For Americans moving to Canada, healthcare is one of the biggest adjustments. Nova Scotia operates under a publicly funded healthcare system, not employer-based insurance like in the U.S. The cornerstone of this system is MSI (Medical Services Insurance).
MSI provides government-funded medical coverage for eligible residents, covering essential healthcare without premiums, deductibles, or co-pays for medically necessary services.
What Is MSI (Medical Services Insurance)?
MSI is Nova Scotia’s provincial public health insurance plan.
It is not private insurance, and it is not tied to employment.
Once approved, most core healthcare services are provided at no cost at the point of care.
Canada spends ~10.8% of GDP on healthcare, compared to ~17% in the U.S., yet achieves comparable or better health outcomes (OECD, 2024).
Who Is Eligible for MSI in Nova Scotia?
Eligibility depends on immigration status and intent to reside in the province for at least 183 days per year. Must receive an NOI from province through Nova Scotia PNP Draw
1. Permanent Residents (PRs)
- Eligible immediately after establishing residency
- No waiting period for most PRs
- Applies to Express Entry, PNP, AIP, and family sponsorship
2. Work Permit Holders
Eligible if:
- Work permit is valid for 12 months or more
- You live primarily in Nova Scotia
Includes:
- Skilled workers
- Healthcare professionals
- Trades & hospitality workers
- Atlantic Immigration Program (AIP) workers
Short-term or seasonal permits usually do not qualify.
3. International Students
- Eligible only if the study program is 12 months or longer
- Most students maintain private or university insurance for prescriptions and dental care
Waiting Periods: What Americans Need to Know
Nova Scotia has largely removed mandatory waiting periods.
- Most eligible newcomers receive coverage upon approval
- Some cases may require up to 3 months, depending on documentation
- Coverage start date depends on when you apply, not arrival date
Tip: Apply within your first 1–2 weeks in the province.
Documents Required to Apply
You’ll need:
- Passport
- PR card or CoPR / Work Permit / Study Permit
- Proof of Nova Scotia address (lease, utility bill, employer letter)
- Family documents (if applicable)
Incomplete applications are the #1 reason for delays.
How to Apply for MSI
Apply in person at Access Nova Scotia (Halifax, Dartmouth, Truro, Sydney, etc.).
Process:
- Submit MSI application form
- Provide immigration + residency documents
- Receive confirmation of coverage
- Health card arrives by mail in 2–4 weeks
What MSI Covers (Key Difference from U.S. Insurance)
Fully Covered
- Family doctor visits
- Emergency room care
- Hospital stays & surgeries
- Specialist consultations (with referral)
- Diagnostic tests (X-rays, blood work, CT, MRI when medically necessary)
There are no co-pays, no deductibles, and no surprise bills for covered services.
Settlement Agencies Offering Health Support
Key organizations include:
- ISANS (Immigrant Services Association of Nova Scotia)
- YMCA Newcomer Services
- Local community immigrant centres
What MSI Does NOT Cover
This is where Americans often need clarification.
- Dental care (routine)
- Prescription drugs (most adults)
- Vision care (eye exams, glasses)
- Paramedical services (physio, chiropractic)
Most newcomers purchase supplemental private insurance for these gaps.
Finding a Doctor in Nova Scotia
Canada does not allow self-referral to specialists.
Options:
- Register on the Need a Family Practice Registry
- Use walk-in clinics or virtual care
- Access urgent care centers
- Pharmacist-led minor ailment services
Doctor shortages exist, but access to emergency and urgent care is guaranteed.
Healthcare by the Numbers (Canada vs U.S.)
- Physician visits per capita: ~7.6/year
- Physician visits per capita: ~4.0/year
- Out-of-pocket healthcare spending: ~15%
-
Out-of-pocket healthcare spending: ~28%
(OECD Health Statistics, 2024)
Bottom Line for U.S. Newcomers
Healthcare in Nova Scotia is:
- Publicly funded
- Residency-based, not employer-based
- Predictable and affordable
- Strong in emergency and hospital care
- Supplemented with private insurance for dental/drugs
Once MSI is approved, healthcare costs become dramatically lower and more predictable than in the U.S.
