How should Canadians, and indeed other visitors to the United States, deal with health care and the COVID-19 threat? The answer is complicated, but the details are laid out here.
In January of this year, the government of the Canadian Province of Ontario eliminated the Out of Country Travellers Program from the Ontario Health Insurance Plan. The Ontario Health Insurance Plan (OHIP) is a government-operated health insurance system for Ontario residents. As the province moved ahead with its plan, it became the first jurisdiction in Canada to eliminate coverage for emergency hospital and physician services received outside the country. While the move was attacked as being inconsistent with the Canada Health Act, which stipulates that all Canadians are entitled to continuing coverage of their provincial health plans when they are temporarily absent from home, the Ontario government proceeded nonetheless. From that moment on, Ontario residents became liable to cover the costs of their health care outside Canada, if they required medical attention while traveling. Canadians from other provinces face similar circumstances.
To address this challenge, the Ontario Ministry of Health recommended that residents get private insurance. The Health Ministry noted that many people already had travel medical insurance coverage through their employee benefit plans, or credit cards. Indeed, many Canadian financial institutions and automobile clubs also offer short-term travel medical insurance. Even Loblaws, the country’s largest supermarket chain, offers travel insurance under its President’s Choice Financial brand.
The matter of health care coverage in the U.S. boils down to your status while being present there. Many immigrants in the United States are eligible to access health insurance under the Affordable Care Act, or what has come to be known as Obamacare. The key criterion is to be “lawfully present.” This includes individuals who are lawful permanent residents, asylees, refugees, foreign nationals admitted under any nonimmigrant visa who are in status, and certain other classifications under the Immigration and Nationality Act. Canadians in TN, L-1, E-2, O-1 and P visa status therefore all qualify. However, visitors and people who are not legally present in the United States do not.
Of course, at the time Ontario made its change, Covid-19 was not yet evident in the life of most people in North America. There was no consideration of what this change might mean for Canadians visiting the United States in the context of the pandemic and the absence of provincial health care coverage. In the case of Ontario, and indeed in the case of very limited health care coverage even from other Canadian provinces, the question became: What will happen if a Canadian comes down with the virus while visiting the United States?
The answer depends on the stages such a Canadian would go through.
Getting Tested – Stage 1
The only way to confirm if you have COVID-19 is, of course, through a laboratory test. This means that if a Canadian has any symptoms, he or she needs to contact a local public health authority. In this case, it is pretty clear that getting tested for Covid-19 is free to everyone, including Canadian visitors. It is covered by legislation enacted by Congress in that regard. So as far as getting tested is concerned, that should not be a problem for Canadians.
Indeed, to ensure against the possibility that some aliens impacted by COVID-19 may be hesitant to seek necessary medical treatment or preventive services because it could impair their ability to later apply for an immigration benefit, the U.S. Citizenship and Immigration Service has indicated “it will neither consider testing, treatment, nor preventative care (including vaccines, if a vaccine becomes available) related to COVID-19 as part of a public charge inadmissibility determination, nor as related to the public benefit condition applicable to certain nonimmigrants seeking an extension of stay or change of status, even if such treatment is provided or paid for by one or more public benefits, as defined in the rule (e.g. federally funded Medicaid).” In short, Canadians are safe from any negative consequence from being tested or treated for COVID-19 in terms of an application for a U.S. immigrant status later.
Treating Coronavirus – Stage 2
Since most people with mild coronavirus illness will recover on their own, usually what is required is that they isolate at home for 14 days. However, if you must be treated, as a Canadian, there is some good news and some bad news in that regard.
The good news is that there is a federal law called the Emergency Medical Treatment and Labor Act that requires that anyone arriving at an emergency room/department be stabilized and treated regardless of insurance status or ability to pay. The bad news is that the Act does not provide any payment for these services. Therefore, individuals who are uninsured may be billed for this treatment. (Some hospitals have charity care or other ways to reduce a bill, but this is not always available and cannot always meet the need.) So the short answer is you will get the treatment, but you will be liable for the cost. If you have insurance, hopefully that will cover the cost. If not, you will be stuck with the bill. There are some insurance travel plans for Canadians that will cover Covid-19. One is SafetyWing, another is HeyMondo. However, you must shop carefully and these must be arranged before travel.
To summarize, Canadians need medical insurance to travel to the USA. If they do not have insurance but need to be tested for the Coronavirus, there should be no problem since testing is free. If, however, it turns out they need treatment in a hospital, while they will not be denied care, they will most likely be liable for the cost of care. In the case of those who have valid U.S. immigrant status, they may be eligible for Obamacare. But in the case of Canadian visitors, coverage is not available. This is a serious challenge since the cost of care in U.S. hospitals can be very substantial, often thousands of dollars a day. The best plan would be to investigate insurance and obtain it before facing such a health care problem.