When applying for permanent residence in Canada, all applicants and some temporary resident applicants are required to undergo a medical examination as part of the application process. The cost threshold used to assess medical inadmissibility under the Excessive Demand provision has now been increased.

Excessive Demand refers to a situation where an applicant is expected to require health or social services whose costs would significantly exceed the average Canadian per capita cost. Based on the results of the medical examination, if an applicant is projected to exceed the established cost threshold after settling in Canada, the application may be refused on medical grounds.

Excessive Demand Cost Threshold

Under Canadian immigration law, physicians use a defined cost threshold to determine whether an applicant’s anticipated health and social service costs exceed three times the average Canadian cost.
As of January 1 2026, the Excessive Demand threshold has been set at CAD 144390 over five years or CAD 28878 per year.
If an applicant is expected to require health or social services exceeding CAD 144390 over five years or CAD 28878 annually, the application will be refused.

The applicable Excessive Demand threshold is determined by the date on which the medical assessment is conducted by a medical professional. The thresholds below apply based on the timing of the medical evaluation.

In 2022, a public policy was implemented allowing exemptions from the Excessive Demand provision when certain ministerial conditions were met. One of the eligibility conditions under this policy was that the applicant’s required health and social service costs did not exceed CAD 24057 per year.

Health services include a wide range of medical services such as the provision of related equipment, diagnostic testing, and pharmaceuticals. More than half of the funding for these services is provided directly by the government or through publicly funded agencies.

Health Services Included in Medical Cost Assessments

The following are included when calculating health service costs:

• Physician services
• Nursing services
• Laboratory and diagnostic services
• Pharmaceuticals and pharmaceutical services
• Hospital services
• Chemotherapy and radiotherapy
• Dialysis
• Psychiatric services
• Supplies related to these services

Social services refer to home based or institutional care, including the provision of care related equipment, when recommended by a medical professional and funded more than fifty percent by the government or publicly funded agencies. These services are intended to support physical, emotional, social, psychological, and occupational functioning.
They also include services where most financial assistance provided directly or indirectly to the recipient is funded by the government.

Social Services Included in Cost Assessments

The following are included as social service costs:

• Home care provided by nurses, physiotherapists, respiratory therapists, or other care providers
• Palliative care
• Psychological counseling
• Medical aids, appliances, and prostheses
• Social services that provide constant supervision and care for individuals unable to integrate into society, including
  residential facilities such as long term care and substance abuse services
  day facilities providing constant supervision such as respite care

Social Services Not Included in Cost Assessments

The following are not considered social service costs:

• Specialized education related services, including the development of individualized education plans and educational assistants
• Social and vocational rehabilitation and recovery services, including rehabilitation facilities, occupational therapy, behavioural therapy, and speech therapy
• Non professional personal support services such as assistance with daily activities including bathing, dressing, eating, meal preparation, and household cleaning

In permanent residence and visa applications, the majority of refusals related to medical examinations are based on Excessive Demand findings. Applicants with pre existing medical conditions whose uninsured medical costs are expected to be high may fall under this category.
If you have concerns about how medical admissibility may affect your application, we encourage you to consult with our office.

This article is a summary prepared by Visa JP Canada based on official information from Immigration, Refugees and Citizenship Canada (IRCC), organized for clarity and ease of understanding.
Source: Medical inadmissibility (English)