Healthcare Costs: The Growing Burden on Albertans

While Canada is globally recognized for its universal healthcare system, the reality for Albertans is that significant healthcare costs are not covered by the government. These out-of-pocket expenses, particularly for prescription drugs, dental care, and vision care, create a growing financial burden with serious implications for the accessibility and affordability of healthcare services in the province. This article delves into the specifics of these expenses, explores their impact on Albertans, and examines potential solutions to alleviate this burden.

Out-of-Pocket Healthcare Expenses in Alberta

Although the Alberta Health Care Insurance Plan (AHCIP) covers medically necessary physician and hospital services, many essential healthcare services remain the responsibility of Albertans 1. To further illustrate this point, consider the following table which outlines common medical expenses and their eligibility for coverage under AHCIP 2:

| Medical Expense | Eligible Expense? | Prescription Needed? | Certification in Writing Needed? | Form T2201 Needed? |...source |

These costs can accumulate quickly, especially for individuals and families with chronic health conditions or those requiring ongoing treatments 3. Some specific examples of out-of-pocket expenses Albertans face include:

• Ambulance services: $150–$450 for residents with a health card; $750–$1,000+ for non-residents and visitors 4

• Prescription drugs: Approximately $142 for brand-name medications and $22 for generics 4

• Dental cleaning: Around $200 per session 4

• Mental health counseling: $90–$250 per session 4

• Physiotherapy: $75–$100 per session 4

Alberta's Healthcare System and Coverage

Alberta Health Services (AHS) is the sole health authority in Alberta, delivering healthcare services on behalf of the Ministry of Health. AHS operates over 850 facilities throughout the province, including 106 acute care hospitals, five stand-alone psychiatric facilities, and various continuing care facilities, offering a wide range of programs and services 5. However, the AHCIP's coverage has limitations. While it covers medically necessary physician visits, hospital procedures, and some dental and oral surgical health services, it excludes several essential services 7.

To be eligible for AHCIP coverage, residents must be physically present in Alberta for 183 days or longer in a 12-month period 8. It is important for Albertans to understand what different insurance plans cover so they can choose the plan that is right for them 9. Some people may have more than one insurance plan to cover their costs.

In Alberta, some health expenses are covered by the government while others are not—and those costs must be paid out-of-pocket. A benefit plan is health coverage that protects you from health expenses that the government does not cover for most individuals 1. Some examples include prescription drugs, dental services, and eye exams. The concept is simple: a large number of people pay premiums (set monthly amounts) for supplementary benefit coverage, and when they have expenses, they are reimbursed through their plan.

The AHCIP provides full coverage for medically necessary physician services and some dental and oral surgical health services. These include basic dental and oral surgery services required to maintain health, such as:

• Extractions of teeth

• Treatment of jaw fractures

• Treatment of oral infections and diseases 10

AHCIP also provides coverage for insured physician and hospital services elsewhere in Canada 11. In most cases, if you present your valid Alberta health care card to an out-of-province medical or hospital service provider and receive insured services, there is no cost to you. However, if AHCIP does not cover a service in Alberta, AHCIP will not cover it outside Alberta.

To provide further context, the Canada Health Act of 1984 sets national standards for medically necessary hospital, diagnostic, and physician services 12. To be eligible to receive full federal cash contributions for health care, each provincial and territorial health insurance plan needs to comply with the five pillars of the Canada Health Act, which stipulate that it be:

1. Publicly administered

2. Comprehensive in coverage conditions

3. Universal

4. Portable across provinces

5. Accessible (for example, without user fees)

These exclusions from AHCIP coverage include:

• Services from allied healthcare professionals like chiropractors, massage therapists, and psychologists 7

• Vision care, including eyeglasses, contact lenses, and routine eye exams for those aged 19 to 64 7

• Dentures and routine dental care, such as cleanings and fillings 7

• Prescription drugs 7

• Ambulance services 7

This limited coverage necessitates that Albertans rely on private insurance or pay out-of-pocket for these essential services, creating a financial strain for many.

The Cost of Prescription Drugs in Alberta

Prescription drug costs in Alberta are influenced by several factors, including the cost of the drug itself, a dispensing fee (up to $12.15), and charges for inventory and other pharmacy services 13. In an effort to control costs, Alberta has taken steps to reduce generic drug prices. In 2010, the province mandated that generic drug prices be capped at 45% of the brand-name price 14. Furthermore, Alberta collaborates with other provinces and territories to bulk-buy generic medications, further enhancing bargaining power and lowering prices 14. More recently, the Alberta government reduced the allowable price for all interchangeable generic drugs included on the provincial formulary to just 18% of the brand drug costs 15. This change is applicable to both the provincial plan and private plans.

Despite these efforts, the cost of prescription drugs remains a significant out-of-pocket expense for many Albertans.

The Cost of Dental Care in Alberta

Dental care in Alberta is largely a private expense, with the AHCIP covering only limited services. The cost of dental procedures is guided by the Alberta Dental Fee Guide, which provides a standardized fee schedule for various treatments 16. The 2025 Alberta Dental Fee Guide can be found here 17:

Code

Treatment Description

2025 Alberta Dental Fees

01103

New Patient Examination

$137.65

02144

4 Bitewing X-Rays (Check for Cavities)

$105.38

11113

3 Units of Scaling (Cleaning)

$250.53

11101

1 Unit of Polishing

$74.40

12113

Fluoride Treatment (Varnish)

$36.05

23112

Front Tooth White Filling (2 Surfaces)

$199.26

23322

Molar Tooth White Filling (2 Surfaces)

$257.19

33121

Root Canal Treatment 2 Canals; non-difficult)

$1,108.48

71101

Tooth Removal/Extraction (uncomplicated)

$167.02

71201

Tooth Removal/Extraction (complicated)

$301.22

However, the actual cost can vary depending on factors such as the dentist's professional fees, clinic location, and the complexity of the procedure 16. Some examples of dental fees include:

• Dental exam for adults: $116.66 18

• Dental cleaning: $300–$400 16

• Fillings for adult molars: $175.42–$292.78 18

• Root canal procedures: $761.19–$1,636.20 19

These costs can be prohibitive for many, leading to delayed or forgone dental care, which can have long-term consequences for oral health.

The Cost of Vision Care in Alberta

Similar to dental care, vision care in Alberta is primarily a private expense. While AHCIP covers eye exams for seniors and children, adults aged 19 to 64 are generally responsible for the cost of their eye exams and vision correction 20. The average cost of an eye exam in Alberta is around $100, but this can vary based on factors such as the optometrist's fees, clinic location, and the complexity of the exam 21. Additional costs include eyeglasses, contact lenses, and any necessary treatments or procedures. These expenses can pose a significant barrier to accessing necessary vision care, particularly for those with low incomes or pre-existing vision conditions.

In Calgary, the cost of an eye exam can vary greatly, typically ranging from $80 to $200 22. The difference largely comes down to the type of exam and the professional performing it. While a basic...source do so much more.

The cost can also depend on whether you need glasses or contact lenses 23. The optometry office you visit may offer unique pricing or deals combining the cost of eyewear and an eye exam. A routine comprehensive eye exam in Calgary usually starts at around $135.

Impact on Accessibility and Affordability

The high cost of out-of-pocket healthcare expenses in Alberta has significant implications for the accessibility and affordability of healthcare services. Many Albertans face challenges in affording these expenses, leading to various consequences.

Cost-Related Non-Adherence

One of the key challenges associated with out-of-pocket healthcare expenses in Alberta is cost-related non-adherence 4. Individuals may delay or forgo filling prescriptions due to cost, potentially worsening their health outcomes 24. In 2021, over one in every five (21%) adults in Canada reported not having any prescription insurance to cover medication costs 3. This lack of coverage sometimes meant delaying or skipping doses because of an inability to afford medication or paying higher out-of-pocket costs.

Delayed or Forgone Care

People may postpone or avoid necessary dental and vision care due to financial constraints, leading to more severe health issues down the line. This is particularly concerning for vulnerable populations, such as families with children with disabilities, who may face higher healthcare costs and experience greater barriers to accessing care 25.

Financial Burden

Healthcare expenses can create a significant financial strain on individuals and families, particularly those with low incomes or chronic health conditions. This financial burden can exacerbate existing inequalities and limit access to essential healthcare services.

These challenges underscore the need for policies and initiatives to address the affordability of healthcare in Alberta and ensure that all Albertans can access the care they need.

Initiatives and Programs to Help Albertans

Recognizing the financial burden of healthcare, Alberta has implemented several programs to assist residents with healthcare costs:

Program Name

Description

Eligibility

Alberta Adult Health Benefit

Provides coverage for dental care, prescription drugs, eye exams, and other essential health services.

Low-income Albertans

Alberta Child Health Benefit

Offers similar coverage to the Adult Health Benefit but specifically for children.

Children from low-income families

Alberta Aids to Daily Living (AADL)

Helps Albertans with disabilities or chronic illnesses afford essential medical equipment and supplies.

Albertans with long-term disabilities, chronic or terminal illnesses

Coverage for Seniors

Provides premium-free coverage for prescription drugs and other health services.

Albertans aged 65 and older

Non-Group Coverage

Offers supplementary health benefits for services not covered by AHCIP.

AHCIP-registered Albertans under 65

Patient Financial Assistance Program

Offers support to eligible patients who need help with the direct costs of cancer care, such as travel, accommodations, and medications not covered by insurance.

Cancer patients facing financial challenges

In addition to these programs, Alberta is undertaking initiatives to modernize its primary healthcare system, improve access to care, and reduce wait times 29. These initiatives include:

• Investing in community health centers to expand services for vulnerable Albertans

• Providing funding to rural communities to enhance team-based care

• Supporting family doctors and nurse practitioners to manage increasing patient volumes

Furthermore, Canada and Alberta have signed a bilateral agreement to improve healthcare over three years 30. This agreement aims to:

• Increase access to primary care providers for Albertans and reduce emergency department visits

• Fund community providers to increase diagnostic imaging capacity in the province, reducing wait times for CT scans and MRIs

These initiatives are aligned with the four shared priority areas for healthcare improvement outlined in the "Working Together" agreement between the federal and provincial governments 31:

1. Expanding access to family health services, including in rural and remote areas

2. Reducing backlogs and supporting healthcare workers

3. Improving access to quality mental health and substance use services

4. Modernizing health systems with health data and digital tools

These programs and initiatives aim to alleviate the financial burden of healthcare and improve access to essential services for Albertans.

Expert Opinions and Analysis

Experts have raised concerns about the growing out-of-pocket healthcare expenses in Alberta and their impact on accessibility and affordability. Some key concerns include:

• High spending with modest results: Alberta has one of the most expensive healthcare systems in Canada, yet its performance on various metrics, such as wait times and access to resources, is mediocre 32. This raises questions about the efficiency and effectiveness of healthcare spending in the province.

• Sustainability of the system: The rising cost of healthcare raises concerns about the long-term sustainability of the system and its ability to meet the needs of a growing and aging population 33. Experts emphasize the need for innovative solutions to ensure the system's long-term viability.

• Impact on vulnerable populations: Out-of-pocket expenses disproportionately affect low-income Albertans and those with chronic health conditions, exacerbating health inequities 34. This raises concerns about fairness and access to essential healthcare services for all Albertans.

• Concerns about privatization: Some experts express concerns about the potential negative consequences of increased privatization in healthcare, arguing that it could lead to higher costs and reduced access for vulnerable populations 35.

To address these challenges, experts suggest several policy recommendations, including:

• Expanding the use of private providers: Allowing private clinics to deliver publicly funded services could increase capacity and reduce wait times 36. This approach has been successful in other provinces and could potentially improve access to care in Alberta.

• Implementing activity-based funding: Paying hospitals based on services provided, rather than global budgets, could incentivize efficiency and improve performance 32. This could lead to better resource allocation and improved healthcare outcomes.

• Improving cost-sharing mechanisms: Exploring options like health spending accounts could provide individuals with more flexibility and control over their healthcare spending 37. This could empower individuals to make informed decisions about their healthcare and potentially reduce costs.

Interestingly, the Canadian healthcare system is often cited as a model by Americans advocating for government-led healthcare 38. This highlights the international attention given to Canada's healthcare system and the ongoing debate about the role of government in healthcare provision.

These recommendations aim to improve the efficiency and effectiveness of the healthcare system while ensuring its long-term sustainability and accessibility for all Albertans.

Comparison to Other Provinces

While all Canadian provinces face challenges with healthcare costs, Alberta's situation is unique due to its high cost of living and large rural population. Compared to other provinces, Alberta has:

• Higher per capita spending: Alberta's per capita spending on healthcare is among the highest in Canada, yet its performance on various metrics is not commensurate with this spending 32. This suggests that Alberta may not be getting the best value for its healthcare dollars.

• Limited coverage for certain services: Compared to provinces like Quebec, which has a more comprehensive drug program, Alberta's coverage for services like prescription drugs and dental care is more limited 39. This can result in higher out-of-pocket expenses for Albertans.

• Variation in out-of-pocket costs: Out-of-pocket expenses for services like prescription drugs can vary significantly across provinces, with some Albertans facing higher costs than those in other provinces 40. This highlights the need for greater consistency and affordability in healthcare costs across Canada.

• Limited out-of-province coverage: Alberta Health Care coverage does not pay for all medical costs when you travel outside the province, even within Canada 41. The AHCIP covers only limited physician and hospital costs outside of Canada. Patients are responsible for the remaining amount after AHCIP's coverage. Supplemental insurance is strongly recommended.

These comparisons highlight the need for Alberta to learn from other provinces and explore innovative solutions to address its unique challenges with healthcare costs 42.

Synthesis and Conclusion

Out-of-pocket healthcare expenses pose a significant and growing burden on Albertans. While the province boasts a universal healthcare system, the reality is that limited coverage for essential services like prescription drugs, dental care, and vision care creates financial strain and barriers to accessing necessary care. This burden disproportionately affects low-income Albertans and those with chronic health conditions, contributing to health inequities.

Addressing this challenge requires a multi-faceted approach. While Alberta has implemented programs to assist with healthcare costs, further efforts are needed to improve affordability and accessibility. This includes exploring innovative solutions like expanding the use of private providers, implementing activity-based funding, and improving cost-sharing mechanisms. By learning from other provinces and adopting evidence-based policies, Alberta can strive to create a more sustainable and equitable healthcare system that ensures all Albertans can access the care they need without undue financial hardship.

Moving forward, policymakers should prioritize the following actions:

• Conduct a comprehensive review of healthcare spending: Analyze current spending patterns and identify areas for potential cost savings and efficiency improvements.

• Expand coverage for essential services: Explore options for expanding AHCIP coverage to include services like prescription drugs, dental care, and vision care, particularly for vulnerable populations.

• Invest in primary care: Increase funding for primary care services to improve access to preventative care and reduce reliance on more expensive hospital-based care.

• Promote health literacy: Empower Albertans to make informed decisions about their healthcare by providing clear and accessible information about healthcare costs, coverage, and available resources.

While this report provides a comprehensive overview of healthcare costs in Alberta, it is important to acknowledge the limitations of the research. Further investigation is needed to fully understand the impact of these costs on specific populations and to evaluate the long-term effectiveness of various policy solutions.

The trends discussed in this report have significant implications for the future of healthcare in Alberta. As the population grows and ages, the demand for healthcare services will continue to increase, putting further pressure on the system. Addressing the issue of out-of-pocket expenses is crucial to ensuring the long-term sustainability and accessibility of healthcare for all Albertans.

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