Many of our American friends assume that everything is covered by our universal healthcare, but that is probably the biggest misconception of all. Even some Canadians assume this — until the time comes where they need to have a certain treatment.
Unfortunately, the provincial plans don’t pay for everything. For this very reason, buying a personal health insurance policy is one of the smartest things you can do.
Why Aren’t Certain Services Covered by the Provinces?
Depending on where you live, there are many services that are likely not reimbursed by your provincial health plan. Due to the exorbitant costs related to hospital services, they are automatically paid by the provinces, as the services that are the most serious and expensive usually are. Put differently, if your health is in real danger, most of your treatment will likely be covered. You may be required to pay for less urgent or cosmetic things.
Some provinces may cover prescription medications for those age 24 and under and 65 and up. OHIP+ only covers certain drugs, so be aware that some may not be covered. (See Ontario Health Insurance Plan’s website) Similarly, Quebec will cover certain drugs but not others. To find out what’s covered in your province, you can visit your province’s health insurance plan website.
Some provinces will pay for vision care services. In Ontario, eye exams are covered for children under the age of 18 and seniors over age 65. If you fall outside those age categories, you should find a plan that will cover you.
Glasses and contact lenses are also not covered by the provinces. As long as they require a prescription, you should be able to submit any claims to your own insurance plan, provided it is a benefit of your plan. Laser eye surgery may be covered under some plans, and is definitely not covered by most provinces.
Accidental Dental Services
If you suffer an injury to your mouth and require emergency dental treatment, your provincial health plan may not cover the cost to fix your teeth, though some may consider it. Some provinces will only pay dental services if performed in a hospital, and restrictions apply. Most individual health insurance plans cover Accidental Dental benefits.
These services are not like your regular checkups where you get cleanings and perhaps a filling. They do not share a maximum with your dental benefits; in fact, they are assessed as a medical benefit due to the accidental nature.
Registered Therapist Treatment
Some provinces will cover a portion of the cost for paramedical services like massage therapy, chiropractic care, or physiotherapy. If you or a family member require treatment from a specialist, check your province’s health website. You may have to pay out of pocket unless you have a private insurance plan that covers them.
Acupuncture, speech therapy and psychology services fall into this category as well. If you need or are considering these kinds of help, you really should think about getting an insurance policy if you don’t have one already.
Therapies aren’t the only methods used to alleviate pain or immobility from injury or illness. Sometimes medical supplies are required and may be prescribed by your doctor:
- Hospital beds, grab bars, etc.
- Casts, braces, and splints
- Crutches, canes, walkers
- Prosthetic body parts
- Medical equipment rentals (oxygen tanks)
These items are usually excluded from provincial plans, although some may pay a portion. Most private insurance plans will cover most of all the costs, provided you have a doctor’s referral listing the diagnosis, and that it isn’t related to a pre-existing condition you had prior to enrolling in the plan.
Miscellaneous Services and Items
Some other things not covered by the provinces can include wigs after cancer treatment, orthopedic footwear, naturopathic services, hearing aids, ambulance fees, and much more.
If you are ever unsure, it’s best to send a cost estimate to your insurance company before committing to anything, or you can simply call your provider to find out if it’s covered.
A private insurance plan is the best way to avoid shelling out money for unexpected medical expenses.
Give Us a Call
Call us today and we can help you find a plan, or understand the benefits of the plan you already have. We can also tell you what information should be included if you are sending a cost estimate.
We are always happy to help you. Just give us a call, and we’ll do our best to point you in the right direction!