Canadian Health Insurance Options

[anisotropy]

We recently pulled the plug and we are wondering if there is any point buying health insurance in Canada.

The healthcare items for us are prescription drugs and dental/vision visits with an annual fixed cost of roughly 1600 for the wife and around 400 for myself. From our preliminary calculations comparing the benefits and costs of various plans: AMA, Blue Cross, Great West Life, etc. It appears we might "break-even" on wife's solo policy and definitely loss money on mine or any sort of combined policy.

Has any Canadians run into this sort of scenario before and how have you handled it? Most of the resources I could find online were tailored toward Americans and the best I could find was this :

https://retirementaction.com/2012/02/29/individual-health-insurance-considerations-for-canadians/

ps. we are in our early 30s and wife has a mild to moderate chronic condition.

Thanks

[Margie]

I just started looking into this too - For our family (parents + two kids) I am more worried about insurability if we don't get it within 30 days of going from employee to self employed!

I will post a chart of fees/benefits once I get it done - very interested if you have already done this....the rates in that article don't seem accurate. 

thanks for any updates!

[anisotropy]

Hi Margie, OP here.

Our conclusion at the moment is that it is cheaper to pay out of pocket. Alberta Blue Cross's plans don't do much for us and the only plan we've found (from AMA) that saves us money does not cover pre-existing conditions so it is a bust. Other insurance companies (Sun Life, GWL, etc) are extremely expensive for what you get.

Though frustrating, this makes sense as insurance companies exist to make money. We are still in the process of going through the list just to be through, but I doubt the conclusion would change.

That being said, we look forward to receive insights from other people.

[KMMK]

I think break even at best is fine right now. I get the policy in place now so they don't deny the application later if you develop a more expensive condition in the future. I'd be more concerned about drug limits and what they'd pay out in a worst-case scenario situation.
Saving money while healthy is next to impossible or the companies would go out of business.

[choppingwood]

GMS (Group Medical Services) has an option that includes a modest amount for pre-existing conditions, which also covers vaccinations like shingles, not covered by all provinces.

Extended health insurance is to cover catastrophic new developments, like a bad car accident or major illness or an organ failure. It is not a buying club for you to save money on every day treatment for your health as it is today.

From my HR days, health insurance companies are aiming to pay out 91%. The 9% covers all their costs and their profits. If they pay more than that, they raise premiums.

I have extended insurance, with a premium prescription policy. I've opted out of dental, because it is much more predictable and and manageable and unlikely to result in savings.

[anisotropy]

OP here, thanks for the input. This is our spreadsheet.

[anisotropy]

OP here. ~2 years into FIRE, thought I would provide a quick update for interested Canadians.

Currently wife has a basic plan with BlueCross, premium is around C$800 a year, out of pocket prescription cost around C$150 a year. We ended up getting insurance for her because one of the med she's on costs C$1500 a month without insurance.

I could be wrong, but from what I understand, normally there would be some out of pocket cost for the C$1500 med, but through some arcane "rule" we pay 0. The arrangement is not through Blue Cross alone; an organization affiliated with the pharma comp (not sure if it's like Pharma-funded patient assistance charity??) facilitated the whole thing. It's great, they handled pretty much everything.

[Missy B]

Hi Margie, OP here.

Our conclusion at the moment is that it is cheaper to pay out of pocket. Alberta Blue Cross's plans don't do much for us and the only plan we've found (from AMA) that saves us money does not cover pre-existing conditions so it is a bust. Other insurance companies (Sun Life, GWL, etc) are extremely expensive for what you get.

Though frustrating, this makes sense as insurance companies exist to make money. We are still in the process of going through the list just to be through, but I doubt the conclusion would change.

That being said, we look forward to receive insights from other people.

Came to the same conclusion myself years ago and stopped looking. They need to make a profit.
Drug plans vary with the province, and some have a cap past which they pay your medication costs, assuming they are on the schedule. Depending on that and your incomes, you might get a better break if you pay out of pocket. I think you have to be incorporated to use a Health Spending Account, but it's worth looking up to see if you can use it as sole proprietor. If you can, it will give you a much more significant tax break than the shitty tax credits the govt offers, with no worries about prexisting conditions or qualifications.

[Oatmeal Stout]

I also decided not to buy any health or dental insurance.

In Ontario at age 65 you qualify for the Ontario Drug Benefit program - basically $100 a year and $6 co-pay.

A bit risky to hope we don't need expensive drugs in the next 20 years...but...

A lot of people don't know about the Ontario Trillium Drug Plan for those under the age of 65 who pay 4% or more of their after tax household income on qualified drugs.  Deductible is 4% of your income and $2 co-pay.

Sounds like some other provinces also have a catastrophic drug plan as well.

[anisotropy]

A lot of people don't know about the Ontario Trillium Drug Plan for those under the age of 65 who pay 4% or more of their after tax household income on qualified drugs.  Deductible is 4% of your income and $2 co-pay.

Sounds like some other provinces also have a catastrophic drug plan as well.

Nice! More reason to go FIRE so we can finally become net receivers after years of being net contributors!