In the remaining provinces, Blue Cross hospital plans and doctor-sponsored medical services plans offered middle-class and unionized employees the option of prepaying the costs of many health services. In the Atlantic region, the Maritime Blue Cross plan, incorporated in 1943, had expanded to incorporate Newfoundland in 1949. As well, a new option, Maritime Blue Shield, offering coverage for medical care while in hospital, coverage for hospital surgical care or coverage for both medical and surgical care, was created in 1948, providing individual families, employee groups and unions with additional means of saving for assistance with unexpected hospital and medical costs. But in 1950, the demand for hospitalization in the Maritime provinces was so great that, when combined with rising inflation, Maritime Blue Cross had a deficit of $214,864.86, while MaritimeBlue Shield had a surplus of $84,368.58. As a result, the hospitals participating in the plan had their accounts pro-rated until June 1952, and New Brunswick plan members whose children suffered from a severe poliomyelitis outbreak that summer found their contracts cancelled because the plan lacked the reserve funds to handle the high costs associated with an epidemic.
In spite of these problems, Maritime Blue Cross and Maritime Blue Shield joined other prepayment plans under the umbrella group created by the medical profession — Trans-Canada Medical Plans — in 1953. By 1957, the director of enrolment was able to report that Maritime Blue Cross had a total of 331,689 members, while Maritime Blue Shield had 199,863 subscribers. But with federal funding for hospital insurance looming ahead, Blue Cross administrators knew that they would have to either become part of provincial administrative agencies or modify their offerings if the Maritime provinces opted for government administration. When the various governments decided to make hospital insurance government-run, the private non-profit plan turned to providing insurance coverage for services beyond the standard ward provisions of the shared-cost program.