How Canadians Can Benefit From Having Health and Dental Insurance Coverage

Canadians benefit from a publicly funded national health insurance program which provides for the basic coverage in hospital care. While as Canadians we receive coverage to some extent, each province and territory may offer additional benefits according to their own respective plans.

If you’re a Canadian, and you have lived in a few of the provinces over time you would best understand how coverage varies considerably from province to province.

Health & Dental Insurance

The average costs for a dental cleaning varies, but generally on average you’re looking to pay between $150 to $200. Besides cleanings; Fillings, extractions, and root canals can set you back hundreds of dollars.

Prescription medications

Provincial governments offer partial or complete coverage for seniors and those receiving social assistance. What about the rest of the Canadian working class, how can they fill in the gaps where coverage is not an option?

This is where supplemental insurance becomes necessary for many. Some insurance companies offer discounts for couples and families with 3 children or more worth looking into.

Supplemental health insurance plans can include the following types of therapies;

• Psychiatry

• Physiotherapy

• Osteopathy

• Naturopathy

• Chiropractor

• Podiatry

You may want to ask yourself the following question when deciding whether or not you need a health insurance plan;

Do I need prescription, vision, or dental coverage?

Supplemental insurance plans usually cover about 40% to 80% of healthcare needs such as: dental, vision, psychologists, podiatrists, chiropractors, hearing aids, and various medical devices.

There are many factors that are weighed into what your monthly plan will cost. Here are a few of the questions you would have to answer to get your rate.

• The number of individuals included in the plan

• The type of coverage you need

• Whether or not you want prescription drug coverage included in your plan

• Your current health, family medical history

• Whether you are a smoker or non-smoker

• Gender influences your rate

• Your profession

• Where in Canada you reside

Whether or not you choose to invest in a supplemental health insurance plan is up to you. The idea is not to wait until you have a health condition or you need a medical service not covered under the Government Heath Plan to inquire about a plan. You want it accessible at the time that you need it. When it comes down to it; health insurance plans are customizable to fit your needs and the needs of those who will have coverage with you.

What’s Covered? How to Use Medicare’s Website to Understand Original Medicare Coverage Better

Many people want to know how Original Medicare will cover a specific health condition, treatment, service, etc. Luckily for me, as an agent, and for you, as a Medicare beneficiary, the website lets you easily search for this. For example, I am going to search how Original Medicare covers Kidney Dialysis. First, I go to On the homepage, you will see a search field. This is where you can type the service you’d like more info on. Once I have typed Kidney dialysis, I hit “GO”, and within a few seconds, a list of services pops up, dialysis services and supplies being the first. I click on the link, and am led to a detailed summary of coverage. It discusses inpatient coverage versus outpatient, training for home dialysis, support services, equipment and supplies, and certain drugs for home dialysis that are covered under Original Medicare. In addition to a list of what is covered is a brief mentioning of what is not. Medicare does not pay for aides to assist with home treatment, any lost pay during self-dialysis training, a place to stay during your treatment, and blood or packed red blood cells for home self-dialysis unless part of a doctors’ service. The page then details how much Medicare will pay for the coverage offered, which in this case seems to be an 80/20 split for just about everything. This is where Medicare Supplements step in to help you with out-of-pocket costs. As you can see, with Original Medicare alongside a Supplement, your coverage will be quite comprehensive. also explains, in broader terms, what Parts A and B cover. There is a link to “What Part A Covers” as well as a link to “What Part B Covers.” I truly love Medicare’s website, I think it is so well done, and I urge you to explore it more!

Just as I discussed with Kidney Dialysis earlier, Medigap policies fill in the gaps of Original Medicare’s coverage for different services and treatments. For example, Medicare pays for the first 60 days of a Hospital Inpatient Stay (there is a deductible that has to be met before they pay anything), but from days 61-90 you pay coinsurance every day, which is $304/day. All Medigap Plans cover this hospital donut hole, and this is good news, because the coverage gets even worse the longer you stay in the hospital. Days 91-150 include a $608 daily coinsurance. A Medigap plan will cover this, and you won’t have to worry about these gaps in coverage with Medicare. In fact, Medicare Supplement hospital coverage will go up to an additional 365 days in coverage past what Original Medicare will help cover!

A quick note: there have been stories in the news lately concerning the labeling of hospital patients as outpatient instead of inpatient and making sure you know your classification. This is another important factor in whether Medicare will cover the costs; how they label you can determine whether Medicare will pay. Part A (which covers hospital stay) will pay if you are labeled an inpatient, and Part B (which does not cover hospital stay) will pay if you are an outpatient. I am going to write a blog about this soon; keep on the lookout for more detailed information!

The list below should help to give you a foundation in understanding what is covered and what is not covered by Original Medicare (and therefore Medicare Supplements):

1. Dental and Vision

2. Nothing cosmetic is covered.

3. If it is routine, preventative, and a yearly sort of deal-you will most like get help with it, although it is always good to check with Medicare.

4. If your doctor is a Medicare provider and accepts Medicare Assignment.

My fourth point in the ground rules list is important to understand. After making sure that your provider works with Medicare, your next question should be whether or not they accept Medicare Assignment. This is a term used to describe the price per service that Medicare is willing to pay. For example, if Medicare pays $1,200 for a certain surgery, if the doctor accepts Medicare Assignment, he is accepting this amount as payment for the surgery. Doctors who work with Medicare are allowed to charge an additional 15% above the Approved Amount (the $1,200), which means they are not accepting Medicare Assignment although they work with Medicare. Now you see why it is imperative that you ask both of these questions before receiving any service from a provider. Medicare Supplement Plans F and G covers this 15% “Excess Charge” for Part B services.

There are many nuances like the one above, but the ones in this article are the major players in the game. I hope this article gave you a better understanding of what is covered by Original Medicare and how Medicare Supplements work alongside Parts A and B.

I have also made a YouTube video that will give you a visual to this article, and also introduce you to my website, which has more information on how Medicare Supplements work with Parts A and B. The link for that video is below!

Do I Need Uninsured Motorist Coverage on My Auto Policy If I Have Medicare Or Health Insurance?

This is a very common question that we encounter in our practice. I’ve even heard of insurance agents who expressed the opinion that people do not need uninsured motorist coverage on their auto policy if they have health insurance or Medicare. The reasoning seems to be that following an accident their medical bills would be covered. Unfortunately, this reasoning fails to take into consideration all of the other benefits available from uninsured motorist coverage to someone who’s been seriously injured in an auto accident or to the estate of someone who has been killed.

The purpose of uninsured motorist coverage is to compensate the insured for all of the elements of damage they would have been entitled to receive from the person causing the accident, but who carried no bodily injury insurance, or very low limits of coverage. In Florida, those damages would include: pain, suffering, disability, scarring, disfigurement, mental anguish, loss of the enjoyment of life, lost earnings and earning capacity, as well as unpaid medical expenses incurred in the past, and those to be incurred in the future. Of this list of damage items, the only ones which would be covered by health insurance or Medicare would be “covered” medical expenses. Beyond having their medical expenses paid, someone carrying no uninsured motorist coverage, who was struck by an uninsured driver, would receive no compensation for all of the other elements of damage described above.

No one ever believes they will be involved in a serious motor vehicle accident. But every day throughout the state of Florida, hundreds of people are seriously injured who also believed it would never happen to them. Following a serious accident, the injured person will immediately begin to consider, who will compensate them for the substantial losses they have incurred and those which will be incurred in the future. Losses such as pain, suffering, loss of enjoyment of life, as well as loss of earning capacity and earnings are very commonly encountered in relatively routine motor vehicle accidents. In the more serious accidents, all of these losses may be incurred, particularly those which involved the death of a loved one. People naturally become angry and frustrated when they have been struck by an uninsured driver, only to discover their own policy of insurance does not include uninsured motorist coverage.

There is something else to consider about carrying only Medicare or health insurance. If there is any liability coverage available to provide compensation of one’s injuries, even though it may be woefully inadequate, Medicare and virtually all health insurance policies, have reimbursement rights. Federal statutes require reimbursement of benefits provided by Medicare and employer sponsored health insurance plans when the injured person receives compensation for their injuries. Most other health plans contain reimbursement rights which are regulated under state law, including Florida. This means that when someone’s health insurance or Medicare provides benefits to them following an accident, those benefits are subject to being paid back if the injured person is successful in getting even minimal compensation from the party responsible.

Therefore, the only way someone may protect themselves is to carry the maximum amount of uninsured motorist coverage they can afford. We urge our clients to examine their declaration sheet on their auto policy, determine what coverage they actually have purchased, and call their agent to get a quote for uninsured motorist or additional uninsured motorist coverage.