Canada Increases Excessive Demand Cost Threshold On Health Services In 2026

Last Updated On 6 January 2026, 10:03 AM EST (Toronto Time)

Canada has increased the excessive demand cost threshold in 2026, the benchmark the immigration department uses when assessing whether an applicant’s health condition could create an “excessive demand” on publicly funded health or social services.

This update matters because medical inadmissibility can affect applicants across virtually every temporary and permanent immigration pathway.

The excessive demand is often the least discussed among applicants but is the most consequential (and most misunderstood) health-ground refusal risk for economic and certain non-exempt streams.

So let’s dive deep into the specifics of medical inadmissibility around the “excessive demand” on publicly funded health or social services, as it is part of eligibility in almost every application, be it for temporary residency or permanent residency.

What Is Medical Inadmissibility In Canada?

If you apply to visit, study, work, or immigrate to Canada, you must be admissible—including on health grounds.

Under the Immigration and Refugee Protection Act (IRPA), a foreign national can be found medically inadmissible if their health condition is likely to:

be a danger to public health
be a danger to public safety
cause excessive demand on health or social services

While “danger” grounds are typically tied to communicable diseases or safety risks, the excessive demand ground is a cost-and-capacity test tied to publicly funded services.

What Changed In 2026: The New Excessive Demand Cost Threshold

IRCC’s published 2026 excessive demand cost threshold is:

$144,390 over 5 years
$28,878 per year

To understand the “increase” in practical terms, the 2025 figures were $135,810 over 5 years (or $27,162 per year).

That puts the 2026 threshold higher by $8,580 over 5 years (and $1,716 per year), an increase of about 6.3% compared to 2025.

Why The Threshold Matters For Immigration Applicants

The threshold is not a “fee” you pay. It is a decision benchmark IRCC uses to evaluate whether the publicly funded costs associated with treating and managing a health condition are likely to exceed the threshold over the assessment period.

Separately, even if projected costs do not exceed the threshold, an applicant can still be refused if the services they require would materially worsen wait times for Canadians and permanent residents in a way that increases health harms.

In other words, excessive demand has two pathways to refusal:

a cost threshold pathway (projected publicly funded costs exceed the benchmark), or
a wait-times pathway (demand would add to existing wait lists in a way that worsens outcomes).

Who Can Be Affected By Medical Inadmissibility

Medical inadmissibility can apply to:

temporary residents (visitors, students, and foreign workers), when a medical exam is required for the application type or intended occupation/length of stay
permanent residence applicants across economic classes (Express Entry streams, PNPs, business pathways) and certain family-based categories
accompanying and (in some cases) non-accompanying family members, because a family member’s inadmissibility can affect the overall application depending on category and rules

The key practical point is that you do not need to have a rare condition to trigger a review.

The issue is not the label; it is the projected publicly funded service footprint.

What “Excessive Demand” Means Under Canadian Rules

IRCC’s medical officers do not guess. They are directed by legislation and regulation to assess medical evidence and then apply defined tests.

The 5-Year Cost Test

The regulations define “excessive demand” (cost side) as demand where anticipated costs exceed triple the average Canadian per capita health and social services costs over a period of 5 consecutive years following the most recent immigration medical exam.

Practically, that definition is what produces an annually updated national threshold number (like the 2026 threshold of $28,878 per year).

In the current regulatory definitions:

health services generally mean publicly funded health services (including things like laboratory services and publicly funded pharmaceuticals, and related devices) where more than half the funding is contributed by governments (directly or through publicly funded agencies).
social services are defined more narrowly than many people assume: residential or institutional care recommended by a health professional, where more than half the funding is publicly contributed.

That narrower definition is a key nuance: not every “social support” program a person might use is automatically part of an excessive demand assessment.

What IRCC Looks At During The Medical Assessment

IRCC indicates that medical inadmissibility decisions rely on the immigration medical exam and supporting medical evidence.

In general, the officer/medical officer considers the condition’s diagnosis, prognosis, and the services likely required to treat and manage it—then weighs those services against the excessive demand rules.

When assessing “excessive demand,” the regulations also specify factors the officer must consider (and must not consider), including:

reports from health practitioners or laboratories
whether a mitigation plan would provide appropriate treatment and would be permitted under the rules
and a prohibition on considering non-medical factors such as the applicant’s intent and financial ability to carry out a mitigation plan, or the feasibility of the plan

This is why excessive demand is not simply a “can you pay?” question.

The framework is designed to be a standardized public-cost and system-impact test, not a wealth test.

Worked Examples Using The 2026 Threshold

Because the 2026 annual threshold is $28,878, you can think of the benchmark like this:

Annual benchmark: $28,878
5-year benchmark: $144,390

Example scenarios (simplified):

If an applicant’s projected publicly funded services are estimated at $30,000 per year, the 5-year projection is about $150,000, which exceeds $144,390 and can trigger an excessive demand finding (unless the wait times and other legal/medical considerations change the outcome).
If projected publicly funded services are estimated at $25,000 per year, the 5-year projection is about $125,000, which is below the threshold; excessive demand would be less likely on the cost side (though the wait-times side can still matter in certain cases).

In real files, costs are built from the expected “basket” of services: medication coverage (where publicly funded), specialist visits, diagnostics, hospital or institutional care, and other medically recommended supports that meet the definitions.

Exemptions: Who Is Not Subject To Excessive Demand Rules

Even if an applicant has a condition that could be costly, IRPA creates an explicit exception to the excessive demand ground for specific groups.

In law, the excessive demand paragraph does not apply to certain foreign nationals, including (commonly summarized as):

refugees and protected persons
certain family-sponsored applicants, such as sponsored spouses/common-law partners and dependent children

These applicants can still be assessed for danger to public health or public safety, but the cost-threshold test is not applied in the same way.

Procedural Fairness Letters: What Happens If IRCC Has Concerns

If IRCC believes you may be medically inadmissible, they may issue a procedural fairness letter before making a final refusal.

The letter explains the concern and gives you an opportunity to respond with updated information.

IRCC’s public guidance highlights that applicants may submit evidence about:

diagnosis and current status (including treatment outcomes)
medications and services required (including changes to treatment plans)
updated costs (including lower-cost equivalents where clinically appropriate)

IRCC may also indicate you generally have 90 days from the date of the letter to respond, and you can request an extension if needed.

Mitigation Plans: When They Apply And What Must Be Included

A mitigation plan is a structured explanation of what you will do to ensure you will not cause excessive demand on health or social services.

Not everyone can submit one—IRCC states you will be invited to provide a mitigation plan only if it applies to your situation.

A Critical Limitation Many Applicants Miss

IRCC’s mitigation-plan guidance is explicit that you cannot opt out of publicly funded health services (with limited exceptions related to outpatient prescription medication in some provinces/territories).

As a result, you generally cannot submit a mitigation plan simply to “cover the cost of health services.”

Instead, mitigation plans typically focus on:

how certain future expenses related to the condition will be supported, such as outpatient prescription medication (where private coverage is possible), and
how eligible social services costs may be addressed through private arrangements (where applicable and credible).

Mitigation Plan Checklist (What IRCC Says Your Plan Must Show)

IRCC indicates a mitigation plan must be credible, detailed, and individualized, and should show:

how the services you need will be provided
how you will pay for those services
what your financial situation will be for the entire period you need services (with financial documents)
plus a signed Declaration of Ability and Willingness

This is typically submitted as part of your response to the procedural fairness letter.

Common Misconceptions That Cause Applicants To Misread Risk

“If I’m healthy enough to work, I can’t be refused.”
- Work capacity does not automatically resolve projected public cost or wait-time impacts.
“If I have private insurance, excessive demand doesn’t apply.”
- Private coverage can be relevant in limited contexts (notably outpatient prescription medication in some cases and eligible social services), but you generally cannot “opt out” of the public health system for core services.
“I can just promise I won’t use services.”
- The framework is built around medical evidence and projected need, not personal promises; and officers are directed not to decide based on non-medical factors like intent or ability alone.

The 2026 threshold ($144,390 over 5 years) modestly increases the ceiling before the cost-based excessive demand test is triggered, compared to commonly cited 2025 levels.

That does not eliminate risk for conditions with high ongoing publicly funded treatment footprints, but it can be meaningful at the margins—especially for applicants whose projected costs were near the prior benchmark.

For applicants and families, the operational takeaway is straightforward:

understand which health and (narrowly defined) social services are likely to be assessed
treat a procedural fairness letter as a structured evidence exercise, not a rejection notice
and respond with updated clinical information and cost evidence that directly addresses what IRCC raised.

Frequently Asked Questions

What medical conditions most commonly lead to medical inadmissibility in Canada?

Canada does not refuse people simply because of a diagnosis. IRCC focuses on three legal tests: danger to public health, danger to public safety, or (for non-exempt applicants) excessive demand on publicly funded health or social services. In practice, risk is driven by the expected need for publicly funded services and system impacts (including wait times), not by the name of a condition alone.

Can I be found medically inadmissible even if I feel fine and can work or study?

Yes, medical inadmissibility is not a fitness-to-work test. IRCC can still assess whether your condition is likely to create a public health/safety risk or require services that significantly strain publicly funded systems, even if you are functioning well day-to-day.

What should I do if I receive an IRCC procedural fairness letter for medical inadmissibility?

Treat it as a structured evidence request, not an automatic refusal. Provide updated medical reports (diagnosis, prognosis, treatment response), clarify what services you actually require, and submit credible cost and care details that directly address IRCC’s concerns. If your situation allows it, a mitigation plan may be relevant, but your response should be medically grounded and specific to the issues raised in the letter.

If one family member is medically inadmissible, can the entire application be refused?

In many streams, family members are assessed and one person’s inadmissibility can affect the whole application, depending on the category and rules for accompanying dependants. Separately, certain groups (including refugees/protected persons and some close family sponsorship categories) are exempt from refusal specifically on the excessive-demand ground, but public health and public safety assessments can still apply.

Kamal Deep Singh, RCIC

Kamal Deep Singh, RCIC (Regulated Canadian Immigration Consultant) licensed by CICC (formerly known as ICCRC) with member number R708618. He brings extensive knowledge of immigration law and new changes to rapidly evolving IRCC.