Key takeaways
- IRCC lists 3 reasons for medical inadmissibility: danger to public health, danger to public safety, and excessive demand on health or social services
- A condition causes excessive demand if the services needed would negatively affect wait times in Canada, or would likely cost more than the threshold
- 2026 cost threshold: $144,390 (CAD) over 5 years, or $28,878 (CAD) per year
- The excessive demand rules do not apply to refugees and their dependants, protected persons, and certain people sponsored by family, such as dependent children, spouses and common-law partners
- If IRCC thinks you may be inadmissible, you get a procedural fairness letter before the final decision. You have 90 days from the date of the letter to respond, or you must ask for an extension
What “excessive demand” means
IRCC says there are 3 possible reasons for medical inadmissibility: danger to public health, danger to public safety, and excessive demand on health or social services. This guide is about the third reason.
A condition causes excessive demand if the health or social services needed “would negatively affect wait times for services in Canada,” or “would likely cost more than the excessive demand cost threshold.” See IRCC’s medical inadmissibility page.
The 2026 cost threshold
| Period | 2026 threshold (CAD) |
|---|---|
| Over 5 years | $144,390 |
| Per year | $28,878 |
This guide does not estimate whether any condition is above or below the threshold.
Who is exempt
IRCC says the excessive demand rules do not apply to:
- refugees and their dependants
- protected persons
- certain people being sponsored by their family, such as dependent children, spouses and common-law partners
IRCC’s wording, “such as,” is not a full list, and the page does not name every category. Economic-class family members, for example the spouse of an Express Entry applicant, are not in the listed exceptions, so this guide does not say they are exempt. Check IRCC’s page for your case.
The procedural fairness letter and the 90-day clock
If IRCC thinks you may be inadmissible, you receive a procedural fairness letter before a final decision is made. You can send information in response. IRCC gives these examples: treatment that cured or improved the condition, a changed medication, or a switch to “a lower cost equivalent.”
IRCC says: “All additional information must be sent within 90 days from the date of the letter. If you can’t respond by that date, you must contact us to request an extension.” You can use a representative, but IRCC says it is “not required.”
Mitigation plans: what they can cover
Not everyone can give a mitigation plan. If it applies to you, IRCC invites you to send one. IRCC says the plan must be “credible, detailed and individual to you.” It must show how the services you need will be provided, how you will pay for them, and what your financial situation will be for the entire time you need services, with financial documents. You must also submit a signed Declaration of Ability and Willingness form. See IRCC’s mitigation plans page.
IRCC says that if you do not need social services or outpatient prescription medications, it will not invite you to submit a mitigation plan. You cannot opt out of publicly funded health services, except for outpatient prescription medication in some provinces or territories. See IRCC’s Help Centre answer.
What the regulation says
Section 34(2)(d) of the Immigration and Refugee Protection Regulations lists, as a medical factor, whether a mitigation plan would provide for appropriate treatment and would be permitted under the rules for delivering health care in Canada. Section 34(3) says the officer “shall not consider non-medical factors, including (a) the foreign national’s intent and financial ability to mitigate any excessive demand; and (b) the feasibility of a mitigation plan.” See the regulation on Justice Laws.
IRCC’s mitigation page asks for financial information, and the regulation limits what the officer considers. These pages do not explain how the two fit together, and this guide does not either.
What this means for you
- You are a sponsored spouse, common-law partner or dependent child: IRCC lists you as an example of people the rules do not apply to. Check your category on the IRCC page.
- You received a fairness letter: note the date on the letter. The 90 days start from that date.
- You are invited to send a mitigation plan: read IRCC’s list of what the plan must show before you prepare it.
What to do next
- Read IRCC’s medical inadmissibility page for your application type.
- If you get a fairness letter, mark the 90-day date and gather the documents IRCC asks for.
- If you need more time, contact IRCC before the date to ask for an extension.
- For exam steps, see our guides on the medical exam for family members and the in-Canada medical exemption.
Frequently asked questions
What is the 2026 excessive demand threshold?
$144,390 (CAD) over 5 years, or $28,878 (CAD) per year.
Are sponsored spouses exempt?
IRCC says the rules do not apply to certain people sponsored by family, such as dependent children, spouses and common-law partners.
How long do I have to respond to a fairness letter?
90 days from the date of the letter. If you cannot respond by then, you must contact IRCC to request an extension.
Do I need a representative?
No. IRCC allows representation but says it is not required.
Can I opt out of public health services in a mitigation plan?
No, except for outpatient prescription medication in some provinces or territories.
Sources
- IRCC: Medical inadmissibility
- IRCC: Mitigation plans
- IRCC Help Centre: Mitigation plans and public health services
- Justice Laws: Immigration and Refugee Protection Regulations, section 34
Facts as provided in our research brief dated October 22, 2026.
This is general information, not legal or immigration advice. For your situation, consult a licensed immigration consultant (RCIC) or lawyer.
