HEALTH: Aged 55 – 65 years and without a medical plan

Anyone who has retired from an organization which had provided medical coverage while they were employed by the company, may have to consider a private plan.

MEDICAL PLAN assistance for those 55 – 65 and without a current medical plan
( August, 2018 )

Why consider buying a private plan
There are numerous costs people without a medical plan must pay: prescriptions, dental services, vacation medical expenses, eye examinations, hospital services and some complementary alternative medicine expenses such as massage therapy, chiropractors, acupuncturists, herbalists, osteopaths, and naturopaths.

Buying a medical plan, like buying insurance, one pays a monthly premium and should the need arise for some medical expense within the purview of that particular plan, the company behind the plan covers the medical costs for the client.

Ontario residents beyond 65, automatically receive coverage under the Ontario Drug Benefit program covering costs of generic medications. Non-generic medication costs are the responsibility of the patient. The Ontario government has also updated its insurance plan, OHIP+, which expands the drug coverage to include more drugs paid for by the government. The OHIP+ goes into effect in August, 2019. [ The Ford government has not addressed this plan to date. ]

Quick Facts

  • Currently, everyone 65 and over is eligible for prescription drug coverage through the Ontario Drug Benefit (ODB) program, which requires seniors to pay deductibles and co-payments based on their income and other factors. Under the ODB, seniors are paying an average of $240 a year out of pocket for their medications.
  • OHIP: the Ontario Health Insurance Plan, a basic medical care plan, is provided to all eligible Ontario residents. The plan pays for services that are medically necessary. These services include visits to your family doctor and specialists. Most basic and emergency health care services are covered by OHIP. More information can be found at HEALTH ONTARIO
  • This expansion of OHIP+ will eliminate the ODB’s deductible and co-payments for seniors, making over 4,400 medications completely free for everyone 65 and older who is OHIP-insured. Ontario will invest approximately $575 million by 2020-21 to align our seniors program with OHIP+: Children and Youth Pharmacare.
  • Seniors (65 years and older) are Ontario’s fastest-growing age group. By 2041, it is projected that 25 per cent of Ontario’s population will be 65 years or older, almost doubling from 2016 to 4.6 million seniors.
  • Ontario’s online search tool helps people quickly and easily search through a list of more than 4,400 publicly funded medications and other drug products.
  • Through the Trillium Drug Program, Ontario makes life more affordable for those who spend approximately three to four per cent or more of their after-tax income on eligible prescription drugs by reducing the cost of medication to up to $2 per prescription, after a deductible.
  • Since launching on January 1st, 2018, OHIP+ has provided free prescriptions to over one million children and youth. The first of its kind program in Canada makes Ontario a leading voice in the movement for a universal pharmacare program that expands medicare to make prescriptions free for all Canadians.

OHIP Services
The Ontario Health Insurance Plan (OHIP) pays for a wide range of health care services. It pays for most basic medical and emergency services. It can pay for all or part of the cost.

There are some services that OHIP does not pay for such as cosmetic surgery (dental or physical), dental services or chiropractic services.

For some treatments, OHIP pays part of the cost. For example:

  • Some services from your doctor, podiatrists, and osteopaths
  • Physiotherapy treatments
  • Dental services in hospitals
  • Eye tests
  • Travel costs: if you live in northern Ontario and must travel long distances for specialty medical care, OHIP may pay some travel costs.

Need more help regarding medical plans, talk to a health care professional. Some insurance companies have medical plans available. You can also contact the Ministry of Health INFOline:

In Ontario:  1 866 532 3161

In Toronto:  416 314 5518

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