New Changes to Express Entry: Upfront Medical Exams & New English Language Test Option
Canada’s immigration system is evolving once again, with two major updates that future Express Entry applicants should know about. Beginning August 21, 2025, Immigration, Refugees and Citizenship Canada (IRCC) will require upfront medical exams for all Express Entry permanent residence applications. In addition, IRCC has announced that the Test of English as a Foreign Language (TOEFL) Essentials will soon be accepted as proof of English proficiency for economic immigration programs.
These changes will impact thousands of skilled workers, international graduates, and professionals hoping to make Canada their permanent home. Let’s break down what these updates mean, who they affect, and how you can prepare.
Upfront Medical Exams Now Required for Express Entry
Until now, most Express Entry candidates could submit their permanent residence application first and wait for IRCC to issue instructions for a medical exam later in the process.
Starting August 21, 2025, that process changes:
All Express Entry applicants must complete their immigration medical exam before submitting their permanent residence application.
Applications submitted before August 21, 2025 will not be affected by this update.
Other permanent residence streams outside of Express Entry remain unchanged.
Why Medical Exams Matter
Canada requires every principal applicant and their family members, whether or not they are accompanying the applicant to Canada, to be medically admissible.
Medical inadmissibility can occur if:
A health condition poses a risk to public health (e.g., infectious diseases).
A condition is likely to cause an “excessive demand” on Canada’s healthcare system, defined as costing more than $27,162 per year (three times the national average per capita health costs).
Applicants with chronic conditions such as diabetes may improve their chances of approval by showing that their condition is stable, managed, and under treatment.
Failing to meet Canada’s medical requirements can lead to refusal of your application, even if you qualify in all other respects.
Test of English as a Foreign Language (TOEFL) Essentials: A New English Test Option
Language proficiency is one of the cornerstones of Canada’s economic immigration system. IRCC currently accepts the CELPIP, IELTS, and PTE Core tests to demonstrate English skills. Soon, candidates will have another option: TOEFL Essentials.
On August 21, 2025, the Education Testing Service (ETS) announced that TOEFL Essentials has been added as an IRCC-designated language test. While not yet in effect, IRCC has confirmed that it will update its website once the test is officially accepted.
Who Can Use TOEFL Essentials?
TOEFL Essentials will be recognized for applicants under:
Express Entry-managed programs:
Federal Skilled Worker Program (FSWP)
Federal Skilled Trades Program (FSTP)
Canadian Experience Class (CEC)
The Atlantic Immigration Program (AIP)
Provincial Nominee Programs (PNPs) – though provinces may choose individually whether to adopt it.
What to Expect from the TOEFL Essentials Test
Measures listening, reading, writing, and speaking skills.
Duration: about 1.5 hours.
Delivered at secure test centres worldwide.
Includes a personal video statement (unscored) in addition to the main sections.
Provides instant results for listening and reading, with full official results available online in six days or less.
Score reports can be sent to unlimited institutions at no additional cost.
Why These Changes Matter for Applicants
These updates highlight two ongoing themes in Canadian immigration:
Faster, more efficient processing – upfront medical exams may help IRCC reduce delays and avoid backlogs.
More flexibility for skilled workers – adding TOEFL Essentials gives candidates worldwide another accessible way to prove their language ability.
For candidates preparing to apply for permanent residence, these changes mean it’s more important than ever to:
Plan ahead by booking your medical exam early.
Choose the right language test that fits your strengths, budget, and location.
Stay updated on official IRCC announcements, as timelines for TOEFL Essentials acceptance are still being finalized.
To learn more information or seek legal advice, please do not hesitate to reach out to our experienced law firm at rharding@hardingimmigrationlaw.com or book a consultation here.
