Private health insurance plans are not all created equal in Canada.
While having private insurance is a great idea if you don’t have coverage through your employer, there are still a lot of factors to consider when it comes to choosing the right plan for you.
Let’s take a look at some of the biggest questions to consider if you’re asking yourself, “what health insurance should I get?”
Short Term vs Long Term Coverage
Some insurers pay for ongoing medical costs, such as prescription drugs that aren’t covered. Others cover you in the case of a medical emergency at home or abroad. Some plans can cover both. The one you choose depends on your situation and risk factors.
Let’s take a look at Sun Life for example. It offers basic, standard and advanced personal health insurance plans that can offset drug and dental costs. These are expenses you may need to be covered on an ongoing basis, especially in the case of prescriptions.
However, Sun Life also offers critical illness insurance, which means you’re protected financially if you or a family member is suddenly diagnosed with a serious illness. It will provide cash flow so you can care for a sick child, while also meeting your other obligations like your mortgage.
However, you may want to secure insurance now for a possible future. For example, Desjardins Insurance has a long-term care insurance plan to pay for care if you develop Alzheimer’s disease down the road.
The expenses from losing your independence can add up. A long-term plan can help you manage costs of hiring care, without having to dip into your retirement savings.
Guaranteed vs Medically Underwritten
These are the two main types of private insurance in Canada. Guaranteed acceptance means you don’t have to answer health questions. Medically underwritten plans are dependent on your current health situation.
How to choose health insurance between these two options?
Let’s first look at guaranteed issue plans. They don’t refuse you for any pre-existing health conditions, and they are generally less expensive than medically underwritten plans. In fact, it’s the only option if you already have an illness that requires ongoing medications.
However, when you choose a guaranteed plan, the fees will still be based on the risk factors for your age and gender. One good example of a guaranteed issue plan is the Basic Blue Choice from Blue Cross. It’s a comprehensive plan for drugs, registered therapists, travel, and more.
With a medically underwritten plan, you will be asked a series of questions, and you might even have to undergo some tests. However, if you’re generally healthy, then this may be a better option.
That’s because the payouts from medically underwritten plans tend to be higher than guaranteed plans.
Manulife offers both underwritten/guaranteed Flexcare plans, as well as a guaranteed issue FollowMe plan. The FollowMe plan is also a good option if you’ve recently lost group coverage through your employer.
Does It Include Dental?
In Canada, public health insurance generally doesn’t cover dental procedures, although you may be able to find some basic coverage from government plans.
A lack of coverage for dental might mean you’re skipping visits to the dentist. This can affect your oral health, which can lead to bigger problems down the road. What if you need a root canal? Or you have a dental emergency like an injury?
These are questions that can help you compare health insurance plans. It’s wise to look more closely at dental coverage when choosing a plan.
Here are a few pointers to consider:
• How often does the plan allow routine visits to the dentist?
• Does the plan cover dental surgery such as root canals or extractions?
• Does the plan offer coverage for dental reconstruction or cosmetic procedures?
Some plans consider items such as crowns a cosmetic procedure, so you may not be covered. You may have children that have crooked teeth or an overbite, so in that case, you should be looking at orthodontic coverage too.
If you have a good history of oral health, then you may be able to get away with a basic plan. However, if you have risk factors such as smoking, you may want to step up your coverage.
Take a Look at Vision Care
Some plans don’t offer much in the way of vision care. But take into consideration that Canadians spent more than $4 billion annually on spectacles in recent years.
Even if you have 20/20 vision now, that doesn’t mean you won’t need glasses or contacts in the future. Designer frames and lenses can add up, so having eyecare coverage can go a long way.
In Ontario, your annual eye exams are only covered by public insurance if you’re under 19 or over 65. If you’re 20 to 64 years old, you must have certain conditions that affect your eyes to be covered. Otherwise, you’re paying out of pocket, which can be pricey – up to $200 or more.
Some private insurance plans offer great coverage for exams and glasses, while others fall short. If you have a history of eye problems in your family, or you already have glasses and need a new prescription, then choose a health insurance plan that’s heavy on vision care.
Some insurance providers, such as Canadian Protection Plan, allow you to add vision care as an option to your other coverage.
How Far Will Your Insurance Take You?
While some public insurance plans will pay for certain procedures outside the country, generally you’re on the hook for these medical expenses.
They can include emergency treatments, surgeries, and extended hospital stays. While health problems can ruin a vacation, getting a huge bill afterward can make it even worse.
While some private insurance plans offer limited coverage for outside medical expenses, others are designed more for travelers.
For example, the Co-operators Group offers multiple insurance options for travelers. It has a plan aimed at Canadian residents traveling outside their country, paying for emergency care. It even covers items such as emergency travel and returns to your original destination.
Don’t pay for what you don’t need.
Would you join a gym that has an Olympic-sized swimming pool and sauna that you will never use? Guess what, you’re still paying for those in your membership fee.
The same can be said for private health insurance plans. You might be paying for coverage for psychotherapy and medical equipment when you don’t need those services.
Some other plans may protect you while traveling, but if you’re not the travel type, you may be paying more than you need to. Look for plans that contain only the items that you actually expect to use. Many plans allow add-ons to core plans if your situation changes.
Another thing to do when you compare health insurance plans is finding out what’s already publicly covered. There’s no point in choosing a plan that has high coverage for medications if you qualify through a provincial plan.
On the flipside, look at plans that do cover services you regularly use. That means if you need massage therapy for chronic pain, you need a plan that will pay for that. If you need mental health support that’s not available publicly (or has a long waiting list), then look for coverage for psychiatrists and other related professionals.
Many insurers will provide similar products, at different rates.
After you’ve narrowed down your search for the best packages that apply to you, then you can better compare the price.
For example, if you only need travel health insurance, then take a look at the monthly or annual premiums and contrast that with the payouts. It’s all about getting the best value for your dollar when you need to make a claim.
Make a list of your expected annual expenses for prescription drugs, eye care, and dental care to help you choose a plan that offers maximum value.
What Health Insurance Should I Get?
It’s pretty much a given that you will need additional health coverage outside of what’s publicly funded at some point. If you’re asking yourself which insurer you should go with, then you’re already taking the right steps to protect yourself.
But it’s not about the lowest cost – it’s about finding a package that applies to your situation. Not for now, but for your future too. You don’t have a crystal ball, so you don’t know what unexpected challenges will pop up down the road that can impact your health and financial stability.
If your family history has a history of cancer, for example, then you could choose a plan that covers you for cancer care should you need it. Industrial Alliance actually offers a CancerGuard policy.
Remember, many plans allow you to buy a core plan, and consider add-ons later when you need them.