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
FAQs
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.
Which is not considered an out of pocket expense? ›
What Is Not an Example of an Out-of-Pocket Expense? The monthly premium you pay for your healthcare plan does not count as an out-of-pocket expense. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services, plus all costs for services that aren't covered.
Do you lose health benefits when you retire? ›
There is no break in coverage between your employment coverage and your retirement coverage. If you don't want your health benefits to continue into retirement, you can cancel your coverage through your employer before you retire.
How much are medical expenses after retirement? ›
A typical 65-year-old retired couple in 2023 could face an estimated $315,000 in healthcare costs. Individuals should plan for costs related to over-the-counter medications, long-term care, and dental care. Medicare may pay for some health care in retirement but does not cover all of it.
How do I know if something is covered by OHIP? ›
Talk to a health care professional to find out if a procedure or treatment is covered by OHIP. You can also contact the Ministry of Health INFOline: In Ontario: 1-866-532-3161.
What does the Ontario health Card not cover? ›
OHIP does not cover:
Prescription drugs for 25 years and older. Dental care. Eye care or eye glasses. Services that are not medically necessary (e.g. cosmetic surgery)
Is healthcare free after 65 in the US? ›
Medicare is a federally funded insurance program for eligible participants 65 or over. Medicare has two parts, Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare does not cover 100% of all costs.
Is Medicare free when you retire at 65? ›
Medicare Part A is free if you: Have at least 40 calendar quarters of work in any job where you paid Social Security taxes in the U.S. Are eligible for Railroad Retirement benefits. Or, have a spouse that qualifies for premium-free Part A.
What happens to health benefits when you quit? ›
In most cases, employment-based health insurance ends when you quit your job. The status of your health insurance will depend on the type of coverage you had through your employer. For example, if your employer had 20 or more employees and offered group health insurance, you may be eligible to enroll in COBRA.
What is the biggest expense in retirement? ›
Housing. Housing—which includes mortgage, rent, property tax, insurance, maintenance and repair costs—is the largest expense for retirees.
However, out-of-pocket medical costs are a significant expense for older adults, especially for those who have retired. The good news is you can claim some of these expenses on your taxes. The key? They must be itemized and exceed 7.5 percent of your adjusted gross income.
How can I protect my retirement savings from medical bills? ›
Asset protection with a specially designed Family Savings Trust can often shield savings from these events. A Family Savings Trust is extremely flexible in form and can incorporate provisions, which combine the features of many domestic arrangements within the language of the plan documents.
Which of the following is not covered by OHIP? ›
Expenses not covered by OHIP include non-medical services such as travel, accommodations and meals unless they are part of insured hospital services.
How long can you be outside Ontario before losing OHIP coverage? ›
You can be outside of Canada for 212 days in a 12-month period and still be covered by your OHIP. If you will be away for more than 212 days, you can apply for continuous OHIP eligibility. This means that you want to keep your OHIP benefits, even though you will be out of the country for more than 212 days.
What does Canada's free healthcare not cover? ›
The Canadian public healthcare system, known as Medicare, is funded by taxes. It covers all care deemed “medically necessary,” including hospital and doctor visits, but generally does not provide prescription, dental, or vision coverage.
What does OHIP cover in the US? ›
The out-of-country program only reimburses you for between $200 and $400 per day for emergency inpatient services (meaning an ICU or operational surgery) and up to $50 per day for emergency outpatient services. the full cost of doctor services, outpatient services or inpatient services.
