From the Mailbag: 8 Questions and Answers About the Canadian Healthcare System

We hear a lot of opinions about the Canadian healthcare system, but what we don’t hear a lot of is answers to our questions that are backed by facts. But, the answers are not hard to find for this great country and its people-centered healthcare system. Here are 8 common questions and the answers based on reliable information.

The Canadian Healthcare System Plans

It is important to browse insurance plans for basic information and direction. Ontario province has a government-run health insurance plan called the Ontario Health Insurance Plan or OHIP. This is a good example of Canadian healthcare throughout the country. It is funded by government payroll deductions and people can apply for this coverage three months after settling in Ontario. The health plans are set up by province and might vary in coverage and eligibility.

Since Ontario has the largest population of the 13 provinces, it provides a good example of the Canadian government supported health care system. Ontario is the 4th largest province and has the country’s capital city of Ottawa, and the largest city of Toronto.

8 Questions About These Healthcare Plans

Following are 8 common questions about Canadian healthcare and some answers.

1. Who is eligible for healthcare coverage? Gainfully employed residents of at least 3 months. This insurance is funded by payroll deductions by Canadian businesses. Other eligible Canadians are covered by transfer payments by the Canadian government. When people apply for this healthcare coverage, they need documents including proof of Canadian citizenship, identity, and residence in Ontario or the province whose plan is being applied for. People can be OHIP-eligible immigrants also, and they will need an IRCC letter confirming that the person is eligible to apply for permanent residence in Canada, a temporary resident permit, or a protected person status document. Other documentation might be required.

2. What health services are available? These are comprehensive plans covering medical doctor services, medically important hospital services, eye examinations for people under 20 and over 65, services by registered podiatrists, and more. The plan covers ambulance services considered medically necessary, home care or long-term care under certain conditions, women’s services such as mammograms, dental surgery, services of midwives, hospital abortions if prescribed by a doctor, and oral contraceptives under certain conditions. There is also basic Ontario drug coverage. Visits to doctors are covered. People choose their doctors and they can go to a walk-in clinic if the visit is deemed medically necessary. Diagnostics such as blood tests and x-rays are covered. It is necessary to read the whole plan for a list of all medical services that are covered.

3. What Is Not Covered? There are many things not covered including dental services in a dentist’s office, cosmetic surgeries, private and semi-private hospital rooms, services of paramedics, and some forms of physiotherapy.  Eyeglasses and contact lenses are not covered. Prescription drugs provided by non-hospital settings such as the family doctor’s office may not be covered. Check with the healthcare plan for other exceptions. Laser eye surgery and chiropractic services are not covered. The people who cannot afford drug costs for not covered prescriptions can get help from the Ontario Drug Benefit program or the Trillium Drug Plan.

4. If a Person Leaves Canada, are they covered when they return? Canadians can be out of Canada for 182 to 212 days depending on the province and still have coverage. If they stay longer, they may be subject to a 90-day waiting period to get covered again. The person must apply for reinstatement of coverage and may need documentation.

5. Is a person covered everywhere in Canada? These insurance plans are different for each of the 13 provinces with health coverage plans. When a person covered in one province is ill or injured in another province, they may have some out-of-pocket expenses and may have to pay for services and then be reimbursed by their plan. It is important to carry the plan’s health care so that a hospital or other healthcare providers can use the patient number to determine coverage and determine out of pocket costs.

6. Do you need an additional insurance plan to cover gaps in healthcare coverage? There are numerous rules concerning government healthcare insurance, so it may be hard to know exactly what is covered or not covered so some people opt for a private health insurance plan to cover gaps. Each person should talk to an expert on this government-sponsored health plan. Compare what is covered in the plan to current health care needs and issues. Then decide if the coverage is adequate or if a private insurance plan is needed to cover medical costs not covered by the plan.

7. What happens when you need treatment that is not covered by your provincial healthcare plan? Part of the care may be covered and then physiotherapy or pain medications might be the patient’s responsibility. Having a small private insurance plan may cover the gap in coverage. A person who needs medical treatment that may or may not is covered by the government plan should call an information specialist with the plan to get coverage details and information on additional help that may be available.

8. Can a person choose their own doctor or hospital? In Canada, people can choose any doctor or hospital.

Another interesting fact about Canadian Healthcare is that the savings to the government are substantial. Canada spends about 40% less on its people’s healthcare than America. Before adopting this healthcare system, they spend almost as much as the United States on healthcare. So, government healthcare plans can be cheaper than a system like the one in the United States. Ontario and the rest of the Canadian provinces are dealing with government budget problems that may affect some coverage for the Canadian healthcare plan. Because of this, it is important to follow the news and government notices about the health plan coverage. Even with small coverage changes, this system is a good one that serves Canadian citizens well.

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