Being so close to the United States, we often hear about the issues Americans are having with their healthcare system. For Canadians, it’s almost unimaginable that people have to pay for visits to the doctor or a hospital. We are very fortunate to have these services paid for by our provincial plans.
It’s easy to take this kind of thing for granted, which is why many of us don’t understand how it works. But it’s always good to educate yourself on government health programs, which will highlight some areas where private plans can help. That way, you can decide for yourself if you should purchase a health plan to take care of things the provincial plan will not.
What Services are Covered by Government Health Insurance?
While the provincial plans are all a little different, the common things that they typically pay for are doctor visits and hospital services. Provincial plans will cover the cost of a ward room, but usually not a semi-private or private room.
Physician fees are exactly that: fees for seeing a doctor. Visits to the doctor are (usually) medically necessary to treat or prevent illness, disease or injury. This includes routine visits, walk-in clinics, and urgent care at a hospital.
Hospital and medical services to address injuries or illness are covered, but treatments for the after-effects of injuries are not usually covered. These include prescription drugs, physiotherapy, chiropractic care, and other services—even when they are recommended by your doctor.
In terms of vision care, most provinces will cover an eye exam for children under the age of 18, and for seniors over 65. Glasses and contacts are not eligible under any plan. Some provinces will pay for podiatry, chiropractic and other paramedical services, but only to an extent.
Most provincial plans will also offer very limited travel coverage, and all advise that you purchase a supplementary travel plan when leaving the country. The reason is that the services they cover are very limited, and there are maximum amounts that they will pay, so this coverage will be much less than you are likely to need if something happens.
Some provinces will cover a portion of eligible prescription drugs.
For example, the Ontario Drug Benefit (ODB) will reimburse certain drugs for those aged 65 and older, and as of January 1, 2018 for everyone under the age of 25, regardless of family income, as well as adults who have lower incomes. Dental services are limited to dental surgery performed in a hospital, for most provinces.
The Government of Canada’s website provides more detailed information on the universal health care system.
The costs of these treatments really add up, when you put them all together. Thankfully, there are many health insurance plans to choose from to help offset these costs. When you take into account the number of times you’ll need these services or drugs, it just makes sense to have a plan. The sooner you get one, the better.
Am I Covered Everywhere in Canada?
If you are a Canadian citizen living in Newfoundland, when you travel to another province, like Quebec, for instance, many services that you might have rendered there might be covered by your Newfoundland plan. But sometimes it’s not enough.
Residents of the smaller provinces like Prince Edward Island or Newfoundland may find themselves out of pocket for out-of-province expenses as their reimbursement may be less than the actual costs.
If, for example, you have to go to the hospital in another province and if they aren’t set up to bill your provincial plan directly, you will have to pay the money yourself and seek reimbursement afterwards. This can be a major strain, especially if you don’t have that money on hand. When you’re hurt or sick, financial problems are the last thing you need. A simple multi-trip travel plan will cover all inter-provincial costs.
Sometimes these types of claims can take weeks (or months) for repayment, while the provinces determine what is covered and what percentage they’ll pay. That’s a long time to wait for your money!
Another thing to know is if you are seeing a doctor at a clinic on a private resort, your provincial plan may not pay anything at all. Having a travel insurance plan will help mitigate many of these concerns. You don’t want any unpleasant surprises when you’re supposed to be having fun.
If I Leave Canada, Am I Covered When I Return?
Many Canadians are lucky enough to live in Florida or other sunny areas for several months of the year. You may wonder what happens to their health insurance coverage when they’re away for an extended period of time.
If you are thinking of living elsewhere temporarily, keep in mind that Canadians may be out of the country for up to 212 days (182 days in some provinces) in any 12-consecutive month period without losing coverage from their provincial insurance plan. These rules may change with recent government announcements to tighten border tracking controls.
If you decide to stay longer than the 182 or 212 days, you may be subject to a 90-day waiting period before your provincial coverage kicks in again, even if you return temporarily. During this waiting period, it would be in your best interest to purchase a Returning Canadian or Visitors to Canada plan just in case of an unexpected illness or injury.
What Happens if I Need Treatment and it’s Not Covered by my Province?
If you only have your provincial healthcare coverage, you will not have full coverage for needed treatments. Let’s say you break your arm. A small portion of your hospital visit will be covered under the provincial plan, however, any physiotherapy or pain medications needed in relation to your injury will be your own responsibility.
If you purchase your own plan, however, you will have coverage for medication and certain paramedical services. Remember, though, you must already have a plan before you get injured.
Talk to an Insurance Broker
There are so many rules around provincial health insurance, it’s difficult to figure out what is or isn’t covered, especially when they update their listings frequently. It’s hard to keep up and know how your own coverage translates. Your best strategy is to contact an insurance broker to make sure you’re not left without protection for needed treatments.
A private health insurance plan can help keep you covered and save you from future financial headaches. It’s great that the provinces will pay a portion for some services, but it’s not enough. You will want another plan to act as a safety net just in case.
Contact our office today to speak with a customer service representative. He or she can answer all your questions, give you a quote and help you on your way to getting the best health insurance coverage for you and your family.