The number that determines whether a health condition affects your Canadian immigration application
Most immigration applicants who have a chronic illness, a disability, or a significant medical history ask the same question: will this affect my application? In Canada, the answer depends on a specific number — the excessive demand cost threshold — which IRCC updates every year and uses to assess whether a health condition would place too great a burden on Canada’s publicly funded health and social services.
For 2026, that threshold is CAD $28,878 per year, or CAD $144,390 over five years. If IRCC projects that managing your medical condition would cost more than this in publicly funded services, you may be found medically inadmissible on excessive demand grounds — unless you fall into an exempt category or can successfully respond to IRCC’s concerns.
This guide explains exactly what this threshold means, how IRCC calculates it, which conditions typically trigger it, who is exempt, and what you can do if IRCC raises concerns about your medical admissibility. For a broader overview of medical inadmissibility, see our guide to medical inadmissibility in Canada.
What is excessive demand?
Excessive demand is one of three grounds on which an immigration applicant can be found medically inadmissible to Canada under the Immigration and Refugee Protection Act (IRPA). The other two are danger to public health (primarily active tuberculosis or untreated syphilis) and danger to public safety (serious mental health conditions with a history of violence).
Of the three, excessive demand is by far the most commonly encountered by economic immigrants. It applies when IRCC determines that an applicant’s health condition is likely to require health or social services whose costs would exceed the designated cost threshold, or whose demand would negatively affect service wait times for Canadian citizens and permanent residents already in the system.
The threshold is not a fee paid by applicants. It is a benchmark IRCC uses internally to assess whether projected costs associated with a condition cross the line into inadmissibility. An applicant does not pay the threshold amount — IRCC uses it to evaluate whether their expected healthcare costs would be too high.
How the 2026 threshold was calculated
IRCC sets the excessive demand threshold annually based on triple the average Canadian per capita cost of health services. It is adjusted each year to reflect changes in national healthcare spending.
The 2025 threshold was CAD $27,162 per year, or CAD $135,810 over five years. The 2026 increase to CAD $28,878 per year represents a rise of approximately 6.3% — an increase of CAD $1,716 per year or CAD $8,580 over the five-year assessment period.
This annual increase is significant for applicants who were close to the threshold in prior years. An applicant whose projected annual healthcare costs were CAD $27,500 — just above the 2025 threshold — would now fall below the 2026 threshold, potentially resolving their inadmissibility concern without any change to their medical situation.
What services are included in the cost calculation
IRCC calculates excessive demand using the projected cost of publicly funded services only. Privately paid care, private insurance, and out-of-pocket expenses do not count toward the threshold in most cases — only services funded by public health and social service budgets are included.
Health services included in the calculation:
- Physician services and specialist consultations
- Hospital inpatient and outpatient care
- Nursing care
- Expensive prescription medications covered by public drug plans
- Specialized medical equipment
- Diagnostic imaging (MRI, CT scans, X-rays beyond the IME)
- Physiotherapy and other allied health services funded publicly
Social services included in the calculation (health-related only):
- Home care and personal support services
- Residential care facilities
- Vocational rehabilitation services (where health-related)
- Special education services (where health-related)
What is not included:
- Services paid for out of pocket or through private insurance
- General social assistance or income support programs
- Services not directly related to the medical condition being assessed
Private insurance can be relevant in limited contexts — for example, outpatient prescription medications in some provinces — but applicants generally cannot opt out of publicly funded core health services simply by holding private coverage. IRCC does not accept a promise to use only private care as a basis for removing the excessive demand concern.
The two pathways to an excessive demand finding
Even if projected costs fall below the CAD $28,878 annual threshold, an applicant can still be found inadmissible on excessive demand grounds through a second, separate pathway: wait time impact.
IRCC assesses whether the demand for services created by an applicant’s condition would negatively affect the wait times of Canadian citizens and permanent residents already waiting for those services. This pathway is particularly relevant for conditions that require access to services that already have long wait lists — certain surgical procedures, specialist consultations, or residential care placements.
Both pathways are assessed independently. Passing the cost test does not automatically mean passing the wait time test. An applicant whose projected costs are below the threshold could still receive an excessive demand finding if their condition would significantly worsen existing wait times for a particular service.
Who is exempt from the excessive demand rules
The excessive demand threshold does not apply to all immigration applicants. Several categories are exempt — meaning only the public health and public safety grounds apply to them, not the cost or wait time assessment.
Refugees and protected persons. Convention refugees, government-assisted refugees, and privately sponsored refugees are exempt from excessive demand assessments. This reflects Canada’s humanitarian obligations under international refugee law.
Spouses, common-law partners, and conjugal partners of Canadian citizens or permanent residents. Sponsored spouses and partners are exempt from excessive demand. IRCC’s policy recognizes that family reunification is a core immigration objective and that separating families on health cost grounds is inconsistent with that objective.
Dependent children. Dependent children — whether accompanying or non-accompanying — are exempt from the excessive demand assessment.
Note on parents and grandparents. Parents and grandparents sponsored under the Parents and Grandparents Program (PGP) are not exempt. They are subject to the full excessive demand assessment, which is why the program sees a relatively higher rate of medical inadmissibility findings compared to other family class streams. This is a common source of confusion — spousal and dependent child sponsorships are exempt, but parental sponsorships are not.
Economic immigrants, PNP nominees, and most other applicants are not exempt. Express Entry candidates, provincial nominee applicants, business class immigrants, and most temporary residents are fully subject to the excessive demand threshold.
Conditions that commonly trigger excessive demand assessments
No condition automatically triggers medical inadmissibility — IRCC’s assessment is based on projected costs specific to the individual applicant, not on a list of prohibited diagnoses. However, certain types of conditions are more likely to generate costs above the threshold because they typically require expensive ongoing care.
Conditions that commonly come under scrutiny include severe intellectual or developmental disabilities requiring residential care or intensive support services; advanced kidney disease requiring dialysis; conditions requiring high-cost biologics or specialty medications covered by public drug plans; serious cardiac conditions requiring ongoing hospital-based management; advanced HIV requiring expensive antiretroviral regimens not available as generics; and conditions requiring long-term residential or nursing care.
A diagnosis of diabetes, depression, asthma, controlled hypertension, or most common chronic conditions does not typically generate costs above the threshold — particularly where management costs are low and services required are standard. The concern arises when the projected annual publicly funded cost of managing a condition over five years is likely to exceed CAD $28,878 per year.
The procedural fairness letter – your opportunity to respond
If a medical officer reviewing your immigration medical exam results determines that your condition may cause excessive demand, IRCC does not immediately refuse your application. Before making a final decision, IRCC must issue a Procedural Fairness Letter (PFL).
The PFL is not a refusal. It is a formal notice that outlines the medical concern, explains the projected costs IRCC has estimated, and gives you an opportunity to respond before a final decision is made. You generally have 90 days from the date of the letter to submit your response, and you can request an extension if genuinely needed.
Your response to the PFL can include:
Updated medical evidence. If your condition has improved, stabilized, or changed since your exam, submit updated reports from your treating physician or specialist. A current diagnosis, updated prognosis, or change in treatment plan can change the cost projection significantly.
Evidence challenging IRCC’s cost estimate. IRCC’s projections are based on average costs for a given condition. If your situation requires less expensive treatment than the average — for example, because your condition is well-controlled on generic medications — provide evidence of actual current and projected costs.
A mitigation plan. IRCC may invite you to submit a mitigation plan — a structured explanation of how you will ensure that certain costs are covered without relying on publicly funded services, where legally permitted. A mitigation plan must be credible, detailed, individualized, and supported by financial documents demonstrating your ability to fund private alternatives. It must include a signed Declaration of Ability and Willingness confirming you can and will fulfill the commitments made.
Not every applicant will be invited to submit a mitigation plan — IRCC determines on a case-by-case basis whether a mitigation plan is appropriate for the specific condition and circumstances.
What happens if IRCC refuses the application
If IRCC issues a final refusal on excessive demand grounds after reviewing your PFL response, you have several options depending on your immigration category and circumstances:
Request for reconsideration. You can submit new evidence or legal arguments asking IRCC to reconsider the decision. This is not an appeal — it is a request to the same office that made the decision, and it requires genuinely new information that was not available at the time of the original decision.
Appeal to the Immigration Appeal Division (IAD). Some applicants — particularly those refused in family class — have the right to appeal to the IAD. Express Entry and most economic class refusals do not have a right of appeal to the IAD; judicial review at the Federal Court is the available recourse.
Judicial review at the Federal Court. You can apply for judicial review of the decision on the grounds that IRCC made a legal error or that the decision was unreasonable. A Federal Court judge reviews the decision — they do not substitute their own assessment but can send it back to IRCC for redetermination if errors are found.
Humanitarian and compassionate grounds (H&C). An H&C application asks IRCC to exercise discretion and grant permanent residence despite inadmissibility, based on factors including the best interests of children, establishment in Canada, and hardship if refused. H&C is a discretionary remedy, not a right, and success is not guaranteed.
If you receive a procedural fairness letter or a refusal on excessive demand grounds, seek advice from a licensed immigration lawyer or authorized immigration consultant immediately. The timelines are strict and the legal options require expert navigation.
Common misconceptions about excessive demand
“If I can work, I cannot be refused.” Work capacity does not resolve excessive demand. The assessment is about projected publicly funded costs, not employment ability. An applicant who is fully employed and contributes taxes can still be found inadmissible if their condition requires expensive publicly funded care.
“Private insurance means excessive demand does not apply.” Private insurance can be relevant in limited contexts for certain medications or social services, but applicants cannot opt out of the public health system for core services. IRCC does not accept a blanket promise to use private care as removing the excessive demand concern.
“My family doctor said I am healthy enough — that should be enough.” IRCC’s assessment is based on the immigration medical exam conducted by an approved panel physician, not your family doctor’s opinion. Panel physician findings and IRCC medical officer assessments are the basis of the decision.
“The threshold is what I will pay.” The threshold is a decision benchmark, not a fee. It is the level at which IRCC estimates publicly funded costs become excessive. You do not pay the threshold amount.
Frequently asked questions
What is the excessive demand threshold for 2026? The 2026 excessive demand threshold is CAD $28,878 per year, or CAD $144,390 over five years. This is set by IRCC and updated annually based on average Canadian per capita healthcare costs.
How is the threshold calculated? IRCC sets the threshold at approximately three times the average Canadian per capita cost of health services. It is reviewed and updated each year. The 2026 figure increased by approximately 6.3% from the 2025 threshold of CAD $27,162 per year.
Does the threshold apply to my spouse and children? Sponsored spouses, common-law partners, and dependent children are exempt from the excessive demand assessment. The threshold does not apply to them. Parents and grandparents under the PGP are not exempt and are subject to the full assessment.
What conditions typically trigger an excessive demand finding? Conditions that require expensive ongoing publicly funded care — such as severe developmental disabilities requiring residential support, advanced kidney disease requiring dialysis, or conditions requiring high-cost specialty medications — are more likely to generate costs above the threshold. Common chronic conditions managed with standard care typically do not.
What is a procedural fairness letter? A procedural fairness letter is IRCC’s formal notice that a medical concern has been identified. It is not a refusal — it is an opportunity to respond with updated evidence or a mitigation plan within 90 days.
What is a mitigation plan? A mitigation plan is a structured submission showing how you will ensure certain healthcare costs are managed without relying on publicly funded services, where legally permitted. It must be supported by financial documentation and a signed Declaration of Ability and Willingness. IRCC must invite you to submit one — not every applicant is eligible.
Can I appeal an excessive demand refusal? Options depend on your immigration category. Family class applicants may appeal to the Immigration Appeal Division. Economic class applicants typically have recourse through Federal Court judicial review or an H&C application. Seek legal advice immediately if refused.
Does the threshold change every year? Yes. IRCC updates the excessive demand threshold annually. It is important to check the current year’s threshold when assessing your situation — a condition that was above the threshold in a prior year may now fall below it.
Concerned about how a medical condition may affect your application?
The first step is completing your immigration medical exam with an IRCC-approved panel physician. Use the IRCC Doctors directory to find an approved physician in your city or country. If you have concerns about how a specific condition may be assessed, speak with a licensed immigration lawyer or consultant before your exam — not after.
Last updated: May 2026. The excessive demand threshold is updated annually by IRCC. Always verify the current threshold at canada.ca before making any decisions based on this information.