Ontario Health Insurance

[Ann C]

My husband and I live in Ontario, Canada. We are very fortunate that our health costs are largely covered by the government.

After age 65, many drugs are covered by the Ontario Drug Plan. Many people do, however, carry additional health insurance that covers a greater range of drugs. Many of the cancer drugs are paid for by the Ontario gov't. under the New Drug Funding Program. To be eligible, the doctor must recommend the patient and specify that the patient meets the government criteria.

Right now my husband and I have additional health insurance that has a cap of $2600/year for drug coverage. We have the opportunity to get into a different health insurance plan that has no cap on drug coverage. However, this no cap drug coverage monthly premium is significantly more expensive.

My question is, given that my husband has RAEB 1, at some point, will we need to have the better insurance plan due to the high cost of drugs that he will probably need? Also will having a plan with no cap allow him to get the best drugs possible?

Any thoughts on this would be appreciated. Right now, he is on a watch and wait. The diagnosis does not seem real much of the time, as he seems fine.

[Neil Cuadra]

Ann,

Perhaps some of our Canadian forum members can give you information or opinions about it, but I suggest that you contact the friendly folks at the Aplastic Anemia & Myelodysplasia Association of Canada and ask them the same questions.

You can let us all know what you learn!

[slip up 2]

Ann...if you can, get the additional coverage even at age 65, I am so thankful we had our own private coverage...Exjade alone is about $10.000.00 per month and if your husband needs growth products they are about $500.00 per shot.
We have great coverage from the Gov't but many drugs are not covered esp. some of the new ones.
I was surprised what is not covered...after the age of 65
If your husband needs nursing care for home....the Gov't only allows so much per week.
So many things I did not know or even think about before our journey with MDS started....
Kate

[Ann C]

Hi Kate,
Thank-you kindly for taking the time to give your thoughtful response to my questions about private insurance in Canada.

Since my husband feels well and is in a watch and wait situation, it is easy to forget that his needs in the future will likely be very different, at some point.
Our current private health insurance has a limit of $1500/every 2 years for inhome private nursing care. The more expensive health insurance that we can opt into has $10,000 annual coverage for inhome private nursing care.
Taken together, the difference in drug coverage and nursing care, the more expensive plan is clearly much more comprehensive.

On Jan. 28, 2013, we should be getting a more comprehensive picture of my husband's situation. In addition to meeting with his MDS doctor, there should be a report back from the transplant team in Ottawa, whom we met with in Oct. 2012.

Thank-you again Kate for your thoughtful and very helpful response.
Ann