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Canadian Retirees, Healthcare Misconceptions and Health Insurance

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By Martin Eising, HealthQuotes.ca Inc.

Aurora, ON (Apr. 5, 2016) – Many Canadians believe that most of their healthcare related costs will be covered by their government healthcare plan once they retire. Unfortunately, this just isn't true.

In fact, according to a recent Sun Life Canadian Health Index study(1):

  • 44% of Canadians expect to pay nothing for prescription drugs
  • 50% of Canadians expect to pay nothing for vision care
  • 73% of Canadians expect to pay nothing for chiropractic services
  • 76% of Canadians expect to pay nothing for home care services.

Quite a disconnect between what we Canadians believe about our healthcare system versus the reality of healthcare costs!

In this article we will shed some light on healthcare costs during retirement. We follow this up with some tips about private health insurance plans that can help to pay for expenses not covered by our provincial healthcare.

Medical Procedures and Hospital Costs

Medically necessary procedures that are performed in a hospital or a doctor’s office are always covered, regardless of age. This includes standard hospital accommodations, procedures, and any prescription drugs that are administered within the medical facility.

Semi-private and private hospital rooms are not covered by provincial healthcare plans.

Incidental hospital costs are also not covered (note: there is something called “Hospital Cash” which is optional health insurance coverage that pays for incidental costs incurred in a hospital).

Prescription Drugs

As mentioned above, prescription drugs administered within a hospital are covered by the province.

The cost of prescription drugs obtained outside of a hospital MAY be partially or fully covered depending on your age, province of residence and the drug being used. Generally speaking, residents aged 65 and up often have coverage for prescription drug costs via some sort of provincial drug plan. For example, Ontario residents who are 65 and up automatically qualify for the Ontario Drug Program, which pays for most (but not all) drug costs.

There may also be other specialty prescription drug programs available, depending on the province of residence and the financial situation of the applicant.

For more information see Prescription Drugs and Canadian Health Insurance.

It is important to note that not all prescription drug costs are covered by these specialty programs.

Also, over-the-counter medications are never covered (by either provincial healthcare plans or private health insurance plans).

Dental Services

The only dental services that are covered by provincial healthcare plans when retired are medically necessary dental surgeries that are performed by a doctor in a hospital. Having said this, convincing your province that the dental service you need is actually a medical necessity can be a very difficult and frustrating process.

Routine services such as cleanings, fillings, scalings and normal extractions are not covered by provincial healthcare plans. Neither are accidental dental costs resulting from a blow to the mouth or jaw.

In addition, costs associated with dentures are not covered by provincial healthcare plans. The exception to this is Alberta, which does offer partial funding for denture-related costs for low-income residents only.

Homecare Services

Home care services are usually not covered by provincial healthcare plans. There are exceptions to this rule, however, depending on where you live and your financial situation.

Generally speaking, there MAY be homecare services available if you have serious financial difficulties and there are local homecare services in your area that are willing to help you out.

Vision Care

There may be some coverage for some vision care costs, depending on a wide variety of factors such as:

  • Province of residence
  • Nature of vision care cost (e.g. eye glasses, eye exams, prescription lenses, etc.)
  • Your age
  • Whether or not the cost is for a procedure that is deemed “medically necessary”

For an eye-related procedure to be deemed “medically necessary” there has to be a high degree of probability that you will go blind without the procedure, in which case there may be full or partial coverage.

When it comes to provincial healthcare and vision care coverage for retirees (e.g. normally classified as 65 years old and up) we can generally say that:

  • There is probably coverage for one eye exam (every two years is common)
  • There is probably no coverage for eye glasses and contact lenses.

For a much more in-depth discussion about vision care coverage please see Vision Care and Canadian Health Insurance.

Paramedical Services

Paramedical services are services provided by medical specialists such as chiropractors, naturopaths, physiotherapists, acupuncturists, psychologists, speech pathologists/therapists, registered massage therapists, osteopaths and podiatrists.

The only paramedical service for which there MAY be coverage (depending on the province of residence) is physiotherapy that has been deemed medically necessary.

Otherwise provincial healthcare plans do not provide coverage for paramedical services.

Health Insurance Plans and Retirement

Private individual health insurance plans (also referred to as “personal health insurance” or “family health insurance”) can be purchased by retirees in order to get coverage for the various things mentioned previously in this article.

There are two types of personal health insurance: guaranteed issue and medically underwritten plans.

Guaranteed issue health insurance plans do not ask any medical questions and acceptance is guaranteed, regardless of your state of health. These type of plans are appropriate if you want coverage for prescription drugs that you are using to treat one or more medical conditions.

Medically underwritten plans involve answering a medical questionnaire, along with an examination of your medical records. Underwritten plans are appropriate if you do not have any pre-existing medical conditions, or if you are not concerned about getting coverage for any existing prescription drug medications.

The premiums for guaranteed issue plans compared to underwritten pans are similar, the big difference is that underwritten plans offer substantially more prescription drug coverage.

Finally, there is a special type of guaranteed issue health insurance called “conversion health insurance”. These conversion plans are only available if you apply within 60 days of losing employee benefits coverage (a very common occurrence when people retire from their job).

Conclusion

We hope you have found this article about retirees, health care and health insurance helpful. It is our mission as Canadian health insurance brokers to help!

Notes

1. Sun Life Canadian Health Index: 2014 Canadian Health Index Report

About HealthQuotes.ca Inc.

HealthQuotes.ca has been insuring Canadians since 1981. HealthQuotes.ca is constantly upgrading their online technology to make it as easy as possible for clients to get health and travel insurance that is just right for them.

Source: HealthQuotes.ca Inc.


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