Immigration, Refugees and Citizenship Canada (IRCC) has announced a major change to the Express Entry system. Starting August 21, 2025, anyone applying for permanent residence through Express Entry will need to complete their medical exam before submitting their application.

Until now, applicants would file their application first and wait for IRCC to issue instructions for a medical. That step is now moving to the beginning of the process. Applications submitted before August 21 will not be affected, and the change applies only to Express Entry—not other permanent residence programs.

Why medical exams matter

To be approved for permanent residence, the principal applicant and their family members must be medically admissible to Canada, even if some family members are not coming with them. The most common reason for medical inadmissibility is if a condition is expected to place an “excessive demand” on Canada’s health services, defined as costing more than about $27,162 per year. Applicants can also be refused if they have a condition that poses a public health risk, such as certain infectious diseases.

Showing that chronic conditions are being treated and are stable—for example, diabetes that is well controlled—can help reduce concerns about inadmissibility.

What to expect at a medical exam

Immigration medical exams must be completed with panel physicians approved by IRCC. The exam usually costs between $140 and $280 per person, plus any extra charges for tests or specialist referrals.

A typical IME can include:

• A review of medical history (past surgeries, ongoing treatments, chronic illnesses)

• A physical exam (eyes, heart, lungs, etc.)

• Chest x-rays (to screen for tuberculosis)

• Blood and urine tests
• Mental health checks
• An immunization record review

When attending your appointment, bring identification (passport or national ID card), four recent photographs, a list of medications, medical reports for existing conditions, and proof of previous vaccinations.

If you already had a medical exam

Applicants in Canada who have completed an IME in the last five years—for a study or work permit, for example—can provide their IME number when applying. If IRCC accepts those results, no new exam will be needed. If the results are considered outdated, IRCC will advise you to take a new exam.

What this means for applicants

With this new requirement, Express Entry applicants should plan ahead. Book your medical exam early with an approved panel physician and keep all documents ready before submitting your application. This small step could save time later and ensure your application moves forward without delays.