Understanding the B.C. health system

How is health care structured in B.C.?

Primary care providers are your main, ongoing, health care support in non-emergency situations. These providers may be a family doctor or nurse practitioner. 

However, if you do not have a regular health care provider or cannot see them, a doctor or nurse practitioner at a walk-in clinic or urgent primary care centre can make needed referrals and provide care.

Medical specialists are experts in a particular area of health care, such as plastic surgery, gynecology or endocrinology. To see a specialist, you must get a referral from a primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. .

Who pays for health care in B.C.?

The government of B.C.’s health plan is called the Medical Services Plan (MSP). It pays for basic, medically required health services such as doctor visits, medical tests and treatments.

MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. does not cover all health care services.  For example, dentistry and medications are two costs that MSP does not cover.

MSP is for:

• B.C. residents who are Canadian citizens or permanent residents
• B.C. residents who are government-assisted refugees
• International students with study permits
• Some people with work permits for six months or more

What if you do not have MSP?

If you are not eligible for MSP you may be eligible for health care coverage in another way, such as:

• Interim Federal Health Program (IFHP Interim Federal Health Program. This is a limited and temporary health care plan that provides health care coverage to some groups of foreign nationals who are vulnerable, disadvantaged or ineligible for provincial or territorial health insurance. ) — this option provides limited, temporary health coverage for resettled refugees, protected persons and refugee claimants and their dependents. For more information on what’s covered by IFHP and how to enroll, visit our Information for Newcomers & Refugees page.
• A private health insurance plan — you may purchase private insurance, such as through your school’s international student health plan if you are a student.
• Health insurance from another Canadian province or territory — if you are from another province in Canada, you can use your home province’s health insurance in B.C. In most cases you will not be billed directly through a process called “reciprocal billing” with the exception of people with Quebec health insurance. To access gender-affirming surgery using your home province’s health insurance you will need to go through your home province’s care system. 

Extended health coverage and funding

Not all health care costs are covered by MSP or other types of health insurance. Health care such as dental, medications, medically necessary Treatments, procedures or services that health care professionals determine are essential for diagnosing or treating a medical condition based on established medical guidelines and individual patient needs. travel, counselling or other health products or services may not be covered through your provincial or private health insurance. In this case, you may be eligible for extended coverage and funding through:

• Fair PharmaCare — This program helps B.C. residents pay for many prescription drugs and dispensing fees, and some medical devices and supplies. The Fair PharmaCare Provides eligible BC residents with coverage for some prescription drugs and medical supplies. coverage you receive depends on your income. If you earn less, they cover more of these costs. Fair PharmaCare is available to B.C. residents covered by MSP. 
• First Nations Health Authority (FNHA) — Indigenous people in B.C. who have “Indian Status” may receive extended health benefits coverage through the FNHA  or through their Nation or Band. For more information on what’s covered by FNHA, visit our Information for Indigenous People page.
• Métis Nation British Columbia (MNBC)  — Métis citizens are eligible for counselling and other social service support through this program. For more information on what’s covered by MNBC, visit our Information for Indigenous People page.
• Extended health plans — You can get more coverage through private health plans. This may be purchased individually or provided by an employer. In some cases, your primary care provider will need to write a letter explaining why coverage is necessary. 

Funding for gender-affirming care

It can be tough to keep track of what is covered and who covers it. Use this overview of gender-affirming care coverage document to learn who covers what.

Challenges in getting health care

Research confirms that, unfortunately, transgender, non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. and Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) people experience barriers to receiving health care, including:

• Refusal of care
• Difficulty getting referrals
• Lack of provider knowledge on trans issues
• Uncomfortable or problematic interpersonal interactions

Helping health care providers better meet your needs

Trans Care BC provides training for health care providers to learn about respectful and appropriate care for trans people (visit our Education Centre to learn more about gender diversity and creating gender-affirming environments). Trans Care BC is working with partners in the health care system to improve care and reduce barriers, but in the current state, gaps in care do exist.

This means that transgender, non-binary and Two-Spirit people may need to educate their health care providers to ensure their needs are met. Our guide on Speaking with Your Provider About Gender-Affirming Care provides tips and guidance to help you communicate your trans health needs.

How to stand up for your rights or get additional support

• Provincial Language Service: If you need a spoken or sign language interpreter, you can ask your doctor or specialist to book one through this service.
• Trans Rights BC: Get information on your right to access health care.
• Health navigation team: This team provides information and resources for transgender, Two-Spirit, and non-binary people across B.C. This may include identifying local services and resources or helping people find a path to access gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. .