RCIC News. 
Starting August 21, 2025, all Express Entry applicants must complete medical examinations before submitting their permanent residence applications, reversing the previous submit-first system
On This Page You Will Find:
- Immediate action steps you must take before August 21, 2025
- Exact costs and timeline for required medical examinations
- Hidden challenges that could delay your Express Entry application
- Strategic tips to navigate the new system efficiently
- Family member requirements that catch most applicants off-guard
Summary:
Starting August 21, 2025, Canada is flipping the Express Entry process upside down. Instead of getting your medical exam after submitting your application, you'll now need to complete it beforehand—a complete reversal of the 2023-2024 system. This change affects every Express Entry applicant and their family members, with exam costs ranging from $140 to $280 per person. While IRCC promises faster processing times, applicants in Africa, Asia, and the Middle East face new challenges with limited panel physicians and extended waiting lists. If you're planning to apply through Express Entry, this policy shift demands immediate attention to avoid costly delays in your Canadian immigration journey.
🔑 Key Takeaways:
All Express Entry applications submitted after August 21, 2025, require completed medical exams upfront Medical exam results are only valid for 12 months, requiring strategic timing Costs range from $140-$280 per person, including all family members regardless of accompaniment Limited panel physicians in certain regions may create weeks-long waiting lists Applications submitted before August 21, 2025, follow the old system and aren't affected
Maria Santos refreshed her Express Entry profile for the third time that morning, her excitement about receiving an Invitation to Apply (ITA) suddenly tempered by a critical realization. The August 21, 2025 deadline was just weeks away, and everything she thought she knew about the Canadian immigration process had changed overnight.
If you're like Maria—planning your Express Entry application or recently received an ITA—you're facing the most significant policy shift in Canada's immigration system in years. Immigration, Refugees and Citizenship Canada (IRCC) has mandated that all Express Entry applicants complete their immigration medical examinations (IMEs) before submitting their permanent residence applications, completely reversing the previous process.
This isn't just a minor procedural change. It's a fundamental restructuring that affects your timeline, budget, and strategy for immigrating to Canada.
Understanding the Complete Policy Reversal
For nearly two years, from 2023 through early 2025, Express Entry operated on a submit-first, examine-later model. You'd submit your complete permanent residence application, then wait for IRCC to send medical examination instructions. This system allowed applicants to spread out their costs and only invest in medical exams after receiving confirmation that their application was being processed.
That system is now dead.
Starting August 21, 2025, you must complete your medical examinations before hitting "submit" on your Express Entry application. Think of it as moving the medical checkpoint from the middle of the airport security line to the very beginning—everyone must pass through before entering the terminal.
The shift represents IRCC's response to a persistent problem: applications being refused late in the process due to medical inadmissibility, creating bottlenecks and frustration for both applicants and immigration officers.
What This Means for Your Application Timeline
Here's where strategic planning becomes crucial. Medical exam results expire after exactly 12 months. This means you're now working within a tight window that requires precise timing.
Let's say you complete your medical exam in September 2025. You have until September 2026 to not only submit your Express Entry application but also receive your Confirmation of Permanent Residence (COPR) and land in Canada. Miss that window, and you'll need to repeat (and repay for) the entire medical examination process.
For most applicants, this creates a new pressure point. You can't simply complete your medical exam and then leisurely wait for an ITA. Instead, you need to strategically time your examination based on your Comprehensive Ranking System (CRS) score and realistic expectations about when you'll receive an invitation.
If your CRS score puts you well above recent draw cutoffs, you might complete your medical exam immediately to be ready. But if you're borderline and might need several months to improve your score through language retesting or additional education credentials, rushing into a medical exam could waste both time and money.
The Real Cost of Upfront Medical Examinations
Beyond the obvious examination fees—ranging from $140 to $280 per person—the upfront requirement creates several hidden costs that catch families off-guard.
First, you're now paying for medical exams for your entire family before knowing if your application will succeed. Under the previous system, you only invested in medical costs after IRCC had already reviewed and preliminarily approved your application. Now, that financial risk shifts entirely to you.
Second, the 12-month validity period creates potential double-payment scenarios. If your application faces unexpected delays—perhaps due to document requests or processing backlogs—you might need to repeat medical examinations that expire before your case concludes.
Third, for families in regions with limited panel physicians, travel costs have become mandatory upfront expenses rather than later considerations. A family of four living in rural Nigeria might now need to budget for flights to Lagos, hotel stays, and examination fees all before submitting their application.
Family Member Requirements That Surprise Most Applicants
Here's a critical detail that trips up many Express Entry applicants: every family member must complete medical examinations, regardless of whether they're accompanying you to Canada.
This means if you're married but your spouse plans to join you later, they still need a medical exam now. If you have adult children who aren't immigrating with you, they still require medical clearance. The principal applicant cannot be approved if any family member fails to meet medical admissibility requirements.
This requirement often catches applicants during family planning phases. A couple expecting a child must factor in that their newborn will eventually need medical examination before the principal applicant can receive permanent residence, even if the child won't initially travel to Canada.
Geographic Challenges and Strategic Solutions
The upfront medical requirement creates significant disparities based on your location. Major cities like Mumbai, Manila, or Cairo typically have multiple IRCC-approved panel physicians with reasonable availability. However, applicants in smaller cities or rural areas face a different reality.
In many parts of Africa, Asia, and the Middle East, the ratio of approved panel physicians to potential applicants creates bottlenecks. Some regions have waiting lists stretching 4-6 weeks just to schedule an examination, not including the additional time needed to receive results.
This geographic challenge requires strategic planning. If you live in an area with limited panel physicians, you might need to:
- Schedule your medical examination well in advance of when you expect to receive an ITA
- Consider traveling to larger cities with more available physicians
- Factor travel and accommodation costs into your immigration budget
- Build buffer time into your application timeline
Some applicants are now coordinating medical examinations during business trips or family visits to major cities, treating the medical exam as a strategic component of their overall immigration timeline rather than a reactive requirement.
What Hasn't Changed (And Why That Matters)
While Express Entry faces this major shift, it's important to understand what remains unchanged. Non-Express Entry permanent residence applications—including Provincial Nominee Programs processed outside Express Entry, family sponsorships, and refugee applications—continue operating under the previous system where medical examinations are requested after application submission.
This creates an interesting strategic consideration for applicants who might qualify for multiple pathways. If you're eligible for both Express Entry and a Provincial Nominee Program that processes applications outside Express Entry, the medical examination timing could influence your pathway choice.
Additionally, applications submitted before August 21, 2025, remain unaffected by this change. If you've already submitted your Express Entry application or receive an ITA before the deadline, you'll follow the previous system and wait for medical examination instructions from IRCC.
IRCC's Efficiency Promise vs. Applicant Reality
IRCC positions this change as a win-win scenario: faster processing times and reduced late-stage refusals benefit everyone. The logic is sound—identifying medical inadmissibility issues upfront prevents applications from advancing through months of processing only to face refusal at the final stage.
However, the efficiency gains for IRCC create new burdens for applicants. You're now absorbing the financial and logistical risks that were previously shared between applicants and the immigration system.
The question becomes whether IRCC's promised efficiency improvements—faster processing times and reduced refusals—will materialize quickly enough to justify the increased upfront burden on applicants. IRCC has committed to monitoring the policy's impact through the end of 2025, suggesting they're aware this represents a significant experiment in immigration processing.
Strategic Recommendations for Express Entry Applicants
Given these changes, successful Express Entry applicants will need to adopt a more strategic approach to their immigration planning.
First, assess your CRS score realistically. If you're consistently scoring well above recent draw cutoffs, you can confidently complete medical examinations and be ready for quick application submission. If your score is borderline, consider improving it before investing in medical exams.
Second, research panel physicians in your area immediately. Don't wait until you receive an ITA to discover that the nearest approved physician has a six-week waiting list. Some applicants are already scheduling tentative appointments that can be confirmed once they receive ITAs.
Third, budget for the full family cost upfront. Many applicants budget for their own medical examination but forget that spouses and children require the same process, even if they're not immediately immigrating to Canada.
Finally, consider the 12-month validity period as a hard deadline for your entire immigration timeline, not just application submission. Your medical results need to remain valid through application processing and landing in Canada.
Looking Ahead: Implications for Canada's Immigration System
As Maria discovered that morning, the Express Entry process she'd been preparing for no longer exists. The new system demands more upfront investment and strategic thinking, but promises a more streamlined path to Canadian permanent residence for those who navigate it successfully.
Q&A
beginner here, long time lurker first time poster... sorry if this is a dumb question but from what I understand canada is changing something about medical exams for express entry?? like you have to do them before applying now instead of after? is this the right place to ask about this stuff lol
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<p>Not a dumb question at all! You're absolutely right - this is a major change that's catching a lot of people off guard. Starting August 21, 2025, Canada completely flipped the Express Entry medical exam process. Instead of submitting your application first and then waiting for IRCC to tell you to get your medical exam done, you now have to complete the medical examination before you even submit your permanent residence application. Think of it like this: before, it was like getting your driver's license and then taking the eye test. Now, you have to pass the eye test before they'll even let you apply for the license. This affects everyone going through Express Entry - you, your spouse, your kids, basically all family members whether they're coming to Canada with you or not. The medical results are only good for 12 months, so timing becomes really important. You can't just get the exam done and sit on it forever.</p>
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<p>I should also mention that this change only affects applications submitted after August 21, 2025. If you manage to submit your complete Express Entry application before that date, you'll still follow the old system where they ask for medical exams after you've applied. The costs range from $140-$280 per person, and if you live somewhere with limited approved doctors, you might need to travel to bigger cities for the exam. Some places have waiting lists of 4-6 weeks just to get an appointment. IRCC says this will make processing faster and reduce late-stage rejections, but it definitely puts more upfront costs and planning on applicants. If you're thinking about Express Entry, now's the time to research approved panel physicians in your area and start planning your timeline carefully.</p>
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FAQ
Q: What exactly changes with Canada's new upfront medical exam requirement for Express Entry?
Starting August 21, 2025, all Express Entry applicants must complete their Immigration Medical Examinations (IMEs) before submitting their permanent residence application—a complete reversal of the 2023-2024 system. Previously, you would submit your application first and wait for IRCC to send medical examination instructions. Now, you must have completed medical exams in hand before hitting "submit." This affects every Express Entry applicant and all family members, regardless of whether they're accompanying you to Canada. The change aims to reduce late-stage application refusals due to medical inadmissibility and speed up processing times. Applications submitted before August 21, 2025, are not affected and will follow the old system. This represents the most significant procedural change in Express Entry since the system's inception.
Q: How much do the upfront medical examinations cost and who needs to take them?
Medical examination costs range from $140 to $280 per person, depending on your location and the panel physician. Every family member must complete the exam, including spouses who aren't immediately accompanying you to Canada and adult children not included in your immigration plans. For a family of four, total costs can reach $800-$1,120 just for medical exams. Additional hidden costs include travel expenses if you live in areas with limited panel physicians—some applicants must travel to major cities, requiring flights and hotel stays. In regions like rural Nigeria or smaller cities in Asia, families often need to budget an extra $500-$1,000 for travel to reach approved panel physicians. Remember, you're paying these costs upfront before knowing if your application will succeed, shifting the financial risk entirely to applicants.
Q: How does the 12-month validity period affect my Express Entry timeline and strategy?
Medical exam results expire exactly 12 months after completion, creating a critical timing challenge. You must receive your Confirmation of Permanent Residence (COPR) and land in Canada before your medical results expire, or you'll need to repeat the entire examination process. This means you can't simply complete your medical exam and wait indefinitely for an Invitation to Apply (ITA). If your Comprehensive Ranking System (CRS) score is well above recent draw cutoffs, you can confidently complete medicals immediately. However, if you're borderline and might need months to improve your score through language retesting or additional credentials, rushing into medical exams could waste time and money. Strategic timing is crucial—some applicants are scheduling tentative medical appointments that can be confirmed once they receive ITAs, while others are improving their CRS scores before investing in medical examinations.
Q: What challenges do applicants in Africa, Asia, and the Middle East face with this new requirement?
Applicants in these regions face significant geographic disparities due to limited IRCC-approved panel physicians. While major cities like Mumbai, Manila, or Cairo have multiple physicians with reasonable availability, smaller cities and rural areas often have waiting lists stretching 4-6 weeks just to schedule an examination. Some regions have only one or two approved physicians serving entire countries or large provinces. This creates a domino effect: longer wait times for appointments, increased travel costs to reach physicians in major cities, and the need for accommodation during multi-day medical processes. Many applicants are now coordinating medical examinations during business trips or family visits to larger cities. The geographic challenge requires building substantial buffer time into application timelines and factoring travel costs into immigration budgets—expenses that weren't necessary under the previous system.
Q: Can I still apply under the old system, and what are my options if I miss the August 21, 2025 deadline?
If you submit your Express Entry application before August 21, 2025, you'll follow the old system and wait for medical examination instructions from IRCC after submission. However, you must have received an Invitation to Apply (ITA) and submitted your complete application by this deadline—simply having an active Express Entry profile isn't sufficient. If you miss the deadline, you have several options: wait for the next Express Entry draw under the new system with completed medical exams, explore Provincial Nominee Programs that process applications outside Express Entry (these still use the old medical exam timing), or consider other immigration pathways like family sponsorship. Non-Express Entry programs haven't adopted the upfront medical requirement, so if you qualify for multiple pathways, medical exam timing could influence your route choice. Some applicants are strategically applying through slower but less front-loaded programs to avoid the upfront medical costs and risks.
Q: What happens if my medical exam expires before I receive permanent residence, and how can I avoid this scenario?
If your medical results expire before receiving your COPR and landing in Canada, you must repeat the entire medical examination process and pay all fees again. There are no extensions or grace periods for expired medical results. To avoid this costly scenario, carefully calculate your timeline from medical exam completion through expected processing times and landing. IRCC's current Express Entry processing standard is 6 months, but factor in potential delays from document requests, background checks, or processing backlogs. Build a 2-3 month buffer into your timeline. If you're approaching the 12-month deadline and haven't received your COPR, contact IRCC immediately to understand your options. Some applicants proactively schedule follow-up medical appointments 10-11 months after their initial exams as insurance, though this means paying twice. The key is realistic timeline planning and avoiding the medical exam until you're confident about receiving an ITA within a reasonable timeframe.
Q: How will this change affect Express Entry processing times and success rates?
IRCC promises faster processing times and reduced late-stage refusals, positioning this as a win-win for applicants and the immigration system. By identifying medical inadmissibility upfront, applications won't advance through months of processing only to face refusal at the final stage. Theoretically, this should reduce the current 6-month processing standard and provide more predictable outcomes. However, the efficiency gains for IRCC create new bottlenecks at the medical examination stage, particularly in regions with limited panel physicians. Success rates may initially fluctuate as applicants adjust to the new system—some may submit applications with incomplete or inadequate medical documentation, while others might delay applications due to medical exam logistics. IRCC has committed to monitoring the policy's impact through the end of 2025, suggesting they recognize this as a significant experiment. Early adopters who master the new system's strategic timing and preparation requirements will likely see faster, more predictable processing than under the previous system.
