Retired and No Longer on a Health Plan: Here are your out-of-pocket expenses not covered by OHIP

Having enough money to cover unexpected costs is a common worry for Canadians planning retirement. We worry about having enough to cover groceries, housing, and the leisure activities we dream of enjoying once we retire. But what about medical expenses?

It turns out that many Canadians are confused about what’s covered by OHIP after retirement. Retirees are often shocked by hidden healthcare costs. And if you were fortunate enough to have a good health plan through your employer, the sticker shock of medical expenses not covered may be especially alarming.

The amount of out-of-pocket medical expenses faced by seniors and their caregivers this year averaged around $5,800, according to the Conference Board of Canada. Costs will continue to rise per capita and are expected to reach at least $8,000 by the year 2035.

What’s not covered by OHIP

As Canadians, we are fortunate to have much of our medical care covered. Even with long wait times and sometimes limited access to doctors, depending where you live, OHIP covers visits to the doctor or nurse practitioner and hospital visits and stays.

Government programs are also available to qualifying seniors to help cover some of the cost of prescriptions and assistive devices. Unfortunately, this doesn’t go very far, especially on a limited income or when living with a chronic disease or disability:

Things not covered by OHIP:

  • vision care, such as glasses, contact lenses, and eye surgery
  • hearing care
  • certain drugs administered outside of hospital, such as certain costly cancer drugs
  • ambulance transportation services that are not deemed medically necessary
  • dental services, except for complex dental surgeries performed in a hospital
  • physiotherapy, unless you’re over 65 or meet certain criteria
  • private or semi-private hospital rooms

Other out-of-pocket medical expenses to consider:

  • Non-prescription medications, such as over-the-counter pain relievers
  • Partial cost of prescriptions unless you’re over 65 or meet the eligibility criteria for ODB if under 65
  • Partial cost of assistive devices, such as canes, walkers, wheelchairs, and hearing aids
  • Most of the cost of home and car modifications made to accommodate a disability
  • Part of the cost for a nursing home or other type of residential care facility
  • Part of the cost of home care services, such as personal support workers or health care aides

Medical expenses not covered by OHIP can leave you blindsided even if you’ve been diligent about saving for retirement and creating financial security for your golden years. Even if you’re fit as a fiddle, it’s important to factor the cost of long-term care when planning your retirement. Doing so can help you maintain your quality of life and ability perform everyday activities as you age or if injury or illness makes it challenging for an extended period.

Educate yourself on available government tax credits and programs for seniors and private health insurance plans to help offset medical costs. Also consider looking into home care services, including free assessment with our registered nurse who can review and assess your health and caregiving needs.

David Porter, CPCA
Director

Living Assistance Services – Senior Home Care

 

 

Article Resources
Measures to Better Support Seniors and Their Caregivers. The Conference Board of Canada. (2019). https://www.cma.ca/sites/default/files/pdf/health-advocacy/Measures-to-better-support-seniors-and-their-caregivers-e.pdf
Get coverage for prescription drugs. Government of Ontario. (2019). https://www.ontario.ca/page/get-coverage-prescription-drugs#section-0
What OHIP Covers. Government of Ontario. (2019). https://www.ontario.ca/page/what-ohip-covers

Renovating Your Home To Comfortably Age In Place – You’ll Need More Than Just a Grab Bar!

The majority of older Canadians want to age in place. This is not all that surprising – home is where the heart is, after all! But if home is where you want to remain for as long as possible, you’ll need to plan for it.

A Closer Look at Elder Care Renovations

When people think about home modifications for seniors, they often imagine installing a grab bar or two, but there’s more to it than that.

Older Canadians are in better physical shape than ever before, but this doesn’t mean that you don’t need to plan for what you may think are “old people problems”. Mobility issues and vision changes are common. The risk of chronic conditions also increases with age.

When you’re planning your future, you’ll want to factor in the cost of renovating your home to accommodate these challenges. Did you just hear a cha-ching? While renovations can be expensive, they’re not as costly as retirement homes and assisted living facilities, which cost from $2000 to $6000 per month, according to the Government of Ontario.

Here are examples of some elder care renovations that can help make aging in place easier and safer:

  • Wider doorways and hallways to accommodate walkers and wheelchairs
  • Slip-resistant flooring, such as vinyl which provides better a level surface traction than stone to prevent falls
  • A ramp to at least one entrance to eliminate the need to navigate stairs to get in and out of the home
  • A curbless shower with a wide entry or a walk-in bathtub
  • A bath seat in the shower
  • Flat transition flooring and strips between rooms to minimize the risk of falls
  • Chair lift or elevator if you have stairs in your home
  • Lower kitchen counters to accommodate a wheelchair or scooter
  • Grab bars next to the toilet and shower

You may be entitled to some $$$

You can apply for a home accessibility credit to help pay for your renovations if you:

  • are eligible for the disability tax creditfor the year
  • are 65 years of age or older

Renovations or alterations that qualify are those that allow you to access your home and move around and function within it, and those that reduce harm when inside or gaining access to the home.

Other tips for aging in place

Here are a few other tips for aging in place:

  • Talk to your doctor. If either you or your partner is living with a chronic condition, your doctor may be able to tell you what types of challenges you can anticipate down the road.
  • Home care. Reputable home care agencies have registered nurses on staff who can assess your care needs and make recommendations for in-home care services that best suit you and your circumstances.
  • Consider your neighbourhood. You may love your home, but where it’s located matters. Is it safe? Is it close to family? Will you have easy access to a hospital, groceries, and your medical appointments?
  • Do your homework. When it comes time to choose a contractor, ask family or friends for recommendations. Be sure to ask for credentials and references, and try to choose a contractor familiar with elder care renovations.

David Porter, CPCA
Director

Living Assistance Services – Senior Home Care

 

 

 

Article Resources
Find a retirement home. Government of Ontario. (2019). https://www.ontario.ca/page/find-retirement-home#section-4
Line 398 – Home Accessibility Expenses. Government of Canada. (2018). https://www.canada.ca/en/revenue-agency/services/tax/individuals/topics/about-your-tax-return/tax-return/completing-a-tax-return/deductions-credits-expenses/line-398-home-accessibility-expenses.html
Long-term care accommodation costs and subsidy. Government of Ontario. (2019). https://www.ontario.ca/page/get-help-paying-long-term-care