Universal health care in Canada is a boon for most people. Individuals can receive many of the basic health services they need at a relatively low cost. This includes access to vision care, dental care, and prescription medications. But few people are aware of the limitations posed by their provincial health plans. Most have never had to put them to the test.
Below, we’ll take a closer look at the extent to which your government health plan actually covers basic services. The details may surprise you. You’ll also learn about circumstances for which a supplementary plan makes sense as well as how to tailor such a plan to meet your needs.
How Far Does Government Health Insurance Coverage Extend?
Each province and territory maintains its own set of coverages, maximums, and plan limitations. That is, the services for which you’re eligible will vary depending on whether you live in Manitoba, Ontario, or Newfoundland. The only way to know whether you need a supplemental health plan is to examine your province’s coverages, and consider them in light of your personal circumstances.
For example, suppose you live in Nova Scotia, and regularly use a number of medications. If you’re under 65, you’ll need to pay 33 percent per prescription up to $350 each year. Once you turn 65, you’ll be required to pay an additional $390 in annual premiums.
In British Columbia, coverage for prescription drugs is handled differently. Those under 65 must pay a deductible up to $2,000 each year (based on family income), after which the cost of each prescription is covered at 70 percent. For individuals over 65, drugs are covered at 75 percent (again, after paying the deductible).
From the above, it is clear that government health insurance coverage is limited. The same is true with regard to coverages for vision care, dental care, nursing services, and services related to hospitalization. It’s also worth noting that provincial plans rarely extend coverage for any treatment that is not considered medically necessary. This includes oral surgery, chiropractic therapy, osteopathy, and numerous other health care services.
When A Supplemental Health Insurance Plan Makes Sense
There’s an argument to be made that a supplementary health plan is always worthwhile. Even if you rarely visit the doctor, and use very few core medical services, accidents and emergencies can occur. Personal health insurance ensures that you and your family get the treatment you need.
Having said that, there are numerous situations for which a supplementary health plan can prove especially valuable. For instance, if you’re self-employed, you may lack access to the health benefits provided by a group plan. Having private coverage in addition to your provincial plan may pay for itself quickly.
This may also be the case if you’re about to retire. Your employer may not extend health coverages to you following your departure from the company. Since your health care needs are likely to increase during retirement, a supplemental health plan can help lower the cost.
Also, consider the needs of your family and dependents. If special circumstances require ongoing hospitalization, treatment, or rehabilitation, government health insurance will be inadequate.
These and other situations warrant purchasing a supplemental health care plan that fills the gaps left by your provincial plan. Unlike government health insurance, a private plan can be tailored to meet your specific needs.
Tailoring Your Coverages To Meet Your Family’s Needs
Think about the services you and your family are most likely to use on a regular basis. Your private insurance package can be designed to emphasize these services. For example, do you or your spouse require chiropractic care to treat chronic back pain? Do you need to have a root canal or orthodontic surgery performed? Does your entire family wear contacts or glasses?
You can customize your supplementary plan to highlight services that provide the most value for you and your family. For example, you may want to emphasize dental and vision care while placing less priority on prescription medications. You might want to adjust your coverages to ensure you have access to a private hospital room as well as air ambulatory services. You may want the flexibility to seek treatment from chiropractors, acupuncturists, and massage therapists.
Government health insurance often fails to cover these and other specialized services. When they do cover them, coverage is limited. A supplemental health insurance plan gives you an opportunity to design a package that better accommodates you and your family.
There is a great deal of insurance advice freely available at the Kanetix infocentre. If you have any further questions, don’t hesitate to leave a message in the forum.