Guide to Health Insurance for Seniors in Canada

What health insurance coverage do seniors need?

As Canadians age, healthcare needs become more extensive—and more costly. As a senior, you’ll need health insurance not just for emergencies, but for ongoing care as you get older. This may include:

• Hospital care
• Prescription drugs
• Dental care
• Vision care
• Hearing aids
• Paramedical services
• Medical equipment
• In-home nursing care
• Mental health support

Despite this, our healthcare access and affordability study found that older Canadians (ages 55+) are the most likely to be uninsured, with 21% reporting no health or dental coverage at all. 

Is private health insurance worth it for seniors?

Whether you need private health insurance depends on individual factors like your pension and the government coverage you get. In most cases, getting private health insurance is worthwhile to bridge the gaps.

If any of the following situations apply to you, a private health insurance plan might be a worthy investment:

• You need access to paramedical services, like physiotherapy, chiropractic, and mental health counselling
• You take multiple prescriptions brand-name drugs that may not be covered by provincial or territorial plans
• You may need long-term care, in-home support, or medical equipment/devices in the future
• You need dental care and/or eye exams that aren’t covered by provincial or territorial plans
• Your pension exceeds the threshold for the Canadian Dental Care Plan, which is $90,000 per year

Further reading: How much does health insurance cost in Canada?

What does the Government of Canada provide for seniors' health insurance coverage?

If you’re a resident of Canada, you may have access to government-covered health care through your province or territory. But while these programs cover the basics, there’s a lot they don’t include that can be particularly important as you age.

Details vary depending on your province of residence, but generally speaking, health care in Canada covers the following:

• Medically necessary doctor’s visits
• Hospital care
• Some prescription drugs

The Canadian Dental Care Plan offers limited dental coverage for those who meet all four of the following requirements:

• You do not have access to dental insurance
• You and your spouse/common-law partner (if applicable) filed your tax returns in Canada so your family income can be assessed for the previous year
• Your adjusted family net income is less than $90,000
• You’re a Canadian resident for tax purposes

The bottom line

The Canadian healthcare system focuses on treatment, leaving large gaps in preventative care that helps seniors age healthfully.

Common gaps in healthcare services for seniors

There are two glaring gaps in Canada’s universal healthcare coverage: prescription drug coverage and paramedical services.

Prescription drugs

Provinces and territories typically offer some prescription medication coverage to specific groups, including seniors. Coverage is often tied to your income, with lower-income seniors receiving more support than those with high incomes in retirement.

Here’s what is usually not covered:

• Alternatives that are not the cheapest version of a drug (e.g., brand-name vs. generic)
• Non-essential or “lifestyle” drugs (e.g., for weight loss)
• New or high-cost drugs (e.g., some cancer treatments)
• Drugs not listed on the provincial or territorial drug list

If you’re on multiple medications that fall outside of the scope of your provincial coverage, your out-of-pocket medical expenses could add up quickly. Private insurance helps bridge the gap to cover brand-name drugs, newer therapies, and medical supplies.

Paramedical services

Paramedical services encompass various treatments, including chiropractic adjustments, acupuncture, massage therapy, physiotherapy, mental health care, and more. This is one of the most significant gaps in provincial or territorial health insurance for seniors—you’ll receive very limited, if any coverage.

So, why does this matter? As you age, accessing preventative care can be key to maintaining your independence. These services aren’t just “extras,” but rather an important part of keeping your mind and body healthy and active well into your senior years:

• Regular chiropractic adjustments and massage therapy can help manage joint or back pain and support mobility
• Physiotherapy is often critical to making a full recovery after an injury or surgery
• Counselling sessions can help manage feelings of isolation, grief, and depression that some seniors feel due to loss of a spouse or friends, distant family, etc.
• Occupational therapy can support activities of daily living to maintain independence longer
• Consults with a dietitian can ensure a healthy, balanced diet that supports your body’s needs as you age

Without private coverage, the entire cost of paramedical services must be paid out of pocket. Here’s what that could look like:

• 60-minute massage therapy: $145 per treatment
• Chiropractic adjustment: $145 initial assessment + $75 per adjustment
• 60-minute occupational therapy: $185
• 60-minute counselling session: $280
• Dietician support: $215 initial assessment + $155 per visit

Note: Cost data taken from IA Financial’s 2024 reasonable and customary fees for Ontario

Assuming you visit each of the above practitioners just once per month, you’d be looking at an out-of-pocket cost of close to $10,000 per year. Securing private health coverage that includes paramedical services with reasonable limits could be a cost-effective way to obtain the care you need without depleting your savings.

Types of private health insurance for seniors

There are three main types of health insurance plans for seniors:

• Underwritten health insurance is an individual policy for people without group benefits through an employer. It typically requires a medical questionnaire, but you can tailor your coverage (within reason) to meet your lifestyle and health needs.
• Replacement health insurance helps retirees transition from group benefits to private plans as they exit the workforce. If you apply within a specific time frame, you may be able to skip the medical review.
• Guaranteed acceptance health insurance is intended for seniors who have pre-existing medical conditions that can affect their eligibility for other types of coverage. It’s generally the most expensive option and may have lower limits or other exclusions.

Let’s look at how they compare.

Take note that there are some generalizations here that may differ depending on the type of policy, coverage provided, and the health insurance company you’re purchasing from.

How to choose the best health insurance for seniors

When you’re choosing a health insurance plan for seniors, you’ll need to balance the coverage you need (or want) with your monthly budget. The best health insurance is the one that fills the gaps in your government coverage and meets your needs now and in the future.

Follow these steps to evaluate your requirements and find a plan that meets them:

Review government coverage. Look at what you have—and, more important, what you don’t. Identify where there are gaps. Hint: it’s probably where you’re currently paying out of pocket or relying on group benefits from your employer.

Assess your needs. Consider both treatments and preventative care. Do you currently take medications, and are they covered by the government plan? Do you have any chronic conditions? In the future, might you require physiotherapy, counselling, or in-home care? How will your healthcare needs increase as you age?

Compare plans. Our overview above should give you a good starting point to compare personal, replacement, or guaranteed health insurance. You should also consider if you need other add-ons, such as critical illness insurance or disability coverage.

Evaluate coverage. Some private health insurance plans can be tailored to your needs, so you’ll want to look at annual and lifetime maximums for the services that matter most to you. Consider whether a cheaper plan might cost you more in the long run (in the form of higher deductibles and lower limits). Determine the value of a plan by comparing the annual cost of the premiums vs. how much you’ll use in benefits.

Purchase your policy. You can typically purchase our health insurance policy by speaking to an insurance advisor, though some insurance companies allow you to finalize the details entirely online. 

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