The $42K rate must have just been implemented because it hasn't been widely advertised. Up until January of this year (an election year no surprise), if you earned a dime over $30K, you paid the full rate of $75 per month.  If you earned  $130K, $230K or even $930K, you paid $75 a month. BC also added a large call centre full of collection agents trained to regularly threaten the financially vulnerable, supported by the CRA. For those struggling to pay these punitive add on BC MSP tax rates, opting out is an option. You'd have to pay out of pocket for any medical expenses incurred though if that came up plus as an added disincentive, you can't opt back into the system for one full year in case you change your mind, or secured a better income with benefits, no exceptions. Surely they could have come up with a better plan padding the health portfolio. All this $ yet recently the health system here was complaining they could "barely keep the lights on." The facts are distorted  in BC too.