurance coverage year-round with a minimum residency requirement of either five or six months, depending on the province or territory.
As such, a U.S.-Canadian dual citizen who establishes residency in Canada can maintain full Canadian health insurance coverage year-round while living in the United States for about half the time.*
Be sure to plan ahead to see what you’ll need in order to qualify. Each province and territory has a website detailing requirements, linked in the table below:
| Province / Territory | Public Health Insurance Plan Eligibility |
|---|---|
| Alberta | Alberta Health Care Insurance Plan (AHCIP) |
| British Columbia | Medical Services Plan (MSP) |
| Manitoba | Manitoba Health (Health Services Insurance Plan) |
| New Brunswick | New Brunswick Medicare |
| Newfoundland and Labrador | Medical Care Plan (MCP) |
| Northwest Territories | NWT Health Care Plan |
| Nova Scotia | Nova Scotia Health Insurance Program |
| Nunavut | Nunavut Health Care Plan (NHCP) |
| Ontario | Ontario Health Insurance Plan (OHIP) |
| Prince Edward Island (PEI) | PEI Medicare |
| Quebec | Québec Health Insurance Plan - Régime d'assurance maladie du Québec (RAMQ) |
| Saskatchewan | Saskatchewan Health |
| Yukon | Yukon Health Care Insurance Plan (YHCIP) |
*If relying on Canadian provincial or territorial health insurance as your sole source of coverage, it’s advisable to supplement with travel medical insurance for any time spent in the United States. Canadian public health insurance plans still cover you while in the U.S. under certain emergency situations, but their coverage may not be sufficient to pay for the U.S. care in full.
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What’s covered by Canadian public health insurance?
Provincial and territorial health insurance plans cover a lot of things, but there’s also a lot that they often don’t cover.
And the specific treatments and services funded through public health insurance can vary quite a bit based on your province or territory.
Typically, a provincial or territorial plan will provide what is considered to by basic healthcare coverage, which would include things such as the following:
- Visits to primary care providers, such as family doctors, general practitioners, nurse practitioners, and doctors in walk-in clinics and/or urgent care centres.
- Visits to hospital emergency rooms.
- Medically necessary urgent transportation to the hospital by ambulance.
- Appointments and treatments by specialists, such as oncologists, cardiologists, and dermatologists, to whom you’re referred by your primary care provider.
- Care and treatment delivered in hospitals and doctors’ inpatient and/or outpatient clinics, including medically necessary surgeries and/or diagnostics (e.g., biopsy) ordered by your doctor.
- Medically necessary treatments for the management of chronic conditions, and medically necessary courses of treatment for other illnesses, which are delivered in hospitals, such as dialysis for those with kidney failure, or chemotherapy or radiation therapy for cancer patients.
Provincial plans often provide little to no coverage for prescription drugs, or for treatments such as elective cosmetic surgery, dentistry, orthodontics, optometry, physiotherapy, massage therapy, occupational therapy, chiropractic medicine, naturopathic medicine, acupuncture, psychotherapy, or counselling.
Canadian residents typically pay for the above forms of services out of pocket, and/or using extended health insurance coverage obtained through group insurance plans offered through organizations such as employers or, in the case, of postsecondary students, student societies.
Wait times and access to care
Many Canadians may pay nothing out of pocket for covered treatments, but there’s another cost: time.
It’s not uncommon for Canadians to wait months or even years simply to obtain an initial appointment after having been referred to a specialist.
You may even need to wait months in line for imaging, such as an MRI, ordered by your doctor to assess potentially life-threatening conditions such as a brain tumour, when a comparable MRI could be done the same day or the same week at a clinic in the United States.
The bulk of care funded through provincial or territorial health insurance plans is delivered at the regional level, so wait times and access to care can vary quite a bit based not only on your provincial plan, but also on your place of residence in that province.
Typically, the physician who assesses your condition will establish how serious the immediate risk to your health appears to be, given what is known of your condition, and that will determine your place in line.
A patient in Toronto in need of non-emergency surgery to address advanced congestive heart failure, for example, could expect to be seen by a specialist within several weeks of referral, and to undergo surgery within a few weeks of their initial appointment with the specialist, according to Ontario’s government website.
In contrast, a patient experiencing a significant impact on their mobility and daily quality of life due to arthritic knees could easily end up waiting a year or longer before they can receive surgery for their first knee replacement.
Some Canadians even choose to pay to skip the wait.
There are numerous reports of those with the means going to the United States to pay out of pocket to be seen faster, especially when they face long wait times for publicly-funded MIR imaging to diagnose potentially life-threatening conditions such as brain tumours.
A valuable backup plan – just in case
Among those who qualify for citizenship by descent, most American retirees aren’t packing up their bags.
Why rebuild your life in a new country on account of Medicare cuts that may or may not happen? In a country that, far from being a promised land of maple syrup and MRIs, is in fact facing its own healthcare crisis, with a shortage of funding and rising wait times?
A proof of citizenship certificate and a Canadian passport cannot serve as a panacea for American retirees’ healthcare needs.
But they can serve as a realistic back-up plan: providing peace of mind for aging U.S.-Canadian dual citizens who face increasingly expensive medical needs, with the Medicare trust facing a projected shortfall by 2033, according to the 2025 report by the Trustees of the Social Security and Medicare trusts.
If you qualify as a citizen by descent, a Canadian passport is insurance for insurance.
Citizenship is for life. Canadian passports are issued for up to 10 years.
Savvy Americans who qualify are getting them because they see the value of additional options in a geopolitical era increasingly defined by turmoil and uncertainty.
An up-front investment of the time and effort of the application, and you can have those in your back pocket, just in case.
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- Do you need Canadian immigration assistance? Contact the Contact Cohen Immigration Law firm by completing our form
- Send us your feedback or your non-legal assistance questions by emailing us at media@canadavisa.com
