Medical expenses are probably one of the most overlooked costs when developing a Financial Plan. As millennials move from job to job and seniors move into retirement many people have gaps in their Health Insurance coverage. It’s important to know what we Ontarian’s can expect from our government’s health care plan. Here are the facts:
Prescription Drugs. The Trillium Drug Program will pay for certain prescription drugs when drug costs for a household are higher than approximately 4% of net family income. The Ontario Drug Benefit Plan only covers seniors (65 and over) and Social Assistance recipients. Seniors must pay the first $100 of prescription costs and then $6.11 per prescription thereafter. These plans will only cover drugs listed on the Ontario Drug Formulary.
Ambulance. Ontarian’s are covered for in-province land and air ambulance when deemed medically necessary. Although some exceptions may apply, patients are responsible for a $45 co-payment.
Dental Benefits. There is no coverage for regular dental care. Children 17 and under from low income families may be eligible for dental care under the Healthy Smiles Ontario Program. Cosmetic dentistry and orthotics are not included. Some dental surgery will be covered if performed in a hospital.
Eye Care. Regular eye exams every 12 months are covered for seniors and children under age of 19. Exams are also covered for individuals between 20-64 with medical conditions affecting the eye.
Hospital Coverage. Patients are covered for standard ward rooms only.
Paramedical. There is no coverage for chiropractors, psychologists, massage therapy or naturopathic services. Podiatrist services are covered up to $135 per year, an additional $30 per plan year is available for x-rays. Speech therapy is covered if performed in a hospital. There is coverage for physiotherapy for seniors and children. If you have been hospitalized and require physiotherapy you will also receive coverage.
Hearing Aids. For eligible individuals The Assistive Devices Program will cover 75% to a maximum of $500 for the cost of one hearing aid.
Nursing and Home Care Benefits. Ontarian’s may qualify for coverage, based on need.
Medical Supplies. For individuals who are eligible, the Assistive Devices Program covers a portion of the cost of medical equipment and/or supplies. Additional funding for insulin pumps to eligible adults and children with type 1 diabetes who meet the clinical criteria. An additional grant of $4200 per year may be paid directly to the recipient.
Out of Country Coverage. Coverage is for emergencies only. OHIP will pay $200 per day for in-patient services. If the services are rendered in an operating room, coronary care unit, intensive care unit, neonatal or paediatric special care unit then OHIP will pay up to $400 per day for hospital services.
If you are not covered by a health benefits plan through your work and want to learn more about individual plans, please give me a call.
Have a great weekend,
Tracey and Paige
Sources:
https://www.otip.com/Why-OTIP/News/The-Ontario-Drug-Benefit-Program-and-deductibles
https://www.ontario.ca/page/get-help-high-prescription-drug-costs
https://www.health.gov.on.ca/en/public/publications/ohip/amb.aspx
https://www.ontario.ca/page/services-covered-by-healthy-smiles-ontario
https://extendedhealthcanada.ca/ontario-health-insurance
https://www.ontario.ca/page/get-support-for-diabetes-equipment-and-supplies
Photo by National Cancer Institute on Unsplash