Quebec’s healthcare system is based on a founding principle: medically necessary care is accessible to everyone, at no out-of-pocket cost, through the Régie de l’assurance maladie du Québec. This principle remains valid—but the reality in 2026 is that the public system faces significant structural pressures that are creating delays, gaps, and gray areas in access to care. Approximately 900,000 Quebecers still do not have a registered family doctor, hospital emergency rooms have median wait times of several hours, and a growing number of medical services relevant to health 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
The RAMQ covers all medical services deemed medically necessary that are provided by physicians participating in the public health plan: office visits, house calls, hospital care, surgeries, emergency care, specialist consultations, and prescription diagnostic tests—including lab tests, X-rays, ultrasounds, and CT scans—as well as medications covered by the public health plan for eligible individuals. In theory, this is very comprehensive coverage. In practice, several factors will limit its actual accessibility in 2026.
The main obstacle remains access to a family doctor. Without a designated doctor registered through the Primary Care Access Portal, getting an appointment for a non-urgent issue can take days or weeks through the available walk-in services. For urgent but non-critical situations—such as infections, acute pain, or issues that do not warrant a trip to the hospital emergency room—wait times at walk-in clinics can be several hours. Furthermore, certain consultations for health issues perceived as lower priority by the public system struggle to receive prompt care: annual preventive health checkups, evaluation of a mild chronic condition, and follow-up on test results.
Services not covered by RAMQ: what you'll still have to pay for
Regardless of delays in the public system, a range of medical services relevant to health are not and will not be covered by the RAMQ—not because the system is in crisis, but because they have been deliberately excluded from the public health insurance plan. Being aware of this list helps you avoid surprises and plan your healthcare expenses wisely.
Comprehensive preventive health screenings for asymptomatic adults with no identified risk factors are not covered—the RAMQ covers diagnostic tests based on clinical indications, not routine annual preventive screenings. Medical examinations for non-therapeutic purposes—driver’s licenses, life and disability insurance, medical certificates for employment or education, sports medicine, and aviation medicine—are the responsibility of the applicant. Cosmetic medicine—injections, chemical peels, and 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 system are also not covered.
Clinique Omicron's mixed model: public and private under the same roof
Omicron Clinic operates under a hybrid RAMQ/private model that clearly illustrates how the two systems can complement each other in a way that benefits the patient. Doctors participating in the RAMQ public health insurance plan treat patients for medical conditions covered by the plan at no out-of-pocket cost to patients who hold a valid health insurance card. At the same time, the clinic offers a range of services not covered by RAMQ—preventive health screenings, aviation medicine, cosmetic medicine, certain tests for administrative purposes, and telemedicine for specific services.
This model offers a tangible benefit for patients: continuity of medical records. When a private consultation—whether for a preventive checkup or an insurance-related exam—identifies a medical issue requiring follow-up or treatment, the doctor can immediately initiate care within the scope covered by the RAMQ. The patient is not shuffled between multiple facilities that lack communication with one another. This integration is particularly valuable for people without a family doctor—many of our locations in Quebec offer extended walk-in access for routine consultations covered by the 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 set by the Quebec Health Insurance Act and the Hospital Insurance Act. These laws prohibit physicians participating in the public health insurance plan from billing patients for services covered by the RAMQ—doing so would constitute illegal overbilling. However, services not covered by the RAMQ may legitimately be billed to the patient, whether by a participating or non-participating physician. Physicians who do not participate in the RAMQ plan are free to bill for their consultations, but patients receive no reimbursement from the RAMQ for these consultations. The legal framework is therefore clear: paying for uncovered care is perfectly legal; paying for care that is normally covered under the public health insurance plan is not.
Does my group insurance cover private clinic visits?
It depends entirely on the terms of your group insurance policy. Most group insurance plans cover prescription medications, paramedical care—such as physical therapy, psychology, and osteopathy—and sometimes eye and dental exams. Some policies, particularly high-end plans or supplemental health insurance plans, provide partial or full reimbursement for preventive health screenings at private clinics, consultations for medical examinations—such as those related to life insurance or sports medicine—or certain mental health services. It is strongly recommended that you review your coverage summary or contact your insurer directly to find out your specific coverage before scheduling a private consultation.
If I go to a private clinic for a preventive checkup and a problem is detected, will the RAMQ cover the subsequent treatment?
Yes, in the vast majority of cases. If a private preventive health screening reveals high blood pressure, diabetes, dyslipidemia, or any other condition requiring medical treatment, the subsequent therapeutic care—follow-up visits, prescriptions, follow-up tests, and referrals to specialists—is covered under the RAMQ’s medical coverage. The fact that the diagnosis was made during a private consultation does not deprive the patient of their right to public coverage for the medically necessary care that results from it. This is precisely one of the advantages of the mixed model: private investment in preventive care can generate significant health benefits by enabling early detection, with treatment costs subsequently covered collectively.
Is it better to go to the emergency room or consult a private clinic for an urgent, non-critical problem?
For a true medical emergency—chest pain, difficulty breathing, neurological deficits, severe trauma, suspected appendicitis—the hospital emergency department remains the appropriate place to go, regardless of the wait time. For urgent but non-critical issues—such as a urinary tract infection, an ear infection, bacterial strep throat, a wound requiring stitches, acute localized pain with no signs of serious underlying conditions—a medical clinic offering walk-in or telemedicine consultations may be a faster and less stressful alternative than waiting several hours in the emergency room, while still being covered by the RAMQ. The appropriate course of action depends on the nature and severity of the problem—if in doubt, the nurses at the Info-Santé 811 service can help determine the most appropriate course of action.
Omicron Clinic
Need to consult a doctor?
In-person or via telemedicine, anywhere in Quebec.
We accept insurance. Telemedicine consultations available 7 days a week. No family doctor required.
