Ottawa, January 06, 2026 — Canada has officially increased the excessive demand cost threshold used in immigration medical assessments for 2026. This change affects how Immigration, Refugees and Citizenship Canada evaluates whether an applicant’s health condition could place an unreasonable burden on publicly funded health or social services.
Medical inadmissibility remains one of the most complex and misunderstood aspects of Canadian immigration law. While many applicants focus on eligibility points, work experience, or language scores, health admissibility quietly plays a decisive role in both temporary and permanent residence applications.
This article explains what the excessive demand rule means, what changed in 2026, who is affected, and how applicants can respond if concerns are raised by IRCC.
Anyone applying to visit, study, work, or immigrate to Canada must be admissible under the Immigration and Refugee Protection Act. Admissibility includes criminal, security, and health grounds.
Under Canadian law, a foreign national may be found medically inadmissible if their health condition is likely to:
| Ground | Description |
|---|---|
| Danger to public health | Risk of spreading communicable diseases |
| Danger to public safety | Risk of sudden incapacity or violent behavior |
| Excessive demand | Likely high cost or strain on public health or social services |
Among these, excessive demand is the most common reason for refusal in economic immigration streams.
Excessive demand does not mean that a person is unhealthy or incapable of working. It is a financial and system capacity assessment.
IRCC evaluates whether the medical services an applicant is expected to need would:
The focus is on publicly funded services, not private spending or personal wealth.
For 2026, IRCC has raised the excessive demand cost threshold used in medical assessments.
| Assessment Period | Cost Limit |
|---|---|
| Annual limit | $28,878 |
| Five year limit | $144,390 |
This threshold represents three times the average Canadian per capita cost of health and social services over five years, as defined by regulation.
The increase for 2026 reflects inflation and rising healthcare costs across Canada.
| Year | Annual Threshold | Five Year Threshold |
|---|---|---|
| 2025 | $27,162 | $135,810 |
| 2026 | $28,878 | $144,390 |
| Increase | $1,716 | $8,580 |
| Percentage change | About 6.3 percent | About 6.3 percent |
While the increase is modest, it can make a difference for applicants whose projected costs fall near the margin.
The excessive demand threshold is not a fee and cannot be paid to avoid refusal. It is a decision making benchmark used by medical officers.
Applicants may still be refused even if their projected costs are below the threshold if the services required would significantly worsen wait times.
IRCC can refuse an application through two pathways:
Both pathways are assessed independently.
Medical inadmissibility can affect a wide range of applicants.
| Category | Impact |
|---|---|
| Temporary residents | Visitors, students, workers requiring a medical exam |
| Permanent residence applicants | Express Entry, PNP, business streams |
| Family members | Accompanying and sometimes non accompanying dependants |
Importantly, a family member’s medical inadmissibility can affect the entire application in many immigration categories.
Many applicants misunderstand what services are included in excessive demand assessments.
| Type | Definition |
|---|---|
| Health services | Publicly funded physician care, diagnostics, hospital services, funded medications |
| Social services | Institutional or residential care recommended by a health professional and publicly funded |
Not all social support programs are included. The definition is narrower than commonly assumed.
IRCC relies on immigration medical exams and supporting evidence. Medical officers assess:
Officers must follow regulations that restrict what they can consider.
| Not Allowed | Reason |
|---|---|
| Applicant income | Not a wealth based test |
| Willingness to pay | Intent alone is irrelevant |
| Employment prospects | Non medical factor |
This ensures a standardized assessment across all applicants.
Excessive demand decisions are not limited to cost alone.
| Test Type | Explanation |
|---|---|
| Cost threshold test | Whether projected costs exceed $144,390 over five years |
| Wait time impact test | Whether services would worsen wait lists and health outcomes |
An applicant may pass the cost test but still face refusal under the wait time assessment.
The new threshold helps illustrate how assessments work in practice.
| Estimated Annual Cost | Five Year Projection | Likely Outcome |
|---|---|---|
| $30,000 | $150,000 | High risk of excessive demand |
| $25,000 | $125,000 | Lower cost risk but wait times still assessed |
| $15,000 | $75,000 | Unlikely excessive demand |
Actual assessments use detailed service breakdowns rather than rough estimates.
Canadian law provides clear exemptions for certain groups.
| Category | Exemption Scope |
|---|---|
| Refugees and protected persons | Fully exempt from excessive demand |
| Sponsored spouses and partners | Cost threshold not applied |
| Dependent children | Cost threshold not applied |
These applicants can still be assessed for public health or safety concerns.
Before refusing an application, IRCC often issues a procedural fairness letter.
This letter outlines concerns and allows the applicant to respond with additional evidence.
| Stage | Timeframe |
|---|---|
| Letter issued | Day 0 |
| Response deadline | Usually 90 days |
| Extension | Possible upon request |
Applicants should treat this as a legal opportunity, not a refusal notice.
Mitigation plans are allowed only when IRCC invites them.
A mitigation plan explains how certain costs will be managed without relying on public services where legally permitted.
Applicants generally cannot opt out of publicly funded healthcare services. Private insurance cannot replace core public health services.
| Requirement | Description |
|---|---|
| Service explanation | What care is required |
| Cost coverage | How eligible costs will be paid |
| Financial proof | Documents for entire care period |
| Signed declaration | Ability and willingness statement |
Many refusals stem from misunderstandings.
| Myth | Reality |
|---|---|
| Being able to work prevents refusal | Work capacity is irrelevant |
| Private insurance avoids excessive demand | Limited impact only |
| Promising not to use services is enough | Intent is not considered |
Understanding these distinctions is critical for applicants and families.
The increase in the 2026 excessive demand threshold offers some relief, especially for borderline cases. However, it does not eliminate risk for conditions that require high ongoing public funding.
Applicants should:
Medical admissibility is a legal assessment, not a judgment of personal worth or capability.
IRCC does not refuse based on diagnoses alone. Risk depends on projected public service use and system impact.
Yes. Medical admissibility is not based on how you feel or your ability to work.
Submit updated medical evidence, clarify actual service needs, and provide accurate cost information that directly addresses IRCC’s concerns.
Yes. In many immigration streams, one person’s inadmissibility can lead to refusal of the entire application, unless exemptions apply.
