Health Insurance for Retirees (Ontario)

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qasimodo
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Health Insurance for Retirees (Ontario)

Post by qasimodo »

DW is approaching retirement (which I already enjoy) at which time we will lose her employer based health insurance. As residents of Ontario we will continue to have OHIP but have begun to mull over the topic additional coverage. We are relatively young and healthy (for now). Is it worthwhile to supplement OHIP for our current needs (apart from travel, which we view to be "mandatory")?

Thoughts and experiences would be appreciated
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Re: Health Insurance for Retirees (Ontario)

Post by brucecohen »

Years ago a health insurance broker who belonged to my ski club told me that individual supplementary plans are not normally worth the money, but group plans through associations are often worthwhile.

DW and I have supplementary medical and dental coverage through an association group plan. The medical covers:
-- Out of Canada/province
-- Prescriptions
-- Paramedic treatment including chiropractor, physio therapy and massage
-- Eyeglasses
-- etc, etc
We did not buy the hospitalization coverage. That mainly covers the cost of a semi-private room. Most hospital rooms are now semi-private anyway.

DW takes some costly drugs and sees her chiro regularly so the supp plan is a money-saver for her. When I did a detailed analysis a few years ago it was pretty much a wash for me. Since then I've needed dental work for the first time in decades, have been put on three more drugs and have needed a fair bit of physio for a shoulder injury. So the plan is now a money-saver for me too, but that might change once I turn 65 and go on the govt's Ontario Drug Benefit program. A key point to ponder: ISTM that healthy people start becoming unhealthy pretty soon after turning 60. Friends and family have all experienced post-60 ailments.

Our out-of-Canada coverage is very handy because we go to the US several times a year. I like the convenience of not having to worry about getting insurance before departure, but it's easy for those without a group plan to buy their own annual come-and-go-as-you-please coverage. I forget the actual name. I did file a claim 2 or 3 years ago when a minor injury while hiking in the White Mountains produced a US$1,000 ER bill from a New Hampshire hospital. The group plan took care of everything.

Note: Premiums for supp medical/dental plans qualify for the medical expense tax credit.
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Bylo Selhi
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Re: Health Insurance for Retirees (Ontario)

Post by Bylo Selhi »

brucecohen wrote:Years ago a health insurance broker who belonged to my ski club told me that individual supplementary plans are not normally worth the money, but group plans through associations are often worthwhile.
My understanding is that sponsors of corporate group plans allow retirees to convert to their individual plans without penalties for pre-existing conditions. For example if your employer's group plan is with Manulife you can convert to MLF's individual plan within 30/60 days of retirement. I would think this would be preferable for anyone with pre-existing conditions.

Anyone know if this is true and/or if there are any special issues to be aware of?
The medical covers:
...
-- Prescriptions
I thought ON covers seniors over 65 for prescription drugs subject to nominal deductibles. Why would you need separate insurance for this?
Most hospital rooms are now semi-private anyway.
And the trend is towards private rooms, especially for seriously ill and post-ops, in order to minimize infections.
Our out-of-Canada coverage is very handy because we go to the US several times a year. I like the convenience of not having to worry about getting insurance before departure, but it's easy for those without a group plan to buy their own annual come-and-go-as-you-please coverage. I forget the actual name. I did file a claim 2 or 3 years ago when a minor injury while hiking in the White Mountains produced a US$1,000 ER bill from a New Hampshire hospital. The group plan took care of everything.
My concern with separate out-of-country medical insurance relates to horrorstories from people who made large claims that were denied because they didn't properly declare "pre-existing conditions." We've discussed this on other threads. How do you assure/insure that you're really insured when you really need insurance?
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Re: Health Insurance for Retirees (Ontario)

Post by brucecohen »

Bylo Selhi wrote:My understanding is that sponsors of corporate group plans allow retirees to convert to their individual plans without penalties for pre-existing conditions. For example if your employer's group plan is with Manulife you can convert to MLF's individual plan within 30/60 days of retirement. I would think this would be preferable for anyone with pre-existing conditions.
The individual plan might be expensive. That's typically the case when a departing employee continues life insurance through an individual plan. I'd first try to find one or more association plan and compare the costs and coverage.
I thought ON covers seniors over 65 for prescription drugs subject to nominal deductibles. Why would you need separate insurance for this?
ODB covers most but not all drugs. You can search the list here. My drugs are on the list but it looks like ODB covers only about 90% of the cost. Once I start ODB I'll see if my own insurance covers the rest and whether that's worthwhile.* Also, there are some people who have to take brand name drugs because, for some reason, the generic version doesn't work right. I don't know if ODB will pay for brand name when a generic is available.

*In our plan prescription coverage is part of the medical package. So I'll have to subtract the cost of drugs from my claims history and see how the total of the other stuff compares to the premiums. And, as you point out, group out-of-Canada coverage is a bit less treacherous than an individually purchased policy because there are no gotcha screening questions upfront. (You do, however, face them at time of claim. I recall having to complete two or three questionnaires that each asked in a somewhat different way if there were any drug changes and/or doctor's consults during the 90 days before departure.) Given that I have a PEC, it might well be worthwhile to keep the group coverage even though ODB will pay almost all of my drug cost.
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Re: Health Insurance for Retirees (Ontario)

Post by Glen »

I have a related question. In retirement I plan to get Public Service Health Care Plan insurance, which is available to me as a retired Canadian Forces member. It covers the expenses that you mentioned, Bruce, but only the first 40 days out of province. We hope to spend more than 40 days down south so we're wondering whether it makes more sense to supplement PSHCP with some other insurance (and like Bylo, we've heard lots of horror stories about pre-existing conditions not being covered) or to consider a brief return to Ontario every 40 days.
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Shakespeare
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Re: Health Insurance for Retirees (Ontario)

Post by Shakespeare »

PSHCP is supplemented/integrated with Medoc (Johnson) for FSNA members.

http://www.fsna.com/index.php?module=CMS&id=139&newlang=eng
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Re: Health Insurance for Retirees (Ontario)

Post by Glen »

That looks good, Shakespeare. Thanks very much. It looks like FSNA membership might be a good investment. Would you expect pre-existing conditions to be an issue for Medoc coverage?
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Re: Health Insurance for Retirees (Ontario)

Post by Shakespeare »

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Re: Health Insurance for Retirees (Ontario)

Post by Bylo Selhi »

brucecohen wrote:group out-of-Canada coverage is a bit less treacherous than an individually purchased policy because there are no gotcha screening questions upfront. (You do, however, face them at time of claim. I recall having to complete two or three questionnaires that each asked in a somewhat different way if there were any drug changes and/or doctor's consults during the 90 days before departure.)
I don't understand. What if there were? Would you not have blanket OofCA coverage regardless with a group plan (as is the case for such plans for current employees)? I see this as the main advantage of such plans even if more expensive.
Given that I have a PEC, it might well be worthwhile to keep the group coverage even though ODB will pay almost all of my drug cost.
Good point. As for name brand vs generics AFAIK private plans will pay for the former providing the physician indicates name-brand-only on the Rx.
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Re: Health Insurance for Retirees (Ontario)

Post by Shine »

As all of us boomers tumble into hospital over the next decade or so, paying insurance premiums for semi-private or private rooms is a non-starter. Unless one is grandly wealthy and can arrange hospital accommodations directly, one will only get what is currently available at the respective institution, and that could well be a gurney in the hall until some soul passes on thereby providing a bed.

I would search out medical insurance for pharmaceuticals and tests rather than accommodation preferences.
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Re: Health Insurance for Retirees (Ontario)

Post by SQRT »

brucecohen wrote:Years ago a health insurance broker who belonged to my ski club told me that individual supplementary plans are not normally worth the money, but group plans through associations are often worthwhile.

DW and I have supplementary medical and dental coverage through an association group plan. The medical covers:
-- Out of Canada/province
-- Prescriptions
-- Paramedic treatment including chiropractor, physio therapy and massage
-- Eyeglasses
-- etc, etc
We did not buy the hospitalization coverage. That mainly covers the cost of a semi-private room. Most hospital rooms are now semi-private anyway.

DW takes some costly drugs and sees her chiro regularly so the supp plan is a money-saver for her. When I did a detailed analysis a few years ago it was pretty much a wash for me. Since then I've needed dental work for the first time in decades, have been put on three more drugs and have needed a fair bit of physio for a shoulder injury. So the plan is now a money-saver for me too, but that might change once I turn 65 and go on the govt's Ontario Drug Benefit program. A key point to ponder: ISTM that healthy people start becoming unhealthy pretty soon after turning 60. Friends and family have all experienced post-60 ailments.

Our out-of-Canada coverage is very handy because we go to the US several times a year. I like the convenience of not having to worry about getting insurance before departure, but it's easy for those without a group plan to buy their own annual come-and-go-as-you-please coverage. I forget the actual name. I did file a claim 2 or 3 years ago when a minor injury while hiking in the White Mountains produced a US$1,000 ER bill from a New Hampshire hospital. The group plan took care of everything.

Note: Premiums for supp medical/dental plans qualify for the medical expense tax credit.
We have a similar set up with my previous employer (we are both retired from the same company). Agree that out of country is very useful. Being a group plan we didn't need to get underwritten, ie fill out health forms, etch. Have found that the dental is not really worth it though. It doesn't cover the expensive procedures we tend to get done and seems pretty expensive ($140/month) so we dropped it.
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Re: Health Insurance for Retirees (Ontario)

Post by brucecohen »

Bylo Selhi wrote: I don't understand. What if there were? Would you not have blanket OofCA coverage regardless with a group plan (as is the case for such plans for current employees)? I see this as the main advantage of such plans even if more expensive.
Not necessarily. In the US many group plans exclude PECs for new entrants. While I haven't heard of that in Canada now, US trends tend to migrate.
As for name brand vs generics AFAIK private plans will pay for the former providing the physician indicates name-brand-only on the Rx.
Yes but I don't know about ODB. It probably does too but likely with some (a lot?) bureaucracy.
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Re: Health Insurance for Retirees (Ontario)

Post by stardancer »

I did a calculation from 2004 when I retired (PSHCP); added up what I actually paid in premiums and co-pay against what I would have paid without a supplementary plan. To the end of 2013- medical I am ahead by $5280; dental I am ahead by $3700, so both plans so far have been worth it. (This may change down the road, as the feds will probably decrease their share of the premiums and I will pay higher premiums. Maybe the PSHCP is not a good example as the premiums are partially subsidized.)

Note: my husband suffers from Crohn's and requires lots of medication; I have hypertension.
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Re: Health Insurance for Retirees (Ontario)

Post by OhGreatGuru »

Shakespeare wrote:PSHCP is supplemented/integrated with Medoc (Johnson) for FSNA members.

http://www.fsna.com/index.php?module=CMS&id=139&newlang=eng
And, because it is integrated, it is cheaper than most alternatives. For under 40 days, the PSHCP coverage is like a $500K deductible to the Medoc plan. And for longer stays you can purchase additional coverage either on a one-time basis or annually. If memory serves me correctly though, the longer-term coverage requires that you pass their medical screening. (But I think that would be the case for most plans) I switched to Medoc from Monnex when my SO reached 65, when rates start going up significantly.
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Re: Health Insurance for Retirees (Ontario)

Post by OhGreatGuru »

stardancer wrote:I did a calculation from 2004 when I retired (PSHCP); .. so both plans so far have been worth it. (This may change down the road, as the feds will probably decrease their share of the premiums and I will pay higher premiums. Maybe the PSHCP is not a good example as the premiums are partially subsidized.) ...
PSHCP/MEDOC is relevant to "Glen's" post, and the replies to it, as he says he is member of PSHCP. But for a general discussion it may be misleading, and OP does not appear to be in PSHCP.
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Re: Health Insurance for Retirees (Ontario)

Post by Benchwarmer »

Glen wrote:It looks like FSNA membership might be a good investment.
I believe that membership is worth it. In retirement the FSNA is the only advocacy voice you have.

For example, to fight the employer breaking the retiree PSHCP premium promise (which was the result of collective agreement bargaining), probably means going all the way to the Supreme Court. This takes resources against an employer which has an infinitely deep pocket.

The $50 annual membership fee is far too low. I would pay 10 times that.
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Re: Health Insurance for Retirees (Ontario)

Post by OhGreatGuru »

Benchwarmer wrote:
Glen wrote:It looks like FSNA membership might be a good investment.
I believe that membership is worth it. In retirement the FSNA is the only advocacy voice you have.
...
I agree. They also will provide you with timely information on changes to CPP, OAS, PSHCP, Superannuation Plan, and PDSP. With the current government intent on making changes to these plans, you want a source of information other than the newspaper.
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Re: Health Insurance for Retirees (Ontario)

Post by Stan »

When I retired I converted from the small group plan to an individual plan with the same company; mainly because the out of country coverage was valid up to age 80 without any medical.
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