Public health insurance in Alberta, including Edmonton, is provided through the Alberta Health Care Insurance Plan (AHCIP). This is a comprehensive system that provides residents of the province with a wide range of medical services without having to pay for each visit to the doctor or each procedure. However, this does not mean that all medical services are covered — the system has clear limits on what it pays for and what remains the responsibility of patients or private insurers. Understanding these limits is critical for every new Edmonton resident, as it affects your budget and healthcare planning.
The AHCIP operates on the principle of medical necessity. This means that the government pays for services that a doctor deems medically necessary for the diagnosis, treatment, or prevention of disease. This means that the government does not pay for services that are considered cosmetic, preventive for healthy people, or services that fall outside the scope of traditional medicine. Therefore, before expecting a particular service to be free, it is important to know how the system classifies a particular procedure.
Fully covered medical services
Visits to doctors and specialists
When you have a valid AHCIP card, all visits to your family doctor are fully covered. This includes the initial appointment when you register with the doctor and all follow-up appointments to monitor your health. The cost of these visits, regardless of how much time the doctor spends with you, is fully paid by the government. This also applies to visits to urgent care clinics and walk-in clinics, where you can go without an appointment.
If your family doctor determines that you need to see a specialist, you will be entitled to a free visit to a cardiologist, neurologist, oncologist, gastroenterologist, dermatologist, or any other specialist who works in the AHCIP system. The process usually involves getting a referral from your primary care doctor, which you will present to the specialist. While the referral itself does not cost anything, you may need additional tests before your specialist appointment, but these tests will also be free if they are medically necessary.
Telemedicine and virtual doctor visits are also covered by the plan. This means that if you can have a consultation via video or phone instead of an in-person appointment, it will also be free. During the COVID-19 pandemic, many doctors in Edmonton and other Alberta cities switched to telemedicine, and this service remains available at many practices.
Diagnostic services
Diagnostic services that your doctor considers medically necessary are fully covered by AHCIP. This means that if your doctor recommends a blood test to check your cholesterol, thyroid function, or any other lab tests, you will not pay for it. All blood tests are performed in government laboratories, and the results are forwarded to your doctor.
X-rays are also fully covered when medically necessary. If you have a broken bone, lung disease, or any other condition that requires an X-ray to diagnose, the government pays for the X-ray. This includes dental X-rays if they are recommended by a doctor in the context of medical treatment.
Magnetic resonance imaging (MRI) and computed tomography (CT) scans are also covered when medically necessary. However, these services often have long waiting lists because public hospitals have a limited number of machines and time available for scanning. For some patients, the wait can be several weeks or even months, depending on the priority and urgency of the medical situation. If you don't want to wait, you can go to a private clinic, where MRI scans are available much faster, but you will have to pay for them out of your own pocket.
Ultrasound examinations, when prescribed by a doctor, are also fully covered. This includes prenatal ultrasounds for pregnant women, ultrasounds of the thyroid gland, kidneys, and other organs. Endoscopy, if medically necessary to examine the stomach or intestines, is also covered by the system.
Hospital services
If you need to be hospitalized, all services during your stay in the hospital are fully covered by AHCIP. This means that if you need surgery, all care during that surgery, including the surgery itself, anesthesia, and use of the operating room, will be free. You will not pay for operating equipment, materials, or the services of an anesthesiologist.
During your hospital stay, you will be given the medications you need for your treatment. These medications, administered in the hospital, will not cost you anything. If you need a blood transfusion, this will also be free of charge. Physical therapy prescribed for you during your hospital stay is covered, as are the services of a psychiatrist if you need psychiatric care during your hospitalization.
You can stay in a standard room at no additional cost. A standard room means a room that you share with one or more other patients. Meals during your hospital stay are also included in AHCIP coverage. If you require a special diet, such as a low-salt diet or a diabetic diet, this is also provided.
Recovery from surgery during your hospital stay is also covered. If you need assistive devices for walking or other services to support your recovery, these are all provided as part of the hospital package. Transfers between hospitals in Alberta are also covered—if you need to be transported from one hospital to another for specialized treatment, the provincial ambulance service will provide this transfer.
Surgical procedures
All medically necessary surgical procedures are covered by the AHCIP. This includes both emergency surgeries, such as removing an appendix in a case of appendicitis, and elective surgeries, such as replacing a knee joint in a person with arthritis. The process of getting scheduled surgery can be lengthy, as patients often languish on waiting lists, depending on the priority of their condition.
Bariatric surgery for obese individuals is also covered, but only for individuals who meet the criteria of the Weight Wise program. This program requires that a person have a body mass index (BMI) above a certain value and that they be willing to change their lifestyle. The program includes dietary counseling and mental health screening before surgery.
Organ transplants, including liver, kidney, heart, and other organ transplants, are fully covered for patients who are considered candidates for transplantation. This includes surgeries for both the recipient and the organ donor. Transplant coordinator services and follow-up monitoring after transplantation are also covered.
Gender-affirming surgery for transgender individuals is also covered under the Alberta Gender-Affirming Surgery Program. This includes breast augmentation or mastectomy (breast removal) surgeries, depending on the patient's needs. However, the patient must receive program approval before surgery, and proper psychiatric assessment and preparation are required.
Psychiatric Services
If you need the help of a psychiatrist (a doctor who specializes in mental illness), these services are fully covered by AHCIP. A referral from your primary care physician is usually required to see a psychiatrist, as psychiatrists are often considered specialists. During your appointment, the psychiatrist may prescribe medication to treat depression, anxiety, bipolar disorder, and other mental illnesses.
However, it is important to understand that psychologist services are not covered. A psychologist is a mental health professional, but not a doctor, and their services are considered out-of-network services under AHCIP. If you need psychotherapy or behavioral therapy from a psychologist, you will have to pay for it out of pocket or rely on private insurance that you may have through your employer.
Hospitalization in a psychiatric ward is also covered. If you are in a mental health crisis, you may be admitted to the psychiatric ward of a local hospital, where you will receive 24-hour supervision and treatment. This will be free of charge for those who have a valid AHCIP card.
Partially covered services
Eye care
Eye care is partially covered, depending on your age. Children under 18 are entitled to one full eye exam (oculo-visual assessment) per year. People over 65 are also entitled to one such exam per year. However, people between the ages of 19 and 64 are not entitled to a free eye exam unless it is medically necessary for the treatment of a specific condition.
Medically necessary eye care is covered for all ages. If you develop a condition such as glaucoma, cataracts, diabetic retinopathy, or any other condition that affects your vision, the examination and treatment by an ophthalmologist will be free of charge. If you need eye surgery, such as cataract surgery, it will also be free.
However, glasses and contact lenses are not covered. If you need glasses or contact lenses to correct a refractive error (nearsightedness, farsightedness, astigmatism), you will have to pay for them yourself. Glasses in Edmonton can cost anywhere from $100 to $400 or more, depending on the quality and design. Contact lenses cost around $50-150 per pair, plus solutions and containers.
Refractive surgery, such as LASIK or PRK for permanent vision correction, is also not covered. These surgeries can cost between $1,500 and $3,000 for both eyes. However, some people consider it a worthwhile investment, as it eliminates the need for glasses or contact lenses for life.
Podiatric Services
Podiatric services are covered partially, up to a maximum of $250 per calendar year (July 1 to June 30). This means that if you need professional podiatric help to treat foot problems, the state will pay up to $250 for these services. If the bill exceeds $250, you will have to pay the difference yourself.
Podiatric surgical services performed in a public hospital or surgical facility under contract with Alberta Health Services are covered in full. However, you will need a referral from your doctor to access these services. If you need foot surgery due to bunions, fungal nail infections, or other problems that require surgical intervention, the government will pay for the surgery at a hospital.
Dental services
Dental services are covered to a very limited extent. Only certain specialized services related to oral and maxillofacial surgery are covered. This includes tooth extractions that are related to the treatment of other medical conditions, such as tooth extractions prior to jaw surgery to correct misalignment.
Routine dental care, such as teeth cleaning, cavity fillings, wisdom tooth removal (unless it is a surgical removal requiring sedation in a hospital), and other procedures are not covered. If you have cavities, you will have to pay a private dentist for treatment. Basic dental cleaning usually costs between $100 and $200, and cavity treatment can cost between $150 and $500 depending on the size of the cavity.
Orthodontic services, such as braces to straighten teeth, are not covered at all. These services can cost anywhere from $3,000 to $8,000 for a full course of treatment. However, some people have private insurance through their employer that covers a portion of orthodontic costs.
Services Not Covered
Medical Services Not Covered
Many medical services are explicitly not covered by AHCIP. Cosmetic surgical procedures such as breast augmentation (unless it is gender-affirming surgery), rhinoplasty, abdominoplasty (tummy tuck), facelifts, and other procedures for aesthetic enhancement are not covered. If you need one of these surgeries, you will have to pay for it out of pocket or through a private clinic that specializes in cosmetic surgery.
Vasectomy (male sterilization) and its reversal are not covered by AHCIP. However, related surgeries, such as infertility treatment for women, are also not covered. Assisted reproductive technologies, including in vitro fertilization (IVF) and other infertility treatments, are also completely excluded from AHCIP coverage. A single cycle of IVF in Canada can cost between $10,000 and $15,000, and insurance rarely covers it.
Psychological services are not covered, unlike psychiatric services. If you need psychotherapy, cognitive behavioral therapy, or any other form of psychological help from a psychologist, you will have to pay for it. In Edmonton, a private psychological consultation typically costs between $100 and $200 per session, and many people require several sessions per month.
The services of other alternative practitioners are also not covered. This includes chiropractors, massage therapists, acupuncturists, naturopaths, homeopaths, nutritionists, and other practitioners who work outside the realm of traditional Western medicine. These services can be very helpful for some people, but they are considered outside the scope of the AHCIP system.
Telephone consultations with a doctor outside of regular office hours are not covered unless they are specifically listed in the schedule of medical benefits. Some doctors offer a hotline for their patients, but if you need a paid consultation during the evening or on weekends, you will have to pay for it.
Prescription drugs
Prescription drugs that you get at the pharmacy after leaving the hospital are not covered by AHCIP. This is one of the biggest expenses for many people. If your doctor prescribes medication to control your blood pressure, diabetes, cholesterol, or any other condition, you will have to pay for it at the pharmacy. Medications can cost anywhere from a few dollars to several hundred dollars per month, depending on the medication.
Alberta has a program that helps some people with the cost of medications. The Alberta Drug Benefit Program provides coverage for people who meet income eligibility criteria. Some people also have private insurance through their employer that covers part of the cost of prescription drugs. However, many people still pay significant amounts for medications out of their own pocket.
Vitamins and supplements are also not covered. If you want to take vitamin D, multivitamins, fish oil, or any other supplements, you will have to purchase them yourself at a pharmacy, health store, or online. The cost of these products varies, but many people spend between $20 and $100 per month on supplements.
Medical records and reports
Medical documents and reports required for third parties are not covered by the system. If your employer needs a medical certificate stating that you are healthy, or if you need a certificate explaining why you are absent from work, you will have to pay for it. Typically, a simple one-page certificate costs between $45 and $55.
If a doctor needs to do a detailed assessment to write a comprehensive medical certificate for an employer or insurance company, the cost can range from $100 to $145. Disability reports for the CPP-D (Canada Pension Plan – Disability) program can cost between $100 and $275, depending on the complexity of the document. Dietary restriction reports for working with food, medical forms for auto insurance, and other documents also require payment.
Vaccines and Immunizations
Most vaccines for common illnesses are covered by the AHCIP. This includes childhood vaccines, flu shots, COVID-19 vaccines, and others. However, travel vaccines are not covered. If you plan to travel to areas with a high risk of yellow fever, typhoid, hepatitis A, Japanese encephalitis, or other tropical diseases, you will have to pay for the vaccines.
The cost of travel vaccines can be significant. The yellow fever vaccine costs about $100-150, the typhoid vaccine about $75-125, and the hepatitis A vaccine about $50-80. If you need multiple vaccines, the total cost can be several hundred dollars.
Services and programs that help with costs
Medical and Preventive Care Assistance Program for Seniors
For people over 65 with low to moderate incomes in Alberta, there is a program called Dental and Optical Assistance for Seniors. This program provides partial coverage for dental and optical services. This means that if you are a senior citizen with a low income, you can get some help with the cost of glasses or certain dental services.
For people aged 65+, there is also the Alberta Seniors Health Benefit program, which provides some coverage for prescription drugs. Based on your income, the government may pay most of the cost of your drugs, leaving you with a small contribution. This is a big help to seniors, who often take a lot of medication.
Alberta Aids to Daily Living Program
If you need medical devices such as hearing aids, prosthetics, crutches, wheelchairs, or other aids to help with daily activities, they are not covered by AHCIP. However, the Alberta Aids to Daily Living Program may be able to provide some of these devices. This program has restrictions on which devices it covers and there are eligibility criteria, but for some people it can be a significant help with costs.
Prescription Drug Coverage Program
The Alberta Drug Benefit Program helps people with the cost of prescription drugs based on their income. If you need to take expensive medications, this program may cover part of the cost. However, there are restrictions on which medications are covered, and you must have a prescription from a doctor to access the program.
Conclusion and practical advice
Understanding what services are covered by public health insurance in Edmonton is critical to managing your health and your budget. In short, the AHCIP system covers all medically necessary medical services, hospitalization, diagnostics, and surgeries. However, it does not cover prescription drugs, dental work, eyeglasses, psychological services, and many other services that may be critical to your health.
Newcomers to Edmonton are advised to register for AHCIP as soon as possible, find a family doctor, and ask them about what services are available to you and what costs you will have to cover yourself. In addition, consider purchasing private insurance for expenses not covered by the government, such as prescription drugs, dental work, and eye care. Some employers provide private insurance, sharing the cost with employees, which can significantly reduce your medical expenses.