BC's Medical Services Plan: how to enroll, the three-month wait and covering the gap

Canada's public health care is real, and once you're in, you'll rarely see a medical bill. The catch: in BC, coverage doesn't start when you arrive. Plan for a gap of up to three months.

The short version

• Every BC resident must enroll in the Medical Services Plan (MSP), the province's public health plan [1].
• Work and study permit holders can qualify if the permit is valid for six months or more [2].
• The wait is the rest of the month you become a resident, plus two full months [3]. Land in March, and you're typically covered from June 1 [5].
• Apply the week you arrive. Waiting doesn't shorten anything, and applying late can leave you uncovered longer [3][5].
• Buy private insurance before you leave the States and keep it until MSP starts. Emergency care before then is billed at full cost [3].

Who qualifies for MSP

To be a BC resident for MSP, you need to be a Canadian citizen or permanent resident, make your home in BC, and be physically present in the province for at least six months in a calendar year [2]. Some people on temporary status can also be "deemed residents":

Your spouse, kids and dependent post-secondary students (over 18 and under 25, studying full-time) can be covered too, as long as they're BC residents [2]. A common-law partner counts as a spouse if you're in a "marriage-like relationship" [2].

Heads-up for families: each person's wait is calculated separately, from their own arrival date [3]. If you move up in August for the job and your spouse and kids follow in October after the school semester, they'll be on a different clock than you.

One more wrinkle: the Ministry of Health, not you, decides your residency date. It depends on your immigration status and can be later than the day you crossed the border [3]. If you entered as a visitor and switched to a work permit later, your clock starts from the switch [3].

How the wait is counted

The rule is "the balance of the month in which residence is established, plus two months" [1][3]. In practice:

So arriving on the 1st of a month gives you the shortest real wait, about three months, and arriving at the end of a month gives you just over two. If you have any flexibility on your start date, the calendar is worth a look.

Waivers exist but are rare. BC says they're approved only in "the most serious and exceptional cases," where costs during the wait were financially devastating, and it looks at whether you had or could have bought private insurance [3]. Don't count on one.

How to enroll, step by step

1. Get a BC address. You'll need one to apply online [5].
2. Apply through the BC Application for Health and Drug Coverage. The same form covers MSP, Supplementary Benefits and Fair PharmaCare. You can apply online, on paper, or in person at a Service BC location [1].
3. Include your family members who live with you in BC.
4. Wait for confirmation. Processing takes a few weeks, and coverage is dated from your eligibility date, not your application date [5].
5. Verify your ID for the BC Services Card. Most adults have to visit an ICBC driver licensing office with primary and secondary ID, declare BC residency and get a photo taken [1]. If you're swapping your US license for a BC one anyway, you can do both at once. Kids and temporary document holders get a non-photo card by mail [1].
6. Keep proof of when you applied, in case a date is ever disputed [5].

Questions go to Health Insurance BC: 604-683-7151 in the Lower Mainland, 1-800-663-7100 elsewhere in BC [1].

Covering the gap

BC is blunt about it: if you're arriving from outside Canada, arrange private health insurance before you arrive and keep it until MSP starts. Hospitals will treat you in an emergency, but you pay the full cost, and those costs can be very high [3]. A clinic visit or ER trip without coverage can run from hundreds to thousands of dollars [5].

What to know when shopping:

• Your US plan probably won't do it. Most US employer and Marketplace plans cover little or nothing outside the US except emergencies, and Medicare generally doesn't pay for care outside the US at all. Read the fine print on "foreign travel" coverage.
• Look for "new immigrant" or "visitors to Canada" policies. Many have to be bought before or on the day you arrive, and buying late can leave gaps or void coverage [5].
• Pre-existing conditions and pregnancy are usually excluded. BC warns that most private insurers won't cover them [3]. If you're pregnant or have an ongoing condition, sort this out before you sign the job offer.
• Ask your new employer. Some Canadian employers arrange interim cover for new hires from abroad, and most offer an extended health plan for things MSP doesn't pay for.
• Fill prescriptions before you go. Bring a 90-day supply of regular meds if your US insurer allows it.

What MSP does and doesn't cover

Once you're in, MSP pays for medically necessary doctor visits and hospital care. No copays, no deductibles, no surprise network bills. But it isn't everything:

That's why the extended health plan at your job matters. It's the Canadian version of the coverage you got from your employer back home, just layered on top of a public base.

Finding a family doctor is its own project in Vancouver, where many people wait to get one. Register with the province's Health Connect Registry once you have MSP, and use walk-in clinics in the meantime.

Traveling once you're covered

MSP covers unexpected care outside Canada, but only up to what the same service would have cost in BC [4]. A US ER bill will blow past that fast. BC itself recommends private travel insurance, even for short trips [4]. So yes, that Thanksgiving trip to see family in Ohio needs travel cover.

If you want to keep a US plan alive for visits home, or you're weighing whether to keep Medicare Part B while living abroad, see our Medicare guide below before you decide.

For tips on which interim policies other newcomers used, ask in our community group for Americans in Canada.

Sources

1. How to apply for the Medical Services Plan (MSP), Province of British Columbia
2. Eligibility for MSP, Province of British Columbia
3. Coverage wait period for the Medical Services Plan, Province of British Columbia
4. Medical Services Plan brochure, Health Insurance BC
5. As a newcomer to BC, when does my health care coverage start?, People's Law School

Keep reading

• Healthcare and health insurance in Vancouver
• Moving to British Columbia: work permits and the BC PNP
• Driving in Canada with a US license, and getting around Vancouver
• Medicare when you live abroad