Health insurance for seniors
There are different types of health insurance plans available for seniors, and they vary in terms of coverage and benefits. Those who are retiring may either continue or convert their group benefit plan, or buy a new individual plan. Guaranteed-issue health insurance plans can cover seniors with pre-existing health conditions, usually at additional cost.
If you’ve made it to the sunset years, you’re one of the lucky ones! Congrats!
When you approach that golden retirement age of 65, you have a lot to look forward to! No more work, more free time, vacations, and discount pancakes at Denny’s on Wednesdays to name a few. But as you age, there are a few things you should square away before your final clock out.
A common question you might have is, do I have enough money to retire? But you should also consider your health insurance. Does your health insurance follow you after you retire? Will you be able to get health insurance as you age or if you have a pre-existing condition? Read on to find out how to choose the best health insurance plans for seniors.
What is private health insurance?
Private health insurance is used to cover expenses not covered by the government, such as prescription medications, dental care, vision care, and paramedical services. Private health insurance in Canada works alongside the publicly funded healthcare system to provide additional coverage for services not covered by the government.
Extended health insurance plans can vary in terms of coverage and benefits. They require individuals to pay regular premiums, which can be monthly, quarterly, or annual payments. The cost of these premiums varies depending on factors such as age, health status, the extent of coverage, and the insurance provider.
What does health insurance cover?
Private health insurance covers the expenses that government healthcare does not.
|Extended health insurance can cover:
Other than these basic medical care costs, your private health insurance plan can cover other commonly required medical expenses for seniors.
|Your health insurance may provide coverage for the following health care services and equipment:
Your exact coverage and coverage limits will depend on the type of plan you have.
Types of health insurance plans available for seniors
As Canadians, we are told we get “free” healthcare. So, you might be asking: “Why do I need extended health insurance?” There are many health insurance plans available to seniors and they all cover different types of medical expenses.
1. Government health insurance for seniors in Canada
Health care in Canada is funded by taxpayer dollars and is administered on a provincial level. Your “free” provincial health care plan will cover things like surgeries, hospital stays, medications while in hospital, doctor’s visits, and other emergency and preventative care. However, it won’t cover all the expenses required to fully recover from an injury or illness.
2. Private health insurance for seniors
Extended health insurance steps in to cover medical expenses and other out-of-pocket costs associated with physical and mental health wellness.
|Health insurance plans are sometimes called:
Types of Extended health insurance plans
Every provider has different types of health insurance plans with varying coverage amounts and limits. Supplemental health care is usually put into a tiered system, with each tier increasing its coverage at higher costs. The plans are usually separated into basic, standard, and enhanced tiers.
Coverage tiers and costs may look like*…
|Basic health plan||Prescription drugs – 60% up to $750
Dental – 60% up to $500
Vision – No coverage
Paramedical Expenses – $25 per visit up to $250 ($35 for psychologist/social workers)
Travel – No coverage
|Standard health plan||Prescription drugs – 70% up to $7,000
Dental – 70% up to $750 (preventative only)
Vision – $250 every 2 years, $50 per eye exam
Paramedical Expenses – 100% up to $300 per practitioner (up to $1,000 for psychologists/social workers)
Travel – $5 million in emergency health coverage for the first 60 days
|Enhanced health plan||Prescription drugs – 80% up to $5,000
Dental – 80% preventative care up to $750, 50% restorative care up to $500, 60% up to $1,500 for orthodontic
Vision – $300 every 2 years, $50 per eye exam
Paramedical Expenses – 100% up to $400 per practitioner (up to $1,500 for psychologists/social workers)
Travel – $5 million in emergency health coverage for the first 60 days
*Quote for a 65-year-old single person in Ontario with no pre-existing health conditions or dependents.
Every plan will have a deductible amount, a waiting period before you can claim coverage, and its own process for claims. Some health insurance providers direct bill, while others will require you to pay for your medical expenses upfront and will reimburse you after you submit the receipts for your medical bills.
Guaranteed acceptance health insurance
Outside of these three options, health insurance providers offer a guaranteed acceptance health insurance option.
Guaranteed issue health plans are best for:
- For this with pre-existing conditions
- For those who are transferring from their group plans
- For those who don’t want to go through medical exams
The eligibility criteria are low. These policies have very few application questions—it’s kind of a pay-to-play policy. It’s more expensive than traditional policies because they don’t ask as many questions. However, it can be an option for you if you are declined because of any previous illness like heart disease, diabetes, or high blood pressure.
|Medically underwritten health insurance||Guaranteed acceptance health insurance|
Replacement health insurance
If you’re retiring, you may not be able to hold onto the health insurance benefit that came with your career. That’s where replacement health insurance comes in. This is kind of like a guaranteed-normal plan hybrid. As long as you apply within 30-90 days of your employer coverage ending, you will be accepted (that’s the guaranteed part). But, unlike your old work policy, you get the flexibility of choosing coverages to fit your unique retirement needs.
Replacement coverage does not have to be with the same insurance provider as your employer plan, but you do have to make sure you switch over within the eligibility window. Cost-wise, it’s in between normal and guaranteed plans (because it’s kind of a hybrid).
Why is private health insurance important for seniors?
Just like the price of housing, food, and everything else, medical costs are going up by the day. While Canada’s publicly funded healthcare system provides essential medical services, it may not cover all the healthcare needs of seniors like mobility equipment and drug costs. Private health insurance helps alleviate the financial burden, making healthcare more accessible and affordable for seniors.
The reality is, the older we get, the more likely it is that our health will deteriorate. Having an extended health insurance plan in place makes sure that you don’t have to stress about how you’re going to pay for your next medical treatment or medication.
Having health insurance means more than financial protection—it provides peace of mind. Your quality of life is directly linked to your health care. Having health insurance allows you to focus on your well-being without worrying about potential expenses. And that is priceless!
Can I keep my employer’s health insurance when I retire?
Some employers will allow you to keep your group health insurance plan when you retire. Some will have age restrictions, depending on the contract they have with their group health insurance provider.
Some health insurance providers will also allow you to transfer from a group plan to an individual plan with them as long as it’s within a certain time frame (usually 60-90 days from the point of retirement). These plans are known as replacement health insurance—you are guaranteed coverage with your same insurance provider without an extensive medical questionnaire.
However, you should shop around first. Guaranteed or instant approval plans can be expensive and group plans have restricted coverage, so they may not be best for you as you approach retirement age. Individual plans allow you the flexibility to choose your own coverage options. They are underwritten based on your own personal lifestyle and health history, not an average of those in your group.
|Options for your health plan when you retire:
At PolicyAdvisor, we can help you look at your current plan details and see if it’s working for your needs either now or as you approach that golden 65th birthday retirement age. If not, we work with Canada’s best health and dental insurance providers and can find the perfect plan for you.
Can I get health insurance if I have a pre-existing condition?
Yes. It’s possible to get health insurance if you have a pre-existing condition. However, the extent of your coverage and the price will depend on your health history. Even if you’ve survived a serious health event like a heart attack, stroke, or cancer, or if you have a chronic health condition, you can still get health insurance. However, policies may have a particular waiting period after these events until they can provide coverage.
|What is a pre-existing condition?
A pre-existing condition is any illness, medical condition, or injury that you have been diagnosed with by a health practitioner or show symptoms of before signing up for an insurance policy.
Guaranteed-issue plans are usually the go-to option if you have any kind of pre-existing medical condition that bars you from traditional health insurance plans. These plans are fast, easy, and convenient to apply for because they don’t ask many health questions. Some may just have basic coverage for prescription drugs and no dental benefits or vision coverage, while others have more comprehensive coverage. However, they are more expensive than other plans and sometimes have coverage restrictions.
What is the best health insurance for seniors?
The “best” senior health insurance plan really depends on your needs and budget. If you have existing health conditions or other complex health issues, you might consider guaranteed issue insurance. However, if you’re in good health for your age, there are many coverage options for you through our insurance partners:
Manulife offers health and dental insurance through its CoverMe Flexcare product. These plans are great for those looking for add-ons and flexible coverage. For example, they have products that are dental-only, vision-only, or even just drug costs after you front the first $10,000. Manulife also offers specific “FollowMe” plans that allow you to retain most of the coverage and cost that you had with your employer coverage, as long as you apply within 90 days of your employee benefits ending.
Sunlife offers personal health insurance as one of its flagship products. They offer plans in the classic three-tier system—basic, standard, and enhanced—with ascending coverage levels depending on your needs and budget.
SureHealth offers several levels of plans, including four types of plans with guaranteed acceptance “LINK” plans for those who have existing health conditions or would otherwise not qualify for standard health insurance.
Desjardins offers health and dental insurance through their SOLO healthcare product. This product has two tiers, basic and enhanced, with vision care included in both and ascending coverage options for prescription medication and dental, depending on your coverage needs.
Desjardins offers a transfer program from your group insurance, called “Health Track Insurance.” Regardless of your age, you can get coverage as long as you apply within 60 days of your group benefits ending.
GMS also offers guaranteed acceptance health insurance in addition to three standard plans (OmniPlan, ExtendaPlan, and BasicPlan). Their products have no waiting periods and coordinate with their LifeWorks program, a digital wellness platform to promote physical and mental well-being.
Get the best quote for seniors health insurance
We understand the unique healthcare needs of seniors and are committed to helping you find the perfect insurance plan that suits your requirements. Our easy-to-use platform provides access to a wide range of top-tier insurance providers, ensuring you have ample options to choose from.
With PolicyAdvisor.com, you can compare plans, benefits, and costs effortlessly, empowering you to make informed decisions that prioritize your health and financial well-being.
If you’re looking to talk to a real human advisor, we have those too! Book a call with one of our friendly expert insurance advisors today to chat about protecting your personal and financial health today!
Seniors Health Insurance
Frequently Asked Questions
What is the average cost of medical expenses in retirement?
Experts estimate at age 65, the annual spend on health care is $5,400 per person. This research is from a 2014 report and as inflation increases, retirees can expect to pay more. This estimate is also for a healthy individual. If you develop or are diagnosed with any type of serious illness, you can expect to pay more. For example, 1 in 2 Canadians will be diagnosed with cancer once in their lifetime—with a greater chance of this as you age. Cancer medicines with 28-day treatment costs over $7,500 now account for more than half of all oncology sales in Canada.
What is long-term care insurance?
Long-term care insurance is a type of insurance policy designed to cover the costs associated with long-term care services for individuals who need assistance with daily living activities due to illness, disability, or aging. These services typically include help with activities such as bathing, dressing, eating, and mobility, which may be required either in a nursing home, long-term care facility, assisted living facility, or even in the individual’s own home. This is not the same as health insurance and is a separate insurance product. However, some health insurance plans have coverage for in-home care.
Do seniors get free healthcare?
Some provinces have programs for seniors that cannot afford their healthcare costs. For example, the Government of Alberta provides eligible seniors with coverage for prescription drugs and other healthcare services. However, these free programs don’t have the most comprehensive coverage—not all medications are on the benefits list. Similar programs exist in other provinces but may be based on annual income.
Does the government cover my healthcare when I turn 65?
In some provinces, there are programs for senior health care for those that need financial assistance. These programs may assist with the partial cost of prescription drugs and other healthcare services not covered by the standard government plan. The eligibility requirements for these social assistance programs vary—some just require that you be over 65 while others have income thresholds. For more information about services for seniors, visit your provincial government’s website.
Do seniors get a discount on health insurance?
Some provincial programs exist that help with out-of-pocket medical expenses, but private health insurance companies don’t offer discounts. This is because the rate of illness and injury among seniors can be high. That being said, health insurance is a competitive market and there are plans at various coverage and premium levels available to you depending on your budget.
Connect with a licensed insurance advisor
Still unsure which plan would be best for you? Schedule a call with one of our expert insurance advisors for one-on-one advice. The conversation has no obligations to buy—let’s just start with a conversation about your insurance needs. Our health and dental insurance agents will ask you a few questions, then shop with Canada’s best insurance companies to get you the best price on health insurance.
- Private health insurance in Canada works alongside the publicly funded healthcare system to provide additional coverage for services not covered by the government
- Seniors with pre-existing conditions still qualify for coverage through guaranteed acceptance health insurance plans
- Those approaching retirement can convert or replace their group plan into an individual plan