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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

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