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Compare and Contrast: Comparing Private Health Insurance in Canada

on 8 Jul, 2019

Almost two-thirds of the Canadian population have health insurance outside of Medicare. Many of these private plans are employer-issued, while others are individually-purchased.

That’s because Medicare, Canada’s public healthcare system, doesn’t cover all health care costs. For instance, it doesn’t cover prescription drugs in most cases. It also doesn’t pay for routine medical exams or preventative dental services.

With healthcare spending on the rise — it has been so since 1975 — it pays to have private health insurance in Canada. It’ll help cover the costs of what Medicare doesn’t provide coverage for.

But with so many health insurers in Canada, how do you choose the best one?

Don’t worry. This post will help you compare your options so you can figure out which health insurance is the best!

Determine What Type of Private Coverage You Need the Most

To find the best health insurance in Canada, you should figure out which type of coverage you need the most. Start by reviewing your previous medical spending, such as how much you pay to visit your doctor. Also, note your yearly out-of-pocket expenses for prescription medications.

In doing so, it’ll be easier for you to determine if you need a higher coverage for prescription drugs. Or if you need to also get more coverage for medical equipment and supplies.

Let’s take a closer look at the most common types of coverage that come with private health plans.

Prescription Drug Coverage

Experts estimate that in 2018, Canadians spent $39.8 billion on medications. That’s about $1,074 per person, and almost 85% of that spending went towards prescription drugs.

The thing is, public health insurance doesn’t come with prescription drug coverage. But most private health plans do, so long as the medication has a Drug Identification Number (DIN). Plus, there are plans that offer both health and dental coverage.

Coverage amounts vary, although you can get anywhere from 60% to 90% reimbursement. For example, if you get the Sun Life Basic Plan, it’ll reimburse you for up to 60% of your drug expenses. If you go with Manulife’s Enhanced FlexCare ComboPlus, you can get up to 90% reimbursement on the first $2,000.

Dental Coverage

Medicare doesn’t cover routine and preventive dental procedures, as they’re not “medically-required”. The good news is, some private health plans fill in this gap, such as the Manulife FlexCare ComboPlus. Even the basic plan offers some coverage for dental exams, cleaning, and filling.

Be sure to check coverage for major dental services, including crowns and bridgework. Although most private plans provide coverage for these, some have a waiting period. For instance, Manulife’s Enhanced FlexCare ComboPlus will only provide coverage after three years.

Vision Care Coverage

Six in every 10 Canadians have potential eye disease, which can lead to vision loss and blindness. But since Medicare only covers certain eye exams, many Canadians don’t seek treatment.

Luckily, vision care coverage is available with most Canada private health insurance plans. This coverage includes eye exams that public healthcare won’t pay for. Discounts for eyeglasses and contact lenses are also included.

Depending on the plan you get, you may also get coverage for laser eye surgery. Some plans under Manulife and Sunlife offer coverage for laser vision correction.

Durable Medical Equipment Coverage

Durable medical equipment (DME) is any durable medical device with therapeutic benefits. These include wheelchairs, walkers, canes, and crutches to name a few. Artificial limbs, or prosthetics, as well as sleep apnea devices, are also types of DME.

In most cases, provincial healthcare plans consider DME as an exclusion. If you or anyone in your family needs these supplies, private health insurance can help. In fact, most private plans include this in their core benefits.

Paramedical Service Coverage

Paramedical services are usually not covered by provincial healthcare plans. Except if the beneficiary has an upgraded plan, such as a “premium assistance status”.

If you don’t, no need to worry as most private health plans provide paramedical coverage. These include services from psychologists, psychotherapists, physiotherapists, and massage therapists. Acupuncture and naturopathic services are also often covered by private insurance.

Check Qualifications and Eligibility Requirements

Individual health insurance plans have eligibility requirements based on one’s health history. For instance, some insurers may not accept applicants who have a pre-existing condition. These include chronic illnesses like diabetes, cancer, hypertension, and lupus.

Other insurers still provide coverage for those who have these pre-existing conditions though. But your rates, premiums, and other costs may be higher.

There are also some insurers who offer guaranteed acceptance, regardless of medical history. Especially for those who are part of a company group plan. Check your employer-issued health coverage, as the same insurer may guarantee your acceptance.

If you’re about to retire, you can still take advantage of guaranteed acceptance plans. Some insurance companies offer guaranteed coverage for members of group plans. You need to apply two months before you lose your group benefits though.

Compare Deductibles and Copayments

Three types of “fees” make up health insurance cost in Canada. These include premiums, deductibles, and copayments.

Premiums

A premium is an amount you pay for your private health insurance every month. It’s the cost of getting insured and covered. The higher your premiums are, the more comprehensive your coverage will be.

Let’s say you’ll get the Manulife FlexCare ComboPlus Starter plan. With this, you can get up to 70% discount on the first $750 for your prescription drugs. But upgrade your plan to the ComboPlus Basic, and you get the same benefit plus 90% off on the next $4,972.

If you take quite a lot of prescription drugs, a plan with a higher premium may be a better choice. You’ll pay a little more every month, but it’ll also give you more coverage for prescriptions. This then reduces your risks of paying exorbitant out-of-pocket costs for medications. 

Deductibles

This is an out-of-pocket expense you need to pay first before your insurance plan kicks in.

For example, your plan has a $1,500 deductible. This means you need to pay $1,500 for your medical costs using your own money first. Your insurer will already pay for anything — up to the plan’s limits — in excess to that.

So, if your medical costs reach $2,500, your insurer will cover all or part of the $1,000 outside of the deductible.

Copayment

A copayment is a fixed amount you pay for covered services after meeting your deductible.

For example, you chose a private health insurance plan with a $100 allowable cost for a doctor’s visit. It also has a copayment of $20 for each doctor’s visit.

If you’ve already paid for your deductible in full, then you only need to pay the $20 copayment. If you haven’t completed your deductible payment yet, you need to pay for the doctor’s visit in full.

Again, most plans with higher monthly premiums come with lower copayments. Whereas plans with lower premiums often have bigger copayments.

Look at Each Plan’s Annual Maximums or Limits

The annual limit of a health insurance plan is the maximum amount the insurer will cover in a year. If you reach your plan’s annual limit, you have to pay the rest of your health care costs within the same year.

Let’s use Manulife’s ComboPlus Enhanced plan as an example. Its annual cap for prescription drugs is $10,000. If your drug spending goes over that limit, you’ll pay for the excess out of pocket.

Some insurers also place limits on the number of visits covered for certain services. If your plan has a limit of 10 doctor’s visits every year, it’ll only cover those 10 visits. You need to pay for the succeeding visits in full, with your own money.

Factor in Your Employer-Issued Health Insurance Plan

Before you start shopping for health insurance plans, check your employee benefits first. You may already have some form of health coverage from them.

In fact, 98% of employers provide restorative dental coverage to their full-time employees. Over 90% also have their employees covered for vision care.

What’s important is to give your existing plan a thorough review first. This way, you can identify which types of coverage you have the greatest need for.

Say your employer already gives you adequate vision care coverage. Your plan, however, lacks dental coverage. In this case, you may want to consider getting individual dental insurance.

Note that some Canadian insurers also offer separate prescription drug plans. These include companies like Manulife, Sunlife, and Green Shield Canada. Consider getting this if your existing health plan covers vision care and dental services but not prescriptions.

Get Quotes for Private Health Insurance in Canada Now

Once you have a list of what you need from your private health insurance in Canada, the next step is to get quotes! Each insurance company offers different coverage levels, so they also have varying rates. The only way to determine which company has the best coverage for your needs is by comparing their plans.

We can help you get started on collecting those health insurance quotes. You only have to fill out this short form, and we’ll find you the lowest Canadian health insurance rates!

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