# Recommendations for medical insurance in retirement



## Mechanic (Oct 29, 2013)

Myself and wife are in our early 60's and have been retired for about 7 yrs now. Before we retired, we were business owners and had a group plan for ourselves and employees but since retiring have had nothing. The plan was always expensive for what was covered and since retiring we have just paid out of pocket for dental and health needs and they have been fairly minor. Although we are both healthy and active, I find myself wondering if we should carry something like Blue Cross as we age ? Would like to hear any recommendations and other peoples ideas before making any decisions. Thanks.


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## RussT (Jul 11, 2016)

My wife and I have been retired for three years. I was able to continue my employer's excellent dental and health benefits when I retired, but the premium is very high - around $500 per month. We decided to keep the insurance when I retired until we could determine what our claims experience would be. We are both quite active and healthy.

So far it has been a bust. We would have been far better off self insuring. But these our likely our best years and the future may be quite different. Nonetheless I'm feeling like a chump right now. I, too, will be interested to hear from others.


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## OptsyEagle (Nov 29, 2009)

Individual plans do not work. As you know, being a former business owner, is that group plans would not work if it wasn't for the employer paying a large part of the cost.

You can get yourself quotes but what you will find with individual plans is that when you review the premium cost to what you and your spouse can reasonably expect to spend in medical and dental costs, you will find the premium cost much higher. One might feel comforted thinking that the insurance also gives piece of mind to cover very expensive things, but when you read the fine print of the policy, you will find they have no intention of doing that. It is filled with maximums, co-pays and exclusions.

Anyway, if you find one that is actually cheaper then paying these things for yourself, let us know. The bottom line for those of us that do not have medical and dental plans...we are on our own. There is no help. When you are 65 I think the government has a plan but until then, your wallet is your protector.


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## agent99 (Sep 11, 2013)

We have been retired for about 14 years. Only health plan we have is OHIP. It covers just about all medical issues and most of prescription medicines (after 65). We pay our own dental and eyeglasses. We are in USA for 3 months, and have emergency travel insurance while here (now ~$2k/90days for two of us, and never used). In past I have looked at insurance that would provide an upgrade to OHIP. It would provide semi-private hospital room etc. But often that is determined by what hospital has available anyway. So never found anything that was affordable and that we felt we needed. Luckily both still fit. 

Is provincial coverage not adequate Mechanic?


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## My Own Advisor (Sep 24, 2012)

Here are some thoughts from a recent blogpost...fwiw:
https://www.myownadvisor.ca/what-to-consider-when-workplace-benefits-are-disappearing/


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## Eder (Feb 16, 2011)

We pay for Alberta Blue Cross for prescriptions only as my wife has drug costs exceeding 10k/year. Has been a good deal for us, about $120/month for both of us. When we travel we self insure unless we go to the USA.


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## Mechanic (Oct 29, 2013)

Thank you guys for the feedback. I looked into this a few years back when I first stopped work and the cost to continue through the group plan were high, it was costly anyway as a small business owner paying both sides. We moved to BC a couple of years ago but had a lot going on and never really thought too much about additional, over the provincial health care. We both are active and fairly healthy and our annual spend is pretty low. When I look at blue cross, the premiums are higher than the coverage, so seems like we may as well just continue to self insure.


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## milhouse (Nov 16, 2016)

I've been thinking about post retirement health coverage too as my friend recently retired and was talking about getting on a plan. It got me thinking what I'm going to do after the missus retires (after me) and we don't have coverage. 
I think we're comfortable with the prospect of paying out of pocket for basic stuff: dental cleaning and basic repair, the odd prescription, basic tests/exams. What scares me are "big bills" that wouldn't be covered by provincial health services. We'd obviously get travel insurance. I'm struggling to identify (out of naivety) what kind of big bills (>$10k?) would not be covered by the province but would be by insurance. Eder's prescription example is enlightening, but I would have thought there would be a yearly max before the province picks up the rest of the tab (eg BC Fair PharmaCare deductible limits), though I'm guessing it may be tough to compare apples to apples with differing coverage and programs among the provinces.



My Own Advisor said:


> Here are some thoughts from a recent blogpost...fwiw:
> https://www.myownadvisor.ca/what-to-consider-when-workplace-benefits-are-disappearing/


Thanks for link Mark. Found it informative.


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## ian (Jun 18, 2016)

When I retired seven years ago I had the option of paying for the company medical plan. We decided against it...the cost then was about $375. month. When we took a good look at the program we found that the expensive dental procedures (caps, root canals, etc) were only covered for 50 percent and only up to a rather limited annual claim. We have both been in good health. 

Had we purchased the insurance over the past seven years Manulife would have been the big winner! Much to our surprise, last year when I turned 65 Alberta Health sent me a note saying that because of our age we are now covered in part by Alberta Blue Cross for prescriptions. So far, of the few prescriptions that we have had, Blue Cross has paid 70 percent or so of the cost. Looks like I will need some dental implants soon....may have to mortgage the farm to pay for them!


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## Longtimeago (Aug 8, 2018)

All insurance works in the same way. The insurer must take in more than they pay out. The only question is if you will be one of those for whom they pay more out than they take in from you or if you will be one of the majority who pay in more than you get out. 

I always like to use life insurance when thinking about insurance at all. If you have life insurance, you are betting you will die while the insurer is betting you will live. I always wonder about people who bet on dying. LOL 

The same is true of medical insurance but at the same time, we do happen to live in a country with some of the best government provided healthcare in the world. So for us unlike our neighbours to the south, the bet is even worse. If we pay for private coverage, we are betting on the even smaller likelyhood of our needing to claim for something that our government coverage does not cover. 

No one can say whether any given individual will regret not having paid for private coverage or not. We would need a crystal ball for that. But what we can say is that if you choose to not pay for private coverage, the odds are in fact in your favour. You know that because the insurance companies are not going broke paying out on claims, more people are paying but not claiming than are paying and claiming. So it's a gamble and you just how to decide how risk tolerant you are.

Personally, I have never wanted to bet on my getting sick or dying. Somehow it just seems to me that you would be asking for it to happen. Every heard of a 'self-fulfilling prophecy' and how they work?
https://positivepsychologyprogram.com/self-fulfilling-prophecy/

I do pay for healthcare coverage when I travel, but that's because our provincial coverage doesn't apply obviously. It's all about the cost vs. degree of risk. A high cost for extra coverage while in Canada relative to a low risk of needing it is not the same as a relatively low, one time cost of travel coverage vs. a low risk of needing it still but a relatively high cost if you did need to pay for everything yourself if hospitalized while travelling.


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## Eder (Feb 16, 2011)

ian said:


> Looks like I will need some dental implants soon....may have to mortgage the farm to pay for them!


We have been going to Mexico for all our dental work. Our dentist is trained in the US and insists on cleaning our teeth herself. $30 US/filling and I think $30 for cleaning/check up x rays. Implants are cheap as well and the savings would pay for flight & stay at https://www.paradisevillage.com/


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## OhGreatGuru (May 24, 2009)

It's pretty tough. Unless you are eligible for a group plan where a lot of the members are (relatively) young and healthy, it's expensive to get insurance. So you basically have to self-insure. Look around for plans from any associations you may belong to: alumni; professional associations; CAA; etc. There are many threads on this subject. Look up Snow Bird associations. They usually list sources.

We don't have universal pharmacare (yet) in Canada, but a lot of provinces subsidize drug costs for people 65 and older. See if this applies in your province, as it may affect your estimation of risk.

Because of medicare, many people can get by with self-insuring within Canada. It's travel abroad that gets risky - especially to the USA.


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## Rebecca (Aug 10, 2014)

You might also want to check your provincial plans for something like Ontario's Trillium Drug Plan. It covers you before you're 65, if you have to pay more than 3-4% of your income on drugs. This is a major benefit if you end up on expensive drugs.

https://www.ontario.ca/page/get-help-high-prescription-drug-costs


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## kcowan (Jul 1, 2010)

Eder said:


> We have been going to Mexico for all our dental work. Our dentist is trained in the US and insists on cleaning our teeth herself. $30 US/filling and I think $30 for cleaning/check up x rays. Implants are cheap as well and the savings would pay for flight & stay at https://www.paradisevillage.com/


Yes DW gets her dental work done here. It is much cheaper overall if you avoid staying at Paradise Village. I get mine done under a dental plan in Canada. Other procedures are also routinely done, like hip replacements. I have also had laser repair of my retina. The guy practiced in Guadalajara but 2 days in PV.


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## birdman (Feb 12, 2013)

While I do not have an specific answer all insurance is expensive but necessary if you cannot afford the potential loss. Home insurance agencies make about 20% of your premium then the insurer itself probably has an overhead (excluding claims) of maybe 20%, then the need a profit of say 10% with whats left (maybe 50% of the premium) is used for claims and claim adjusters, etc. I expect the same applies to auto insurance, medical insurance etc. Even if Canada brings in pharmacare of some sorts this will add to the overhead and of course we will pay for that with higher taxes. Of course one has to make their own call whether or not to self insure. Fortunately I had contents insurance over our ski condo when it was destroyed by fire 2 yrs ago as the claim (contents, loss of use, rental loss, and rental costs during repair totalled $70,000. Building was replaced by the strata. I self insure medical costs which are tax deductible.


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