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 Medicare.gov website lets you easily search for this. For example, I am going to search how Original Medicare covers Kidney Dialysis. First, I go to medicare.gov. 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.

Medicare.gov 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.

What Every Business Owner Ought To Know About Voluntary Benefits

Some Plain Talk About A Simple Decision That Is Often Difficult to Make

If he had provided voluntary benefit options to his employees, he would have fostered trust and loyalty, his employees would have felt safe in the knowledge that he was looking out for them. This safe culture would have lead to stable, productive, confident teams, where everyone felt they belonged.”

They left, some for lower paying jobs that provided voluntary benefits.

The first notable defection was a talented project manager who left to take on a maintenance supervisor position at a nearby property management company. He had to leave to find better ways to protect the financial well being of his family. He went on to build his team by selectively recommending to his new boss the hiring away of his former co-workers.

Of course, the company tried to adjust by switching to a 1099 model from a W-2 model, hiring subcontractors but without a solid vetting process, the switch was not successful the company folded in 2007. The management nucleus that enabled it to grow to an 11 million dollar revenue company in 3 years was gone. The branding perception of a company that did not care about its employees had taken hold.

I believe in the value of the voluntary benefits insurance business and seek every opportunity to go in and relate this experience to business owners.”

Who benefits? Both employer and employees benefit. The employer benefits through greater employees satisfaction and retention through improved benefit programs, this, at little or no financial cost to his company. The employees benefit through the ability to custom design an affordable benefits package to protect their income from unexpected costs associated with illness or injury.

What must employers do? Provide employees the option to make informed decisions about protecting their income. For, employees are increasingly more invested in their care. In truth, many employers when asked about employees benefits their first reaction often is, “I’m all set,” but are they really? If your employees are not, as you believe you are, it is because you have not given them the choice.

Why must employers do it? Your employees want it. A 2013 study highlighted that 64 percent of employees want their employer to provide a wider array of voluntary benefits that they can choose to purchase. Some actually need it and will happily pay for it because of the peace of mind it engendered. Again, this at no cost to the employer’s operating budget.

How must employers do it? Create the environment where employees feel free to exercise this choice. Further, facilitate a welcoming and private setting for this information transfer to take place between the employee and the benefits provider.

Where should this happen? It is preferred that this takes place through the company’s group option (payroll deduction) where employees are guaranteed a cost saving of up to 35 percent, rendering the cost of most products at less than a dollar per day.

When must an employer do this? There is rarely a better time than now.

All in all, the who, what, why, how, where and when on voluntary benefits. The ball is in the employer’s hands, play it well and you will be the winner (in-a-nutshell).

David Allen, an independent Agent Representing Aflac
Within our office we have over 50 years of experience working with small to medium sized businesses helping them developed more comprehensive benefits offerings.