International students live, work and pay taxes in Ontario like any other residents. National data show more than 275,000 international students in Canada work while enrolled.
Yet those who fall ill while studying in Ontario are excluded from the province’s public health-care system. Beyond the financial inequity lies the question of whether people who contribute to their communities should be denied the basic medical care afforded to others.
In 2022-23, more than 256,000 international students called Ontario home and contributed $16.9 billion to Canada’s gross domestic product (GDP). The province’s auditor general noted in a 2021 report that international tuition revenue contributed nearly $1.7 billion to colleges in Ontario. That exceeded the $1.6 billion in public funding from the province.
Yet despite contributing academically, culturally and economically, international students are excluded from Ontario’s Health Insurance Plan (OHIP) and must rely on fragmented private insurance that routinely leaves gaps in care.
Paying twice for health care
Domestic students automatically qualify for OHIP, but international students at public universities are usually enrolled in the University Health Insurance Plan (UHIP). Colleges and private institutions negotiate their own plans with insurers.
These arrangements seem fair on paper. However, in practice, international students pay twice for health care — once through the taxes they pay and again through annual premiums that currently run about $800 to almost $2,400 for mandatory private insurance. These costs are often tucked into long lists of ancillary fees attached to tuition and are easily overlooked.
Private insurance also provides international students with less coverage. Most domestic students are eligible for OHIP+, which covers prescription medications for Ontarians under age 24 who don’t have private insurance.
However, international students, who are largely in the same age group, are excluded and must rely on the university private plan, which does not cover prescription drugs outside hospital care.
Stress and economic hardship
A few years ago, while I was studying at a public university in Ontario, a close friend had a serious fall at a gym. Our immediate concern wasn’t just her injury, it was whether we could afford the care she might need. We weren’t sure what her private plan would cover and were worried about surgery, medication and physiotherapy costs. The stress compounded the fear of the medical emergency itself.
Even basic diagnostic services can become a financial burden. Health-care providers often ask international students to pay upfront before treatment or consultation because not all providers accept UHIP.
This is discouraged under the Canada Health Act to ensure medically necessary services are available based on need, not ability to pay. To enforce that, the federal government introduced a reimbursement policy to ensure providers uphold accessibility.
An unequal design
The health-care inequity facing international students in Ontario is not accidental, but structural. In 1994, the province eliminated OHIP coverage for them. Since then, post-secondary institutions have had wide discretion over what health services are included under UHIP and how much students must pay. As a result, coverage varies dramatically.
This lack of standardized fees violates the principle of equity that Ontario’s public institutions should uphold. It also undermines Canada’s image as a fair and inclusive country for education.
International students are drawn here by the promise of safety, opportunity and high-quality public programs, including access to health care. But being denied the same care as others sends students the opposite message — that they are outsiders valued only for their money.
Add to this that post-secondary education in Ontario has become increasingly reliant on international tuition to fill gaps left by stagnant provincial funding. This overreliance deepens inequity. Public institutions depend on international students to stay afloat yet exclude them from the health care their dollars help sustain.
Health as a measure of belonging
During my studies in Ontario, I never truly felt welcome in the health-care system. It felt conditional, coverage was inconsistent and I was constantly reminded that I was an outsider.
Now, I am living and pursuing my education in Alberta, where I am currently eligible for public health care. I finally feel included and genuinely part of the community to which I contribute.
However, Premier Danielle Smith’s recent announcement of a fall referendum that may introduce changes to eligibility for provincially funded programs, including health care for international students and others, has created renewed uncertainty. Will this inclusion continue?
Universal health care was built on the idea that people should not be denied care because of who they are or from where they come. Leaving students without basic health coverage creates a contradiction between Canada’s values and its practices. True inclusion means extending fairness beyond citizenship status.
A better way forward
There are several ways for Ontario to make health care more accessible and equitable for international students.
The most straightforward step would be to extend OHIP to them. It’s an approach already adopted by four provinces that offer public coverage: Alberta, Newfoundland & Labrador, Saskatchewan and New Brunswick.
Using average per-person health spending for Canadians under age 65 (about $2,700 annually), the cost of covering Ontario’s 256,000 international students would be roughly $700 million a year, less than one per cent of Ontario’s overall health spending.
Some may argue that extending OHIP to international students would be a strain and require new spending, but the experience of other provinces shows that these concerns are often overstated.
Approaches other than all-out provincial coverage demonstrate that reform is financially and administratively feasible.
British Columbia charges students $75 a month for six months to receive public coverage for an entire year. Manitoba provides international students with an International Student Health Plan that mirrors the province’s medically necessary coverage and is offered at no cost. Nova Scotia allows students to transition into its medical service insurance benefits once residency requirements are met.
These models show that Ontario has options for fairer medical coverage for international students.
It could take an important first step by requiring minimum standards for private university health plans. These would need to match OHIP+ benefits, particularly prescription drug coverage. This alone would close some of the most significant gaps and bring UHIP closer to what domestic students already receive.
International students are asking only for fairness. They live, study and work alongside domestic students. They contribute to the tax base, are part of a cultural vibrancy of Ontario’s cities and should be treated equally when they are ill and need medical care.
Only then will they feel truly welcome and a valued part of Canada’s most populous province.
