On November 24, 2025 the Alberta government unveiled its proposed legislation to revise the province’s public health insurance. The government says the legislation is intended to modernize practice rules for physicians, but also drug coverage, shifting the province into a “payor of last resort” position for anyone with employer-sponsored health benefits.

According to the government, the changes made under Bill 11, the Health Statutes Amendment Act, 2025 include allowing Alberta employers to offer employees access to private health services from a physician through their health plans and prevent employers from terminating or reducing health benefits for employees over age 65 who are actively employed.

Amendments related to modernizing practice rules for physicians will come into force upon proclamation planned for spring 2026. Under the new legislation, physicians in Alberta’s publicly funded system will be allowed to work in both public and private settings, “toggling” between the two on a case by case and patient by patient basis.

“Alberta patients will continue to receive care through a strong public health system but will also have the option to purchase services they are currently waiting for,” Minister Adriana LaGrange stated in a press conference held after the bill’s unveiling. “Family physicians will not be eligible for flexible participation at this time.” Similarly, they say cancer treatments and emergency surgeries will remain fully covered by the public plan with no private options, at this time.

Amendments related to drug coverage, meanwhile, would come into force upon proclamation planned for summer 2026.

Currently, they say 76 per cent of Albertans have employer-sponsored health insurance. “Oftentimes there’s ambiguity as to who will be the first payor. This just sets it out in legislation that we will be the payor of last resort,” LaGrange said. “Those that do have plans, they should access those plans first and we would be the second payor – very similar to the dental programs that are out there.” 

Closely monitoring changes 

When asked for comment about the new legislation, the Canadian Life and Health Insurance Association (CLHIA) would only say the association is closely monitoring the changes. They add that it will take some time for insurers to fully understand all of the details.

“That’s probably very accurate,” says professor of political science and C.D. Howe Institute fellow in residence, Katherine Fierlbeck. “They are really watching this because this is really quite volatile. Insured services, non-plan services and what the Act says is that everything is essentially dependent upon whether the Minister of Health wishes to weigh in.” 

In a series of columns for the C.D. Howe Institute, entitled Alberta’s Proposed Health Insurance Changes, I, II and III, Fierlbeck explains what is meant by insured and non-plan services in the province and discusses what is meant by “flexibly participating physicians.” 

She says allowing physicians to practice privately is likely compliant with the Canada Health Act, as the Act does not actually require all medically necessary care to be publicly insured.

“We think that the Canada Health Act says that all medically necessary care should be provided publicly. That’s what the common perception is. But if you actually read the Canada Health Act, it nowhere says that,” she says. “When the Canada Health Act came out in 1984, there was a follow up interpretation letter, which explicitly stated that the provinces were able to determine which services they wanted to insure and that they had the right to determine what was medically necessary. It varies from province to province.” 

She adds that all insured services are generally medically necessary by definition, but the reverse is not true: All medically necessary services are not necessarily publicly insured. 

As well, when Canadian medicare was first set up, she says health care was such that everything medically necessary was either provided in a hospital or by doctors. “So those were what was insured,” she says.

Wide expansion of scopes of practice 

Since then, particularly in the past six years in Canada, there has been a wide expansion of scopes of practice for a number of regulated healthcare professionals (nurse practitioners and pharmacists among them), alongside an explosion in the offering of virtual services which she says demands a look at the role of private insurance.

“Once you have a viable market in private services, then the question becomes should you be able to use private insurance? Because we haven’t really had much of a market in private health care, per se. Until quite recently, the whole question about private insurance has been, for the most part, completely moot.” 

Fierlbeck adds that some provinces do disallow private insurance, but others don’t. “Provinces should start thinking about where they want to stand on private insurance. Now would be a good time to start thinking about it.”