Canada Brings Back Mandatory Upfront Medical Exams for Express Entry Applications

In a significant policy reversal, Immigration, Refugees, and Citizenship Canada (IRCC) has announced that upfront medical exams will once again become mandatory for all Express Entry permanent residence applications. The new requirement takes effect on August 21, 2025, marking a return to pre-2023 procedures.

This change represents a complete about-face from October 1, 2023, when IRCC eliminated the upfront medical exam requirement as part of its efforts to streamline the Express Entry process.

What’s Changing and When

Starting August 21, 2025, all Express Entry applicants must complete their immigration medical examination (IME) before submitting their permanent residence application. According to Canada’s official immigration website, “If you’re applying under Express Entry, you must do a medical exam first. This is called an upfront medical exam.”

The timing matters: Applications submitted before August 21, 2025, will continue to follow the current process, where applicants receive medical exam instructions after submitting their complete application.

The Old vs. New Process

Before August 21, 2025:

1. Submit complete Express Entry application
2. Wait for IRCC instructions
3. Complete medical exam within 30 days of receiving instructions
4. IRCC makes final decision

After August 21, 2025:

1. Complete medical exam with approved panel physician
2. Obtain IME results and documentation
3. Submit complete Express Entry application with medical results
4. IRCC processes application with medical clearance already in hand

Why the Policy Reversal?

According to immigration experts, the change aims to “reduce late refusals, speed decisions, and give applicants clearer go/no-go information” before they invest time and money in the application process. However, this benefit comes with tradeoffs around timing, costs, and accessibility.

The upfront requirement means applicants will know their medical admissibility status before committing to the full application process, potentially saving those with medical issues from unnecessary application fees and processing time.

Impact on Different Applicant Categories

Express Entry Only

This change applies exclusively to Express Entry applicants. Other permanent residence programs, including family class sponsorships and Provincial Nominee Programs outside Express Entry, remain unaffected.

Current Canada Residents with Recent Medical Exams

There’s good news for applicants already in Canada. Applicants in Canada who have completed an immigration medical examination within the last five years (for example, for work or study permits) may be able to use their existing results.

When applying, these individuals can provide their IME number or unique medical identifier. If IRCC determines the previous results can’t be used, they’ll receive instructions for a new examination.

Medical Examination Requirements and Process

Finding an Approved Physician

All immigration medical exams must be conducted by IRCC-approved panel physicians. Applicants cannot use their personal doctors for these examinations.

To schedule an IME:

1. Visit IRCC’s panel physician directory
2. Select your country or territory
3. Contact a physician directly to book an appointment

What to Expect During the Exam

A comprehensive IME typically includes:

• Complete medical history review (surgeries, treatments, chronic conditions)
• Full physical examination (cardiovascular, respiratory, vision, etc.)
• Chest X-rays (primarily screening for tuberculosis)
• Blood and urine tests
• Mental health assessment when indicated
• Vaccination record verification

Cost Considerations

Medical exam fees vary by location but typically range from $140 to $280 per person. Additional costs may include:

• Specialist consultations if required
• Additional diagnostic tests
• Radiologist fees for X-rays
• Treatment of any identified conditions

Required Documentation

When attending your medical exam, bring:

• Valid identification (passport or national ID)
• Four recent passport-style photographs
• Complete list of current medications
• Medical records for existing conditions
• Vaccination history and certificates

Medical Admissibility Standards

Canada maintains strict health requirements for permanent residents. Applicants may be found medically inadmissible if their condition:

Excessive Demand Threshold

The most common reason for medical inadmissibility is if a health condition would likely create “excessive demand” on Canada’s public health services. This threshold is defined as exceeding three times the national average per capita healthcare cost, or $27,162 annually.

Managing Chronic Conditions

For applicants with conditions like diabetes, hypertension, or other chronic illnesses, demonstrating that the condition is well-controlled and stable can significantly improve the chances of medical approval.

Public Health Concerns

Certain infectious diseases may also result in inadmissibility if they pose a risk to public health, though many conditions can be managed with appropriate treatment.

Strategic Implications for Applicants

Timing Considerations

The new requirement creates additional complexity in application timing. Applicants must:

• Factor in medical exam scheduling (which can take weeks in busy areas)
• Wait for results processing (typically 30 days)
• Ensure medical results remain valid throughout the application process

Financial Planning

With upfront medical requirements, applicants face higher initial costs before knowing if their application will be successful. This represents a shift from the previous system where medical costs were incurred only after initial approval.

Geographic Challenges

The change raises “access concerns” for applicants in remote areas where panel physicians may be scarce or difficult to reach. This could particularly impact applicants from rural areas or developing countries with limited medical infrastructure.

Bottom Line

This policy change represents a significant shift that prospective immigrants should factor into their planning. While the upfront requirement may provide clearer medical admissibility information earlier in the process, it also increases initial costs and complexity.

Current Express Entry candidates with applications in progress won’t be affected, but anyone planning to apply after August 21, 2025, should begin researching panel physicians and budgeting for medical exam costs well before their planned application date.

The move signals IRCC’s continued evolution of the Express Entry system, prioritizing processing efficiency even as it places additional upfront burdens on applicants.