Health Insurance

[Springbok]

From another thread:

Springie and Jo Anne: No need for math lessons...reread the first post. It says "roughly $1 million". The title I used is somewhat catchier than "If I Had A Million dot One-five dollars".

Treetops: Yes, private insurance is a must and I think will come to two thousand bucks or so per year for a family of three.

Well, 2c, I must admit I need new eyeglasses!

Regarding health insurance. Why is this needed? We get insurance when we are out of the country, but with the Ontario Helth Plan and the drug benefits for those over 65, we have not bought health insurance - We at one time had it though a company plan, but main benefit seemed to be for semi-privat.e hospital rooms.

Maybe this should be a separate thread - I will start one.

Can anyone shed light on why we NEED private health insurance when we have universal medicare?

[twocentsworth]

Dental coverage?? That's not covered under public health insurance. Or would it be better to pay that out of your own pocket?

[Shakespeare]

would it be better to pay that out of your own pocket?

If you've got good teeth, pay from your own pocket.

[Bylo Selhi]

Can anyone shed light on why we NEED private health insurance when we have universal medicare?

Because there's stuff that OHIP either doesn't cover or doesn't cover sufficiently.
1. Semi and private room upgrades from ward. That could be valuable for extended hospital stays, especially if one wants some privacy.
2. Private duty nursing care.
3. Dental care.
4. Coverage outside home province. OHIP only pays the Ontario rates outside ON. That's not a big deal generally within Canada. But if you get sick in Nirvana-to-the-South, especially a hospital stay and surgery and you could be bankrupt.
5. Many plans also cover some but not all of stuff like vision (eyeglasses) care, hearing (aid) care, etc.
6. Etc.

Added: Whether or not the premium is worth it to you depends on your needs. If you travel often to the US, then you definitely need extra coverage. Otherwise your million dollar nest egg could disappear in a (skipped) heartbeat.

[Jo Anne]

We don't have private health insurance of any kind.

We have a very good doctor in town, with no waiting to get in and see him. He's just joined one of those Family Health Network things, so someone will always be available at short notice.

When I needed my gall bladder out last year, the wait time wasn't unreasonable, and if it had been an emergency it would have been taken care of quickly.

The only prescription drugs either of us takes is allergy stuff, at a cost of about $100/year.

Dentist bills run to maybe $1000/year, but I wouldn't pay for dental insurance out of my own pocket anyway, because I think it's cheaper to self-insure.

My parents and in-laws have always received excellent care in the local hospitals. Paying for private insurance seems to me to be throwing away money.

[like_to_retire]

Can anyone shed light on why we NEED private health insurance when we have universal medicare?

Private insurance covers extended health care benefits and additional hospital benefits not covered by the provincial plan.

The health care benefits can cover all drugs, vision care (eyeglasses and examinations), dental oral surgery, health practitioner benefits, etc and the hospital benefits can cover semi private rooms.

The list is very, very long, in fact my plan's coverage fills a small book. You'd be suprised how much the provincial plan does not cover...

ltr

[Shakespeare]

Professional associations or alumni associations may offer group coverage that gives semi-private rooms, etc. This is often a better deal than can be obtained individually.

And, you definitely should arrange for out-of-country insurance for any trips.

Beyond those points, if one has a large nest egg self-insurance may be sufficient.

[Bylo Selhi]

And, you definitely should arrange for out-of-country insurance for any trips.

Some "gold" credit cards also offer this insurance for short (2 to 3 weeks) trips abroad. However one should read the fine print carefully, especially seniors because they've started imposing age restrictions and they often exclude "preexisting conditions" -- something many seniors have an abundance of

CARP et al offer seasonal coverage for snow birds. You can also buy out-of-country coverage through travel agenst, however I suspect they're expensive.

Beyond those points, if one has a large nest egg self-insurance may be sufficient.

Agreed. But it's worth familiarizing oneself with common out-of-pocket expenses. IIRC an upgrade from ward to private can cost several hundred dollars a day.

[Springbok]

IIRC an upgrade from ward to private can cost several hundred dollars a day.

Not sure about the big-city hospitals, but most "wards" relatives have been in seem to have at most 4 beds and often just two.

In our case, we have been fortunate to be healthy, so have not given health insurance much thought.

We pay for our own dental coverage - seldom more than $300/yr for both of us.

We do pay for travel insurance and have bought this through BMO - Not sure if we get the best deal.

For those over 65 in Ontario, Drugs are covered ( http://www.health.gov.on.ca/english/pub ... ing65.html )

Eye examinations are free for over 65's too. Eyeglasses have to be paid for - A few hundred $$ every couple of years.

"The list is very, very long, in fact my plan's coverage fills a small book."

I am interested in what is not covered

[Bylo Selhi]

Not sure about the big-city hospitals, but most "wards" relatives have been in seem to have at most 4 beds and often just two.

My understanding is that ward is 4 beds, semi-private is 2 and private is 1. Hospitals will give you a "free upgrade" if you only have OHIP but no ward beds are available. Likewise they downgrade you if that's all they have. If you're really ill then it makes little difference, but if you're there for something relatively minor or recuperating, etc. then you may find it difficult to sleep if someone in the ward is moaning and groaning all night.

We pay for our own dental coverage - seldom more than $300/yr for both of us.

About a year ago I had to have a tooth capped because it had so many fillings that there was little "tooth" left. That cost ~$1,000 with extended coverage picking up about 50%. After that procedure my tooth was very sensistive for several weeks and I was referred to an endodontist for a root canal. That would have cost another $1,000. (Fortunately I insisted on toughing it out for another couple of months and the sensitivity has long passed.) That's one tooth. I still have all my teeth, many of which have fillings. (Fortunately my company pays for our extended health coverage so that doesn't cost me anything out-of-pocket -- yet.)(*)

I am interested in what is not covered

Check out private insurers' websites (e.g. Blue Cross) to see what they offer

(*) As I've learned from the behavioural economists, since I'm a major shareholder I do indeed pay, albeit somewhat indirectly, the premium

[twocentsworth]

Springie: The drugs are covered for those over 65...but...if you take the retirement plunge early, at say 50, and something unexpected should go amiss, the extra drug coverage of a private plan may come in very handy indeed. Generally, we self-treat with homeopathic/naturopathic medicine so we aren't expecting a phamaceutical binge, but who knows what the future holds. As Bylo found out, an expensive root canal is another possibility.

Jo Anne: I was wondering what you two did for coverage. I think you live in a VERY good spot as far as the doctor and medical scene goes. Not all rural/small towns are as lucky.

[Jo Anne]

Generally, we self-treat with homeopathic/naturopathic medicine so we aren't expecting a phamaceutical binge, but who knows what the future holds.

My husband and I are very much against the whole prescription drug thing. I think most things (cholesterol, blood sugar, etc) can be better dealt with through improved diet.

Jo Anne: I was wondering what you two did for coverage. I think you live in a VERY good spot as far as the doctor and medical scene goes. Not all rural/small towns are as lucky.

We also have very good public nursing homes here. We're covered on all bases.

[twocentsworth]

Lucky stiffs!!

[treetops]

Age 57. I carry 2 health plans: an extended medical plan ($70 per month), and a catastrophic drug plan ($70 per quarter). So far, the extended medical isn't worth it (high co-pays, yearly maximums), and I'm considering self-insurance.

The catastrophic plan covers any drug expenses over $4800 per year. This may go away when I turn 65, but i suspect that the drugs covered under the Provincial plans may shrink under the strain of aging boomers.

Anyone know if the folks in Ottawa are making progress with health spending accounts i.e. personal tax-exempt savings plans for healthcare.

P

[twocentsworth]

Another thought, Jo Anne: You and hubbie might like to explore the naturopathic allergy medicines instead of those vile pharmaceuticals. Works pretty good for us with no side effects. I use stuff I pick up at the local health food store (their naturopathic "drug" section) while my wife gets special concoctions made up by her female naturopathic doctor. We were on asthma puffers after we got back from Australia (developed it over there, what with all the year-round bloomin' botanicals), but with her help we kicked the habit and rely on the occasional midl dose of homeopathic-naturopathic remedies instead.

[twocentsworth]

Treetops: Which outfit did you use for the catastrophic drug plan? Any details on that plan?

[Jo Anne]

Another thought, Jo Anne: You and hubbie might like to explore the naturopathic allergy medicines instead of those vile pharmaceuticals. Works pretty good for us with no side effects. I use stuff I pick up at the local health food store (their naturopathic "drug" section) while my wife gets special concoctions made up by her female naturopathic doctor. We were on asthma puffers after we got back from Australia (developed it over there, what with all the year-round bloomin' botanicals), but with her help we kicked the habit and rely on the occasional midl dose of homeopathic-naturopathic remedies instead.

Good idea.

Mike's allergic to dust mites and I'm allergic to vaccuuming. Bad combination. He uses a prescription nasal spray (Nasacort?).

I didn't know there were natural products for allergies. Can you give me any product recommendations?

[twocentsworth]

I use "Pollinosan" which is rated for "Hay fever, sneezing, watery eyes and allergic reactions". I also team that up when necessary with "Sinna" for "Sinus inflammation and sinus congestion". Both are homeopathic drops made by A. Vogel which you add to a wee bit of water and swirl around in your mouth for about a minute and then swallow. They're distributed by Bioforce Canada Inc out of Montreal and should be available at a health food store. If not, I'm sure they could order them in for you or provide suitable alternatives. Sinna is also available in small soluble pills which dissolve under the tongue.

Our other homeopathic must-have is "Lobelia Plex" for light asthma symptoms and lung problems associated with coughing. It's made in Brussels by UNDA and distributed in Canada by Seroyal Int'l Inc in Toronto. I go down to the local drugstore -- which handles alternative stuff as well -- and they order it for me when I run out.

My wife gets stronger medicine for allergies and the like via her naturopathic doctor. These are, as I like to call them, a "witch's brew" of herbs and natural remedies which she orders from specialty companies or sometimes tweeks herself. Damn fine stuff. Ever since I met my wife -- and we go back to grade 10 !! -- she's had a yearly bout of horrendous coughing that sounds like she's on the verge of croaking. (And she's a wee thing -- or at least she used to be ) No normal medical doctor ever sorted her out. It took the use of the homeopathic-naturopathic stuff to put an end to that nonsense. (And as high-school sweethearts, her coughing used to drive me absolutely nuts! There were times when I thought she was going to start bringing up blood, she would hack so loud and hard.)

Good luck!

[Arby]

So far, the extended medical isn't worth it (high co-pays, yearly maximums), and I'm considering self-insurance.

I've come to the same conclusion about my extended medical/dental plan. My annual premium has increased 50% over the past 4 years. I'm in good health, and rarely make use of the benefits. I can afford to self-insure. What I really want is catastrophic medical/drug insurance, with a $5K-$10K deductable. Presumably the premiums would be much less than I currently pay. Any suggestions on companies offering catastrophic medical/drug insurance?

[Bylo Selhi]

What I really want is catastrophic medical/drug insurance, with a $5K-$10K deductable. Presumably the premiums would be much less than I currently pay. Any suggestions on companies offering catastrophic medical/drug insurance?

Hi, I'm from the government and I'm here to help you Budget 2003 - Investing in Canada's Health Care System

This budget makes significant investments to address the concerns of Canadians about their health care system: waiting lists, availability of diagnostic equipment and accountability for their tax dollars. These federal investments, in conjunction with those of provincial and territorial partners, will help to improve access to the health care system for Canadians, enhance accountability for how health dollars are spent, and ensure the future sustainability of the system.

* The 2003 First Ministers’ Accord on Health Care Renewal is a commitment designed to improve the accessibility, quality, and sustainability of the public health care system and enhance transparency and accountability in health care spending.

* Federal support to health care will increase by $17.3 billion over the next three years and by $34.8 billion over the next five years. This includes:

* $9.5 billion in transfers to provinces and territories over the next five years;

* $2.5 billion in an immediate investment through a Canada Health and Social Transfer (CHST) supplement to relieve existing pressures;

* $16.0 billion over five years to provinces and territories for a Health Reform Fund targeted to primary health care, home care and catastrophic drug coverage;...

Be patient, patient. Dr Ujjal's on the case

[Norbert Schlenker]

Anyone who wants catastrophic drug coverage can just move to BC. There is a public program here called Pharmacare that picks up prescription costs at successively higher levels depending on income. There is a calculator here to give people an idea of coverage.

Above about $35000 net income IIRC, there is a 3% deductible, a 30% copay after that, and a 4% annual maximum. Discounts for seniors, lower percentages for lower incomes. Paid for by fellow taxpayers.

[treetops]

My catastrophic coverage is with Manulife/formerly Maritime Life/formerly Liberty Health.

What I really want is catastrophic medical/drug insurance, with a $5K-$10K deductable

It pays 100% for drugs when out-of-pocket exceeds $4800 per year. I need it until 65 or until Ont/Feds implement a catastrophic plan for sub-65's.

Cost = $280 per year

P

[twocentsworth]

Thanks for that!

[northbeach]

I am between jobs where my new part time position does not carry extended health benefits.

I checked into carrying on with GWL as I could sign on without questions.

However looking at the cost of insurance versus current dentist and prescription yearly costs I would come out a loser if I signed on. Also there are caps for prescription, dental, home care etc... that it would be almost impossible that one could ever get more than my annual premium.

I wonder if extended health insurance is ever worth it given that we have a satisfactory health care system.

I figure I may need insurance when out of the country. Also I have extra low cost accident insurance through TD. Forgot if it covers car only or all types of mishaps> should review.

Hope to stay healthy regardless.

[FinEcon]

You didn't mention your province of residence so things may differ accross provinces. I'll look at the major categories of healthcare as I see them.

Medical Care
Healthcare is a moot point since you are not able to purchase private insurance to cover publicly insured medical services as no insurer is allowed to sell it to you.

Drugs
I'm in BC, we have Pharmacare which is another income redistribution scheme where the price you pay for pharmaceuticals is a function of your income, so no real need for an extened health plan (EHP) to covers pharms. However, when you have both your plan is applied after pharmacare so drugs will be practically free. The last prescription I picked up, out of pocket cost after Pharmacare and my EHP was 68 cents.

Extended Heath - Other
I would not even consider a EHP to cover vison, hearing, mobility, orthotic products and/or services because the amounts covered are always stingy. Really, I mean the plans I know of (my own and others through friends and family) only seem to cover a mediocre portion of the price of glasses, hearing aids, wheelchairs, etc.

Dental & Orthodontics
Cannot speak for others but in my world oral hygiene is number one so I'm not in need of dental work due to dilligent preventative maintenance. If your work doesn't provide dental you are going the cash based route. Private dental plans are so expensive they are almost unheard of. Don't believe me? Next time you're at the tooth doc, ask the receptioninst how many people at that practice have private dental insurance. Depending where you live, she may very well say none.

Orthodontics can be expensive but again private coverage is non-issue same reasons as dental insurance. However, I know of two people who paid cash for orthodontic work and recieved a major discount paying cash, one of them paying $3000 instead of just over $4000 for braces.

In the case where you are not eligible for an employer sponsored plan you will be pretty much forced to self insure because the prices will be skewed upward severely (moral hazard and adverse selection) because he cannot adequately determine a risk premium in the small, therefore the cost will be prohibitive. Your best bet is to build a fairly large rainy day fund and keep it in a high interest savings or money market account.