Introduction
Many Quebec residents assume a RAMQ card provides full coverage. While RAMQ offers strong basic medical protection, it has significant gaps. These include dental, vision, certain medications, and medical costs outside Quebec.
Understanding RAMQ's coverage gaps is crucial. It prevents surprise bills that can derail savings, RRSP strategies, or retirement plans. With over 20 years of experience, I see how the right mix of public and private coverage protects both health and finances for Quebecers.
This 2026 guide explains RAMQ's coverage, its limitations, and when private health or travel insurance becomes essential. This information supports your overall financial planning in Quebec.
Understanding Essential RAMQ Coverage in Quebec
RAMQ (Régie de l’assurance maladie du Québec) is the provincial health insurance plan covering essential medical services. It pays for medically necessary care within Quebec and, to a limited extent, in other Canadian provinces via reciprocal agreements.
As of 2026, RAMQ generally covers:
- Visits to family doctors and specialists
- Hospitalization in a public hospital (room in a ward, surgery, tests ordered in hospital)
- Medically necessary diagnostic tests (X-rays, some scans, lab tests)
- Maternity care and medically necessary follow-ups
RAMQ does not cover most non-essential or "comfort" services. It also excludes the majority of costs when traveling outside Canada. Assess RAMQ's limitations to avoid assuming all expenses are covered.
Doctor and Clinic Visits: What RAMQ Covers
For eligible residents, RAMQ pays for medically necessary visits to family doctors, walk-in clinics, and most specialists. There is no deductible or co-pay for these visits in the public system.
However, RAMQ will not pay for:
- Forms and reports (insurance forms, medical certificates, driver’s licence forms)
- Elective or non-medically necessary services (for example some preventive exams, cosmetic procedures)
- Certain telemedicine or virtual care platforms outside the RAMQ system
Private health insurance often adds value. It reimburses services not included in RAMQ, such as certain paramedical practitioners or additional preventive care.
Hospital Care: RAMQ's Coverage Details
RAMQ fully covers medically necessary care in public hospitals. This includes surgery, emergency visits, tests ordered while admitted, and standard ward rooms.
But it does not automatically cover:
- Private or semi-private rooms (unless medically justified)
- TV, phone, parking, and other “comfort” extras
- Some advanced medications or treatments outside provincial lists
Private insurance can reimburse a private room, daily hospital cash benefits, or costs not paid by RAMQ. This can be important for added comfort or to stay close to family.
RAMQ vs private insurance – basic comparison
| Aspect | RAMQ (Public Plan) | Private Health / Travel Insurance |
| Doctor & hospital in Quebec | Medically necessary only | Sometimes enhanced comfort (private room, extras) |
| Prescription drugs | Public plan for eligible residents only | Employer or individual plans; often broader drug lists |
| Dental care | Very limited (children under 10, some surgery) | Routine & major dental (cleanings, fillings, crowns) |
| Vision care | Very limited (children, specific cases) | Exams, glasses, contact lenses, laser surgery (partial) |
| Outside-Quebec emergency care | Very limited reimbursement | Designed to cover real foreign healthcare costs |
Travel Insurance: Bridging RAMQ Gaps Outside Quebec
One major misunderstanding concerns RAMQ coverage outside Quebec, especially internationally, which are often far below actual foreign hospital charges. For detailed official information, refer to RAMQ’s guidelines on covered services outside Quebec. However, be aware that reimbursement rates are based on Quebec tariffs, which are often far below actual foreign hospital charges.
For example, a U.S. hospital might charge 20,000 CAD for emergency surgery. If RAMQ's Quebec tariff for that procedure is 2,000 CAD, RAMQ will only reimburse approximately the Quebec amount. This leaves you or your family with a substantial balance.
With rising global healthcare costs in 2026, Quebec residents must consider travel insurance essential trip planning. It is not an optional add-on.
When Quebec Residents Absolutely Need Travel Insurance
You should strongly consider travel insurance if:
- You travel outside Canada for any duration (vacations, snowbirds, work trips, visiting family)
- You go to another Canadian province but want extra protection for air ambulance or expenses not paid by RAMQ
- You have pre-existing conditions and travel often (you may need a plan that covers stable conditions)
Good travel insurance can cover:
- Emergency medical care up to 2–5 million CAD
- Air ambulance, repatriation to Quebec, return of children or remains
- Some trip interruption / cancellation benefits (depending on the plan)
As a financial planner, I help clients integrate travel insurance into their overall risk management. This is especially vital for retirees whose financial plans depend on protection while spending winters abroad.
Short Trips vs. Long Stays Abroad: Key Considerations
For weekend or short trips to the U.S. or elsewhere, a simple per-trip travel policy is often inexpensive and highly effective. For snowbirds or professionals on long work assignments, a multi-trip annual plan or specialized expat coverage is usually better.
The key is to check:
- Maximum trip duration (e.g., 15, 30, 60, 182 days)
- Pre-existing conditions clauses
- Coverage for high-risk activities (skiing, diving, adventure sports)
RAMQ coverage varies by age, destination, and health. An advisor can review your coverage to prevent costly surprises.
Prescription Drugs: Public vs. Private Plans in Quebec
In Quebec, prescription drug coverage mixes the RAMQ public plan and private group plans. If you have access to a private group drug plan (through your employer, spouse’s employer, or a professional association), you are legally required to join it.
If you do not have access to such a plan, you must enroll in the RAMQ public drug insurance plan, which:
- Charges an annual deductible and monthly premium (often collected through your income tax)
- Reimburses medications on the provincial formulary list
- Has maximum annual contribution limits based on income
Understanding RAMQ's drug coverage is crucial. Some newer or more expensive medications may not be covered, or they may require special authorization.
How Private Plans Complement RAMQ Drug Coverage
Private drug plans can:
- Cover a wider range of medications than the public formulary
- Offer lower co-pays or deductibles for many people
- Extend coverage to dependents with more flexibility
Drug expenses significantly impact monthly budgets and retirement cash flow. An integrated review of RAMQ coverage, private drug plans, and long-term health projections optimizes net income and protection.
Understanding Drug Coverage While Traveling
Neither RAMQ nor most private drug plans automatically cover emergency medical care abroad like dedicated travel insurance does. However, some plans may reimburse the cost of urgent prescriptions obtained during travel.
You should:
- Verify if your travel insurance covers emergency medications
- Carry enough of your regular medications when traveling, plus a small margin
- Keep copies of prescriptions and a list of medications in case of emergency
Coordinating medication coverage avoids medical risks and high out-of-pocket costs abroad. This involves understanding RAMQ's limitations and private insurance options.
Health benefits vs total financial plan – comparison
| Area of Life | Risk if Relying on RAMQ Alone | Benefit of Integrated Private Coverage |
| Retirement cash-flow | Large medical bills can erode savings | Predictable premiums, fewer unexpected withdrawals |
| Debt & mortgage planning | Medical emergencies may trigger debt | Protection reduces need for high-interest borrowing |
| Tax optimization (RRSP, FHSA) | Forced withdrawals to pay bills | Better chance to keep tax-efficient investments intact |
| Family protection | Spouse/children may bear heavy costs | Coordinated health, disability, and life coverage |
Dental, Vision, and Paramedical Care: Key RAMQ Gaps
RAMQ dental coverage is extremely limited. It generally covers certain procedures for children under 10 and oral surgery performed in a hospital for medical reasons.
RAMQ does not usually cover:
- Regular dental check-ups and cleanings
- Fillings, root canals, crowns, bridges, or implants
- Orthodontics (braces) in most common situations
For vision, RAMQ may cover:
- Eye exams for children under 18
- Exams for people with specific medical conditions or at certain ages
But it does not normally pay for glasses, contact lenses, or elective laser surgery.
Why Private Health Insurance Matters for Everyday Care
Private group or individual health insurance can cover:
- Dental prevention and basic treatments (cleanings, fillings)
- Major dental work (crowns, bridges) and sometimes orthodontics
- Vision exams, glasses or contact lenses up to a limit
- Paramedical services (physiotherapy, massage therapy, chiropractic, psychology, etc.)
This highlights how RAMQ's gaps directly affect your annual budget. Many Quebec families underestimate their annual out-of-pocket spending on these services.
Building a realistic financial plan means factoring in these costs or obtaining appropriate coverage. This is especially true if you have children, self-employment income, or no employer benefits.
Real-Life Cases: RAMQ Gaps and Financial Protection
Below are anonymized examples from my practice as a financial planner and financial security advisor in Quebec.
Case 1 – The snowbird couple without travel insurance
A retired Montreal couple spent winters in Florida. For years, they relied on their RAMQ card, assuming "Canada pays if something happens."
The husband suffered a heart attack in the U.S., requiring emergency surgery and a 10-day hospital stay. The total bill exceeded 180,000 CAD. RAMQ reimbursed only a fraction based on Quebec tariffs, leaving a significant balance.
When they came to see me, we restructured their retirement plan. We redirected part of their RRSP withdrawals and added comprehensive annual multi-trip travel insurance aligned with their health. Their ongoing premiums were small compared with the risk, and future travel no longer threatened their financial security.
Case 2 – The self-employed professional without group benefits
A 32-year-old IT consultant in Quebec City was self-employed, with no employer health plan. He had RAMQ but paid out of pocket for dental, vision, and physiotherapy after a sports injury.
During our financial review, we analyzed RAMQ coverage implications for his situation. By implementing an individual extended health and dental plan, plus emergency travel coverage for frequent U.S. trips, we reduced his volatile health expenses and protected his cash flow.
We coordinated premiums with his business income, optimized deductions, and integrated costs into his overall tax and retirement savings strategy.
FAQ
1. Does RAMQ cover emergency medical care outside Quebec?
RAMQ reimburses some emergency services outside Quebec, but only at Quebec rates. These rates are often much lower than foreign prices. Understanding these limitations is crucial before any trip, especially outside Canada.
2. If I have RAMQ, do I still need private health insurance in Quebec?
Yes, in many cases. RAMQ does not cover routine dental, most vision costs, paramedical services, and comfort options like private hospital rooms. Private coverage can fill these gaps and protect your budget from frequent out-of-pocket expenses.
3. Are prescription drugs fully covered by RAMQ?
If you are on the public drug plan, RAMQ covers medications on its formulary. However, you still pay premiums, deductibles, and co-insurance up to annual caps. Some drugs or brand-name options may not be covered, making coordination with private insurance beneficial.
4. Do I need travel insurance for short trips to the U.S. or other provinces?
Yes, even short trips can incur very high medical bills, with RAMQ reimbursing only a portion. Travel insurance is specifically designed to cover emergency medical expenses abroad. It is essential for comprehensive protection.
5. How can I know if my current mix of RAMQ and private coverage is sufficient?
Review your coverage based on age, health, family situation, travel habits, and financial goals. A licensed financial planner can analyze your RAMQ coverage and recommend adjustments.
Book a free, no-obligation consultation to review your RAMQ, private health, and travel insurance and see how they fit into your overall financial plan.
Phone: +1-514-834-5558
Email: contact@bkfinancialservices.ca
Available in English, French, Russian, and Hebrew for Quebec residents seeking tailored guidance for 2026 and beyond.
