By law, all Quebec residents must have health insurance coverage for prescription drugs. Whether public or private, drug insurance reimburses all or part of the cost you pay when purchasing prescription medication.
Employers, unions, associations and professional orders can give their employees or members access to a private plan as part of a benefits package.
What is private health insurance?
Private health insurance refers to any health insurance policy purchased by a person or an employer from a private insurance company instead of a provincial or federal government.
A private plan provides coverage to employees or members. It’s also referred to as a group insurance or employee benefit plan.
- Do you have enough health insurance?
- How to choose a health insurance plan that’s right for you and your family
What is public health insurance?
The Régie de l’assurance maladie du Québec (RAMQ) manages public health insurance in Quebec.
The RAMQ provides coverage to Quebecers who do not have access to a private health insurance plan. This includes people who are:
- not eligible for a private plan (for example, self-employed workers),
- age 65 or over,
- recipients of financial assistance and holders of a claim slip, or
- children of people covered by the public plan.
What does a private health insurance plan in Quebec require?
Quebecers covered by private health insurance must include their spouse and children in their plan, unless their spouse and children are already covered by another private plan.
People with access to more than one private plan (through their employer, spouse's employer or a professional association) may choose the plan they consider the most advantageous.
In Quebec, private drug insurance plans must meet minimum conditions (but can be more generous) regarding:
- the coverage they provide (for example, RAMQ's List of Medications), and
- the financial participation they require of the persons they insure (for example, the level of coinsurance – the percentage that’s reimbursed – or the maximum contribution toward the cost of drugs on the RAMQ list).
What happens to your health insurance when you retire?
If you’re still eligible for a private plan at retirement, you must be enrolled in that plan until age 65.
If you do not have access to a private plan, you must register with RAMQ.
What happens to your health insurance after age 65?
Quebecers are automatically registered for RAMQ’s public prescription drug insurance plan when they turn 65.
If you’re still eligible for a private plan, then you have a choice to make. You can choose to get insured:
- by the public plan only (unless the private plan is a condition of employment, in which case they must choose between options 2 and 3);
- by the public plan (first payor) and by a private plan offering supplemental coverage (second payor); or
- only by a private plan offering at least the basic coverage.
RAMQ will send you a notice six months before your 65th birthday.
What happens if you transfer from one insurance plan to another?
Thinking of moving from a private plan to the RAMQ public plan? You may find that the list of covered medication is more limited. What’s more, you’ll probably notice differences in the way deductibles are collected and in the coinsurance level.
The reverse is also true for deductibles and coinsurance – that’s if you switch from the public plan to a private plan.
You may also see differences in your coverage or the list of covered medications when you transfer from one private plan to another. Beside the required minimums in Quebec, the provisions of private drug plans can vary considerably. As of July 2020, coverage is 63% and the maximum annual contribution for drugs on the RAMQ list is $1,144.
And, what if you need “exceptional medications” or “special authorization drugs”? These are medications for which your doctor had to make special arrangements to ensure coverage. In such cases, you may have to go through the process again to have exceptional medications covered under a new plan.
Does RAMQ check to see if you have health insurance?
In Quebec, you need insurance in order to receive prescription medications. RAMQ does regular checks to make sure you’re registered for public health insurance if you don’t have a private plan.
If your situation changes, you’ll have to notify RAMQ. For example, let’s say you lose your employee benefits (which includes insurance from your group plan) due to job loss. In this case, you would need to inform RAMQ that:
- your situation has changed and
- you no longer have private health insurance.
The same thing applies if you have public insurance but later obtain private insurance through an employee benefit plan. You’ll have to tell RAMQ about it. In this case, you may have to repay to RAMQ the amount it paid for your medications. Or you’ll have to pay the premium (monthly or annual fee) retroactively.
To check your situation, fill out the online questionnaire on the RAMQ website.
Régie de l’assurance maladie du Québec, in the section Citizens, Prescription Drug Insurance
Ordre des pharmaciens du Québec, in the section Grand public, Les médicaments, Assurance médicaments