How to Find the Best Health Insurance for the Elderly

As Canadians retire and age into the next stage of their life, there’s often questions about the finding the right healthcare coverage. While Canada offers universal healthcare that covers a lot of the basics, most elderly Canadians find themselves with additional healthcare needs. 

Here’s everything you need to know about finding the best health insurance for the elderly in Canada.

In Canada, seniors, like other residents have access to government-funded health insurance through provincial or territorial plans. These plans generally cover essential medical services like hospital stays, doctor visits, and some diagnostic tests. When you reach the age of 65, you also become eligible for the Canada Dental Care Plan which covers a range of oral healthcare services.

While these government plans are great for basic care, they often don’t cover other medical needs, such as prescription drugs, vision care, and extended health services, like physiotherapy, that you need as you age.

As the senior population is expected to exceed 11 million by 2043—up from 7.6 million in 2023—healthcare demands are likely to rise, and with them, having comprehensive coverage becomes even more important. 

By securing additional insurance, you can enjoy peace of mind knowing that you’re covered for any of the gaps left by current government plans.

The cost of private insurance varies based on factors like age, pre-existing medical conditions, and the level of coverage you’ve chosen.

Here are a few costs to consider for elderly health insurance. 

• Monthly Premiums: Depending on the plan and coverage level, monthly premiums for elderly health insurance can range pretty significantly. These premiums generally increase with age and the inclusion of additional services like dental care or prescription drugs.
• Deductibles and Co-Payments: Not all insurance in Canada includes deductibles or co-payments but it’s important to understand where there are out-of-pocket costs associated with coverage. For example, you may have a co-pay for prescription drugs or you may only have coverage for a certain percentage of your paramedical expenses.
• Paramedical and Vision Care: Paramedical services and vision care coverage are typically not included in government plans and can be additional services on top of basic private coverage plans. So if these are important to you, be prepared for additional costs when choosing a health insurance plan. 
• Long-term Care Insurance: This insurance offers additional coverage for the cost of care in a nursing home or in-home care services, which aren’t fully covered by provincial plans. 
• Prescription Drug Plans: In some provinces, such as Ontario, seniors are eligible for government drug plans. These plans can help offset the cost of medications but there can be limitations for specific medications, prescriptions, and brands. If you have medication needs that fall outside of public coverage, you may choose a private health insurance plan that covers a wider range of drugs. However, this can increase your monthly premiums or require a co-pay.

With total health spending in Canada expected to increase by 2.8% in 2023, having the right health insurance can help you navigate rising costs and ensure you receive the care you need.

Here are some of the benefits of having health insurance coverage as a senior.

As the cost of living and healthcare continues to climb, health insurance provides valuable financial protection for healthcare needs that aren’t covered by universal healthcare plans. Additional coverage for services like private hospital stays, prescription drugs, and specialized treatments can also help reduce the risk of unexpected medical expenses.

With a large aging population in Canada, it’s widely expected that there will be a rise in healthcare spending, which could impact the cost of services not fully covered by government plans.

While provincial and federal health insurance covers many essential services for the elderly, there are limits to what's included. Having additional health insurance can expand your access to other services, including:

• Vision care
• Expanded prescription coverage
• Paramedical services (Such as massage therapists, registered dietitians, physiotherapists, social workers.)
• Private or semi-private hospital rooms
• Medical devices (Such as wheelchairs, hearing aids, or orthotics.)

While these services may not always be considered medically necessary, they can be vital for maintaining good health in your senior years.

Health insurance also offers peace of mind, knowing you have a financial safety net for unexpected medical situations. 

Whether you need a new prescription or have a sudden change in medical situation, insurance can reduce the stress associated with health issues by ensuring that the financial side of things are taken care of. 

This allows you to focus on recovery and well-being rather than worrying about how to pay for the care you need.

With the rising costs of long-term care, having insurance that factors in your future needs can make a substantial difference in your financial security.

Long-term care insurance coverage can help pay for a nursing home, assisted living facility, or in-home care if you need it in the future. While there is financial support for these services, they aren’t always fully-covered by provincial plans. 

Private health insurance often offers options that allow you to choose the level of coverage that best suits your needs. This flexibility can be particularly beneficial as you age, enabling you to adjust your plan based on changes in your health or lifestyle. Whether you need more extensive coverage or prefer a more basic plan, health insurance allows you to tailor your coverage based on your needs.

As you age, healthcare needs can become more complex, making it important to know which procedures are covered by both private and government-funded health insurance plans.

Here's a list of common procedures typically covered by senior health insurance in Canada:

• Hospital Stays: Coverage typically includes necessary inpatient care, surgeries, and overnight stays in a hospital. Private health insurance can help guarantee coverage for private or semi-private rooms for a more comfortable hospital visit.
• Doctor Visits: Regular check-ups, consultations, and visits to specialists are generally covered by government healthcare plans, helping you manage chronic conditions and receive ongoing care.
• Diagnostic Tests: Government healthcare plans cover tests such as blood work, X-rays, MRIs, and CT scans, which allow for the early detection and monitoring of various health conditions.
• Emergency Services: Coverage includes ambulance services and emergency room visits, ensuring you can access urgent care when needed. In some provinces, there is a co-pay for ambulance fees which can sometimes be covered by private health insurance plans.
• Prescription Medications: Depending on your province and any additional private insurance, many essential medications, including those for heart disease and other chronic conditions, may be covered. Additional coverage or brands can be covered through private health insurance plans.
• Surgical Procedures: Provincial health insurance covers most medically-necessary surgeries, including heart surgeries and other critical operations.
• Rehabilitation Services: Provincial healthcare plans often cover necessary physiotherapy, occupational therapy, and other rehabilitation services, particularly after surgery or a major health event. If you need these services outside of a covered event, private health insurance can help cover the costs.
• Home Care Services: Some provinces offer support for home care services, including nursing care and personal support workers, for seniors requiring assistance at home.

Selecting the right health insurance plan is crucial as you approach your senior years. With so many options available, it's important to consider your unique needs.

Here's a step-by-step guide to help you make an informed choice:

Start by evaluating your current health status and potential future needs. Consider any existing conditions you may have, such as heart disease, diabetes, or arthritis, and think about the likelihood of requiring specialized care in the future. 

Understanding your health needs will guide you in choosing a plan that offers the right coverage.

Different plans offer varying levels of coverage for services such as hospital stays, prescription drugs, dental care, and vision care. 

Some plans might include additional options like Critical Illness Insurance, which provides a lump sum payment if you're diagnosed with a serious illness like cancer or stroke. Review the specifics of each plan to ensure it covers the services you're most likely to need.

Costs can vary significantly between plans, so it's important to balance what you can afford with the coverage you need. Consider all potential costs  monthly premiums, deductibles, co-payments, and any out-of-pocket maximums. 

Remember that while a lower premium might be attractive up front, it could come with higher out-of-pocket costs when you need care.

Some plans offer more flexibility, including additional benefits like travel insurance or access to wellness benefits or alternative treatment. 

If you have specific needs or preferences, look for plans that offer these options. Critical Illness Insurance can also be a valuable addition, providing financial support if you're diagnosed with a serious condition.

Take the time to compare different health insurance plans and providers. Look at what each plan covers, reviews from customers, and the various costs.

Use a platform like PolicyMe to get a quick quote. By answering a few quick questions about your healthcare needs, you can get a personalized quote in just 60 seconds with 3 different coverage options to choose from. 

Before making a final decision, carefully review the fine print of any plan you're considering. Pay attention to exclusions, limitations, and conditions that might affect your coverage. Understanding these details can help you avoid surprises and make sure that you're fully covered.

Here are the steps for filing a health insurance claim as an elderly patient.

1. Gather Necessary Documentation: Ensure you have all the required documents before filing a claim. This usually includes receipts, prescriptions, and any medical records related to the service or product for which you're claiming.
2. Check Your Policy: Review your health insurance policy to confirm that the service or product is covered. Understanding your coverage details will help you know what to expect regarding reimbursement and any limits that may apply.
3. Complete the Claim Form: Most insurance companies allow you to submit a claim online or in paper format. Complete the form, providing all necessary information about the service, provider, and associated costs.
4. Submit the Claim: Claims can typically be submitted online through your insurance provider's portal, by mail, or sometimes even by fax. Ensure that you include all required documentation to avoid processing delays.
5. Follow Up if Necessary: After submitting your claim, monitor the status through your insurance provider's website or customer service line. If there are any issues or delays, follow up as soon as possible to resolve them.
6. Review the Explanation of Benefits (EOB): Once your claim is processed, you'll receive an Explanation of Benefits (EOB) detailing what was covered and what you may owe out-of-pocket. Review this carefully to ensure accuracy.
7. Appeal if Denied: If your claim is denied, review the reason for denial provided in your EOB. You may appeal the decision if you believe the service should be covered. Follow your insurance provider's appeal process, providing any additional documentation as needed.

Your healthcare needs can change as you age, making supplemental coverage a valuable addition to your existing health insurance. Here's a look at some popular options for seniors in Canada.

EHC plans cover services such as physiotherapy, chiropractic care, and massage therapy, which typically aren't included in standard provincial plans. Some insurers may include prescription drug coverage under EHC.

Supplemental drug plans help cover medications not fully covered by government plans, reducing out-of-pocket costs, especially for ongoing treatments.

These plans cover routine dental care and major dental work for those who may not be eligible for federal dental coverage. It also includes vision services like eye exams and glasses that aren’t covered by provincial plans.

For those who travel, supplemental travel insurance covers unexpected medical costs abroad, protecting you from potentially high expenses while on the road.

This provides a lump sum payment if you're diagnosed with a serious illness, offering financial flexibility to cover medical costs or other expenses during recovery.

Long-term care insurance helps pay for extended care services, whether in a nursing home or at home, protecting your savings from high care costs.

Though not directly tied to health insurance, many retirees consider Term Life Insurance for Seniors bundle life insurance with their health insurance. It offers financial security for loved ones, covers final medical expenses, and helps you leave a legacy for your loved ones.

• Take the time to evaluate your current and  future healthcare needs when choosing the best health insurance plan for seniors.
• Supplemental insurance options like vision and extended health coverage provide access to essential services often not included in basic provincial health plans.
• Private health insurance offers financial protection against rising healthcare costs and access to a broader range of services for aging adults.
• Finding and securing the right health insurance plan for the elderly is easy with PolicyMe.