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Guide to Health Insurance in Canada

Guide to Health Insurance in Canada
Canada’s provincial healthcare plans offer comprehensive coverage for most permanent residents of the country. However, not everything is covered by these government plans, and an increasing number of Canadians are in need of private health insurance for expenses that are not covered in their province or territory of residence. If you are wondering who is most likely to be living without insurance, consider this: a massive number of retiring baby boomers and contract workers generally do not have access to insurance through their workplace. This creates a gap in coverage that, fortunately, can be addressed through private health insurance.

Learn what the rules are in your province, how changes might affect you, and whom you should turn to for more information.

The Cost of Provincial Health Insurance Coverage

As outlined in the Canada Health Act, each province provides healthcare for its qualified residents, but there are differences in what is and is not covered in each province. Generally, provincial coverage does not include prescription drugs, dental visits, vision care, medical equipment, hospital accommodations (other than wardroom), registered therapists and ambulance transportation.

This is by no means a full list of exclusions. For specific details, please consult the individual health ministry for your province or territory.

Some provinces collect monthly or annual premiums for healthcare coverage, while others offer some additional services like prescription drugs and medical transport to only certain qualified residents (e.g., senior citizens or the chronically ill.)

This article is intended to give an overview of the costs of provincial health insurance and programs that may be available in some provinces and territories:

  • In British Columbia, a premium ranging from $11–$150 is collected each month from families with a household income of more than $22,000 annually, though the province has announced changes for these rates for 2017;
  • Alberta charges premiums of $200–$1,000 per year for households with an income of more than $50,000 per year;
  • In Ontario, those with incomes over $20,000 per year pay a premium that ranges from $0–$900 and is collected as part of the annual taxation process;
  • Québec residents are required to carry health insurance coverage for prescription drugs under provincial law. They may do so through a group plan or through the Québec Public Prescription Drug Insurance Plan. This applies only to drug coverage, not to other treatments;
  • New Brunswick residents who do not have access to group benefits may be eligible for an income-based drug coverage program launched in May 2014. Similar to Québec, this coverage applies to prescription drugs only, and does not cover other health-related treatments like physiotherapy and medical equipment;
  • Nunavut offers an Extended Health Benefits plan (EHB) to senior citizens and residents diagnosed with chronic conditions, and it can be used to offset the cost of prescriptions and travel to other locations with more extensive medical care facilities.

Most provinces and territories have special accommodations for prescription drug coverage for residents over the age of 65, though there is often a copayment amount that must be paid out of pocket. These fees range broadly by province. Contact your insurance provider or your provincial health ministry for more detailed information on how these copayments may affect you.

Planning for the Future of Provincial Health Insurance

It is important to note that what is currently covered by provincial plans may be dropped from the program at any time, when there is a new provincial budget or a change in government leadership in the province or territory.

What’s happening in Ontario right now is a perfect example of how your financial plans can change based on a change in government strategy. There has been some talk in the province about making changes to the deductibles for seniors covered by the Ontario Drug Benefit (ODB) Plan. Because the move has been deemed politically unpopular, the plan has been put on the back burner for now. However, that doesn’t mean it won’t come up again in the future.

While provincial governments are making great strides in providing better, more affordable access to prescription drugs for their residents, many other vital services remain outside the plans. As budgets tighten and the delivery of healthcare becomes more expensive, government health officials will review their list of covered services and make changes accordingly.

Choose to Work with an Insurance Broker

The insurance industry pays close attention to the regulatory conditions in each province to ensure they can respond to changes in government coverage with appropriate private health and dental insurance policy adjustments for those in need. Experts agree that carrying private health insurance to bridge any gaps in government coverage is the safest way to protect yourself from unexpected healthcare costs.

Speak with an insurance broker today to discuss the best coverage options for your specific needs. Our helpful customer service representatives are available to help you, live and in person, Monday to Friday from 8:45 a.m. to 4:45 p.m. Call us today!

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