Quebec's healthcare system is based on a founding principle: medically necessary care is accessible to all, at no direct cost, thanks to the Régie de l'assurance maladie du Québec. This principle remains valid - but the reality of 2026 is that the public system faces significant structural pressures that create delays, gaps and gray areas in access to care. Some 900,000 Quebecers still don't have a registered family doctor, hospital emergency rooms have median wait times of several hours, and a growing number of health-relevant medical services are simply not covered by the RAMQ.
In this context, the question of when and why to use a private medical clinic becomes a practical decision that many Quebecers ask themselves. Neither ideologically simple nor economically trivial, this decision deserves clear information on what each system covers, how they can complement each other, and in what situations recourse to private care represents a rational - even necessary - choice to protect one's health.
What RAMQ covers - and its practical limits in 2026
RAMQ covers all medically necessary medical services provided by physicians participating in the public plan: office consultations, home visits, hospital care, surgery, emergencies, specialty consultations, prescription diagnostic tests - laboratory analyses, X-rays, ultrasounds, scans, drugs covered by the public plan for eligible individuals. In theory, this is very broad coverage. In practice, however, a number of realities limit effective accessibility in 2026.
The main obstacle remains access to a family doctor. Without a regular doctor registered via the Guichet d'accès à la première ligne, getting an appointment for a non-urgent problem can take days to weeks via the available troubleshooting mechanisms. For urgent but non-critical situations - infection, acute pain, problems that don't warrant hospital emergencies - waiting times at walk-in clinics can reach several hours. What's more, some consultations for health problems perceived as less of a priority by the public system struggle to get prompt attention: annual preventive check-ups, assessment of a mild chronic condition, follow-up of test results.
Services not covered by RAMQ: what you'll still have to pay for
Irrespective of the delays in the public system, a whole range of health-relevant medical services are not and will not be covered by RAMQ, not because the system is in crisis, but because they have been deliberately excluded from the public health insurance scheme. Knowing this list can help you avoid surprises and plan your health expenses in an informed way.
Complete preventive check-ups for asymptomatic adults with no identified risk factors are not reimbursed - RAMQ covers clinically indicated diagnostic examinations, not systematic annual preventive check-ups. Medical examinations for non-therapeutic purposes - driver's licenses, life and disability insurance, medical certificates for employment or studies, sports medicine, aviation medicine - are at the applicant's expense. Aesthetic medicine - injections, peels, rejuvenation treatments - is entirely private, with the exception of rare recognized medical indications. Screening tests not included in official screening programs, certain travel vaccines, clinical nutrition consultations in certain contexts, and many mental health services outside the public network are also not covered.
Clinique Omicron's mixed model: public and private under the same roof
Clinique Omicron operates on a hybrid RAMQ/private model that illustrates how the two systems can complement each other in a coherent way for the patient. Physicians participating in the public RAMQ plan treat patients for their covered medical problems at no direct cost to the patient holding a valid health insurance card. At the same time, the clinic offers a range of services not covered by RAMQ - preventive check-ups, aviation medicine, aesthetic medicine, certain examinations for administrative purposes, and telemedicine for specific services.
This model offers a concrete advantage for the patient: continuity of the medical file. When a private consultation - preventive check-up, insurance examination - identifies a medical problem requiring follow-up or treatment, the doctor can immediately initiate care within the framework covered by the RAMQ. The patient is not shuffled between several structures without communication. This integration is particularly valuable for people without a family doctor - many of our branches in Quebec offer extended walk-in access for routine consultations covered by RAMQ.
Frequently asked questions about private medicine vs. RAMQ in Quebec
Is it legal to pay for medical care in Quebec?
Yes, within the limits defined by the Quebec Health Insurance Act and the Hospital Insurance Act. These laws prohibit physicians participating in the public plan from billing patients for RAMQ-insured services - this would be illegal overbilling. However, services not covered by RAMQ can legitimately be billed to the patient, whether by a participating or non-participating physician. Physicians not participating in the RAMQ plan are free to bill for their consultations, but patients receive no reimbursement from RAMQ for these consultations. The legal framework is therefore clear: paying for care that is not covered is perfectly legal; paying for care that is normally covered under the public plan is not.
Does my group insurance cover private clinic visits?
This depends entirely on the terms of your group insurance contract. Most group plans cover prescription drugs, paramedical care - physiotherapy, psychology, osteopathy - and sometimes eye and dental examinations. Some policies, such as top-of-the-range insurance or supplementary health insurance plans, reimburse part or all of the cost of preventive check-ups in private clinics, consultations for medical examinations - life insurance, sports medicine - or certain mental health services. We strongly recommend that you consult your summary of benefits or contact your insurer directly to find out about your specific coverage before a private consultation.
If I go to a private clinic for a preventive check-up and a problem is detected, will subsequent care be covered by the RAMQ?
Yes, in the vast majority of cases. If a private preventive check-up reveals hypertension, diabetes, dyslipidemia or any other condition requiring medical treatment, the subsequent therapeutic management - follow-up consultations, prescriptions, control analyses, referral to a specialty - falls within the medical framework covered by the RAMQ. The fact that the diagnosis has been initiated in the context of a private consultation does not deprive the patient of his or her right to public coverage for the resulting medically necessary care. This is precisely one of the advantages of the mixed model: private preventive investment can generate considerable health value by enabling early detection, the treatment of which is then paid for collectively.
Is it better to go to the emergency room or consult a private clinic for an urgent, non-critical problem?
For genuine medical emergencies - chest pain, breathing difficulties, neurological deficits, severe trauma, suspected appendicitis - hospital emergency departments remain the appropriate recourse, whatever the wait. For urgent but non-critical problems - urinary tract infection, ear infection, bacterial angina, wounds requiring stitches, localized acute pain without signs of severity - a medical clinic offering walk-in or telemedicine consultations may represent a faster, less stressful alternative to several hours' waiting in the ER, while still being covered by the RAMQ. Appropriate referral depends on the nature and severity of the problem - if in doubt, Info-Santé 811 nurses can help determine the most appropriate recourse.
Omicron Clinic
Need to consult a doctor?
Treatment within 24-48 hours. In-clinic or telemedicine, anywhere in Quebec.
Insurance receipts. 7j/7. No family doctor required.
