What do you mean it’s not covered? I thought healthcare in Canada was free!
As Canadians, we've come to believe that we shouldn't have to pay for anything related to our health and I agree. I've seen too many family members struggle with staggering costs for prescription drugs, medical devices, home care and assisted living.
“Free” would be nice if it were true, but the reality is, we are responsible for an increasing number of health related costs.
Costs Go Up As You Age
According to a recent report from The BMO Wealth Institute, Canadians over age 65 expect to spend $5,391 a year on out-of-pocket healthcare expenses.
If you are fortunate enough to have benefits through your employer or a private insurance plan, a large proportion of the extra costs will be covered, at least until you reach retirement age. If you don’t have benefits, then you will rely solely on what the government pays.
The Ministry of Health and Long-Term Care, through OHIP, covers a wide range of health services but only those it considers are medically necessary.
Services provided by licensed physicians are covered by OHIP but they can bill you directly for uninsured services such as missing an appointment, writing insurance letters and telephone prescription renewals. Diagnostic tests ordered by physicians, hospital stays and most surgeries are also covered.
Other Health Care Providers
Services provided by podiatrists are partially covered under OHIP. Other healthcare providers such as physiotherapists are covered fully or partially depending on specific criteria such as your age, medical status and enrollment in social support programs.
Some in-home services such as personal support and nursing may also be covered if you qualify.
If you have dental surgery in the hospital, some of it is covered. You and your family may qualify for additional benefits if you are receiving coverage through the Ontario Disability Support Program or Ontario Works.
An eye examination is covered once every 12 months if you are:
· Under 20 or over 65
· 20-64 and have medical conditions requiring regular eye exams.
Canada is the only industrialized nation with universal health insurance but no public coverage of prescription drug costs. One in 10 Canadians can't fill prescriptions because of the expense.
Prescription drugs in Ontario are covered through the 2 main programs below.
Funding may also be available through several specialized programs for specific conditions and diseases. If you don’t qualify for any of these, you must pay out-of-pocket.
1. Ontario Drug Benefits Program (ODB)
This program is for seniors who live in Ontario and have a valid Ontario health card. The majority of the cost of approved drugs is covered, but you must pay a small yearly charge and a dispensing fee to have your prescriptions filled.
2. Trillium Drug Program
Trillium helps people under the age of 65 who have high prescription drug costs relative to their household income. There is a deductible of about 4% (paid quarterly) based on your household income.
What’s Not Covered?
There’s a long list of services or items that have partial or no OHIP coverage, but to make it simple, here are some of the major ones:
· Non-medically necessary procedures such as cosmetic surgery
· Most dental care
· Mobility devices (limited coverage)
· Assisted living (nursing homes) (partial coverage)
· Certain medical procedures
· Naturopaths and other alternative medicine practitioners
· Chiropractic services
· Physiotherapy (limited)
Healthcare Really Isn’t Free.
The basics are covered, but many services are not.
It’s important to understand what coverage you are entitled to whether it’s through government or private insurance funding. But it can be hard to figure out because the information is not well publicized.
I can help you save on medical costs:
I reduced one client’s drug bill from nearly $30,000 a year to about $2400 by combining a number of different programs.
Give me a call so that I can help you figure out how to access the maximum funding for your healthcare needs. The first half hour consultation is complimentary.