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In BC (Canada) medical premiums are $54/mo. You can also go out and get extended insurance, which covers lost wages, extended benefits etc. (most decent employers offer extended medical after 3 months).

If you don't pay your medical premiums, you are STILL COVERED, but the meter is always running and the bills get higher and higher. The Canada Revenue Agency (tax folks) manages medical premiums now, if you are behind too far and they have been unable to contact you and make payment arrangements, they keep tax refunds, HST rebates etc until the debt is paid. If you still don't get them paid up, they can garnish your wages. There's no way out.

Unemployed get free medical through the welfare system and VERY low income earners get a subsidized medial (something like $25/mo I think).

Either way, medical is not opt in, its mandatory. Premiums are affordable and they do collect if they need to. Sounds like you are just too far south to get what you desire though.