In the Canadian immigration system, "Medical Inadmissibility" is a crucial but often overlooked assessment standard. Under the Immigration and Refugee Protection Act (IRPA), if a foreign national's health condition is likely to be a danger to public health or safety, or cause "excessive demand" on Canada's health and social services, their application may be refused.

As 2026 arrives, Canada has updated the specific monetary standards for judging "excessive demand."

2026 New Threshold Details and Comparison

IRCC’s published 2026 excessive demand cost thresholds are:

• 5-Year Cumulative Threshold: $144,390 CAD
• Annual Threshold: $28,878 CAD

To understand this change intuitively, we can compare it to the 2025 data: the 2025 5-year threshold was $135,810 (or $27,162 annually). This means the 2026 standard has increased by $8,580 over 5 years, and $1,716 annually, representing an increase of approximately 6.3%.

This figure is not arbitrary. By regulation, the cost ceiling for "excessive demand" is defined as three times the average Canadian per capita cost for health and social services.

The Dual Assessment Criteria for "Excessive Demand"

It is worth noting that exceeding the cost threshold is not the only reason for refusal. When assessing "excessive demand," IRCC actually follows two parallel assessment pathways:

1. The Cost Pathway: The applicant’s projected cost for public services exceeds the annual or 5-year threshold mentioned above.
2. The Wait-times Pathway: Even if projected costs do not exceed the threshold, if the medical services required by the applicant would occupy scarce resources and increase wait times for Canadian citizens or permanent residents—thereby increasing health risks—the application may also be refused.

Affected Groups and Exemptions

This policy covers almost all categories of immigration applications, including:

• Permanent Residence Applicants: Including Express Entry, various Provincial Nominee Programs (PNP), business immigration, and certain family sponsorship classes.
• Temporary Residents: Visitors, international students, or foreign workers, if their application type or intended length of stay requires a medical exam.
• Accompanying and Non-accompanying Family Members: In certain categories, if a family member is inadmissible due to health reasons, it can result in the refusal of the principal applicant's entire application.

However, the law explicitly defines exempt groups. Refugees, protected persons, and sponsored spouses, common-law partners, and dependent children are exempt from the "excessive demand" provision. While they must still undergo a medical exam to rule out public health and safety risks (such as infectious diseases), they will not be refused due to high medical costs.

Defining Health Services vs. Social Services

During the assessment, IRCC has specific definitions for "services," which are often narrower than applicants might expect:

• Health Services: Refers to publicly funded health services, including hospital care, laboratory services, publicly funded pharmaceuticals, and related devices.
• Social Services: Primarily refers to residential or institutional care recommended by a health professional (such as nursing home care), where the majority of funding is contributed by the government.

This means that not every "social support" program an applicant might use is automatically counted in the assessment; this nuance is critical for applicants with specific health conditions.

Procedural Fairness Letters and Mitigation Plans

If an officer believes an applicant's health costs may exceed the limit, they typically issue a Procedural Fairness Letter (PFL), giving the applicant an opportunity to explain and respond.

At this stage, applicants can submit a "Mitigation Plan." This is a step that is easily misunderstood. IRCC explicitly states that applicants cannot simply promise to "pay out of pocket" to avoid the cost calculation for public health services, because Canada generally does not allow individuals to opt out of the public health system (with limited exceptions for outpatient prescription drugs in some provinces).

Effective mitigation plans typically focus on:

1. Non-publicly funded items: Explaining how costs such as outpatient prescription drugs will be covered by private insurance or personal funds.
2. Social service arrangements: Demonstrating how eligible social service needs will be met through private arrangements, thereby avoiding the use of public resources.

The plan must be detailed, credible, and include proof of financial ability and a signed declaration of intent.

Conclusion

The increase in the 2026 "excessive demand" threshold objectively provides more room for approval for applicants with chronic diseases or specific health conditions. However, the immigration medical assessment remains a standardized and rigorous process, focusing on measuring public cost and system capacity rather than serving as a simple test of personal wealth. For applicants who may face health risks, understanding these policy details in advance is crucial.