# Health, Dental & Drug Insurance/Benefit Plan for an early retiree



## jimbob.seeker (Sep 12, 2013)

Hi CMF members:

I hope this post is appropriate for this forum.

My wife and I plan to retire in less than two years at the respective ages of 57 and 59.

My wife's company has an excellent Health, Dental & Drug Benefit Plan and we have enjoyed that tremendously over the years. The plan is not offered to retirees unfortunately.

At this time we spend about a combined $60.00 per month on drugs. Of course we hope that this amount will not increase anytime soon but unfortunately one never knows what lurks around the corner.

Any comments, thoughts, suggestions or recommendations on a strategy for covering health and dental costs (for just my wife and me) in our retirement years would be greatly appreciated.

My dentist says he has yet to see a dental plan that's worth the paper it's written on. Comments on this anyone?

Should I be looking for a plan that covers drugs until we are 65 (when ODB coverage will start)?

Should we look for a plan that covers catastrophes or is the Ontario health plan sufficient?

Any suggestions on which companies and what types of plans I should explore would be greatly appreciated.

Please be generous with your comments.

Thanks a lot,
JimBob


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## AltaRed (Jun 8, 2009)

I think it is good to have some level of an extended health plan post-retirement, at least until 65, and perhaps longer (I don't know about Ontario's ODB plan and what it covers beyond some level of prescription drugs compensation), so cannot help you there.

Regarding dental coverage, my view is that unless you and/or your spouse have below average dental health, dental plans are not worth the money. The reason is that carriers have to make money on them in aggregate across all their policy holders, and thus premium income has to exceed payouts. Only you can make that judgment, i.e. if you think caps/crowns are going to start to hit you in a big way, then perhaps go for a dental plan.

Similarly, eyeglasses and/or examination coverage is a waste of money for the same reason. The insurance companies have to make a profit in aggregate on policies issued.

The typical carriers I am aware of are Sun Life, Manulife and Blue Cross, with Blue Cross probably being the best. There may be others. I don't have a need for such a plan because I am covered as an annuitant from my former work group plan (of which my former employer pays part of the premiums). I would not take the dental or eyeglass coverage if I was paying 100% of the premiums.


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## the-royal-mail (Dec 11, 2009)

Insurance companies are in business to make money. They will have to charge you "premiums" to "cover" the costs of what you will need. They can determine those costs pretty easily plus they need to make a profit. I would personally just pay cash for these things you need including your dental checkups, scaling and drugs. It will most likely come out cheaper for you.


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## Ihatetaxes (May 5, 2010)

Dental is the big one for a lot of retirees. A couple implants here, a couple of crowns there. I bet many couples are spending over $5k/year on dental.


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## AltaRed (Jun 8, 2009)

Ihatetaxes said:


> Dental is the big one for a lot of retirees. A couple implants here, a couple of crowns there. I bet many couples are spending over $5k/year on dental.


But if you cannot be part of a group plan, outfits like Blue Cross will charge premiums (on individual plans) commensurate with your age class. Depending on dental health, it may not be worth it.


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## the-royal-mail (Dec 11, 2009)

Most dental plans do not cover things like implants and crowns, they only cover basics like checkups, cleanings and fillings. If you want bigger things like implants you'll have to pay extra for them through a more expensive plan. That's why I'm saying you're better off to pay cash for these things as they are needed.


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## Itchy54 (Feb 12, 2012)

Hubby and I are in the same kind of situation and are planning on retiring next year at the age of 57 ...this might change. We have told the dentist to check our teeth very well and let us know if any existing crowns need replacing before that time. I have one that is quite old that will need a replacement so we are planning for that (my nerves are already on edge).
Only a few years ago his employer covered medical/dental costs after retirement, but not so any more. They will give him extended health but I will have to pay for mine. They will give a discount on dental and my old employer, at this time anyways, will cover half the cost of provincial medical plan. When we get closer I will have a very good look at the dental plan (that will be discounted my employer--again that can change at any time). We will likely use Blue Cross.
Can't help with your Ontario plans...sorry.


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## Daniel A. (Mar 20, 2011)

I looked into this before retiring my heart meds cost around 2000.00 a year the best I could find a few years ago was a plan that would have cost close to 300.00 a month.


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## OptsyEagle (Nov 29, 2009)

Unfortuneately you will be on your own here. The only reason the employer group plans make any sense is because your employer pays for most of it. When you are retired you will not have an employer to do this. So as I said, you are on your own. Good luck. I hope you enjoy your retirement.


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## MoneyGal (Apr 24, 2009)

Most, if not all. It's a tax-free benefit to employees, and one of the last ones available!


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## Cal (Jun 17, 2009)

But good to start planning 2 years out like you are, as you can get any needed treatment done while covered, to reduce some of your future out of pocket expenses.


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## RedRose (Aug 2, 2011)

This is so opportune, I am just looking for a plan myself, so far I have checked out Manulife.
Their Enhanced package is $184 a month which seems to cover most things.

I am basically looking for hospital, physio, and drug benefits, the dental would be a nice feature but not a necessity.
I am a tad anxious right now and have problems making decisions, *can't sort the wheat from the chaff*. What else is new!!!

I just got news yesterday that I have Stage-1 Breast Cancer so I know I will need some help with medical expenses in the coming months.
I am 4 months off 65 so I know that the Ontario drug program will kick in just not sure about hospital and allied professionals for the upcoming months and year.

I apologise if this has highjacked your question but I thank you for starting the discussion.

I will be checking into Blue Cross as some of you have suggested that is the better one.
Any further contributions welcome too.


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## the-royal-mail (Dec 11, 2009)

^ Sorry to hear about the bad news.

To address your point, you will have to disclose all your health conditions and drugs etc. Those things will cost you extra in addition to the base rate you mentioned.

I stand by my assertions above.

Best,


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## RedRose (Aug 2, 2011)

Oh Thank YOU *royal mail* for your prompt response.

I was just getting a bit concerned over the hospital coverage for a private or semi private room.
I guess I could pay out of pocket like you say the premiums would be higher.

The allied professionals, physiotherapists and such are a handy component. I just paid $90 yesterday for a consult.
Oh onwards and upwards and the beat goes on...


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## marina628 (Dec 14, 2010)

RedRose ,
I am sorry to hear your news but you are very lucky they caught it early.There are social workers in the hospital that will do assessments for you and some things are covered depending on your income.
My brother`s medications at home are $450 a week but thank god his insurance covers 80%. If I can give you one piece of advise it is to get CCAC involved while in the hospital to avoid wait times when you are home because even if you do not qualify for funding these guys have every kind of support you will even need on one piece of paper for you.My brother has good insurance and we are paying privately for what he is not covered for but they have helped us get massage and foot care and they got us rates about 30% less than I could find for PSW and nursing which has saved us about $5000 this year.You are definitely not alone in this battle.

Marina


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## Toronto.gal (Jan 8, 2010)

jimbob.seeker said:


> 1. wife and I plan to retire in less than two years at the respective ages of *57 and 59.....Should I be looking for a plan that covers drugs* until we are 65
> 2. My dentist says he has yet to see a *dental plan that's worth the paper it's written on.* Comments on this anyone?


*1.* I would say most definitely, as lots can happen in that 6 & 8 year gap [65 - 57/59]. You know how it is, that you need it most when you don't have it and/or least expect it. Keep in mind how expensive some drugs are.

Just get a quote from all the health plans you know [I would get quotes from 5 at least] to compare coverage & prices.

You may find some useful information here:
http://www.insurance-canada.ca/consinfohealth/healthins1.php 

*2.* You know that you will need major restorative services at some point, but rather than spending hundreds per month on private insurance, you could self-insure, ie: save a monthly amount yourself rather than paying one. For example, $100/month x 3 years = $3,600, which would more than cover basic cleaning once/per year for both, and if you're good with this, + floss, etc., you might delay the more expensive services for years, so with a bit of luck also, you might not need major work until you have saved enough to pay for those services as well. However, if you can find a plan with reasonable combined premiums for health/dental, then you might consider that, too. 

To give you an average approx. cost of the more expensive services: [in my city anyway]

- *root canal:* anywhere from $400 to $1K per tooth [depending on tooth# - see below link]
http://www.dental-picture-show.com/endodontics/a-how-many-root-canals.html

- *crowns:* $1K+ [normally need them after a root canal as dead teeth without nerves become brittle].
http://www.frontrangedentalcenter.com/2012/09/purpose-dental-crown/

- *dentures:* $800 to $2K, depending whether partial or full [upper/lower] - I'm guessing u have a few years to save for this. 

- *implants:* most plans don't even cover for these, which happen to be the most expensive given the procedure is quite involved.
http://www.cda-adc.ca/en/oral_health/procedures/dental_implants/


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## Toronto.gal (Jan 8, 2010)

RedRose said:


> Stage-1 Breast Cancer.


Sorry Rose to hear about your health news, but early detection, in most cases, mean microscopic & limited invasion, so you're very lucky to have been diagnosed at almost the earliest possible time! I would consider a 2nd opinion.


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## OptsyEagle (Nov 29, 2009)

That's all well and good but most insurance individual plans have maximums to ensure that the those unexpected large costs don't end up getting paid by the insurance company.

As I said before, unless you have an employer willing to garner the lion's share of the cost, you are effectively on your own. You can either pay the lower costs of the all the drugs and dental work, no matter how large that number may be, or you can pay the higher cost of an individual insurance plan. That is how it will work for 99 out of a 100 people. 

I wish there was a way to grow money on trees, but there just isn't.


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## Toronto.gal (Jan 8, 2010)

OptsyEagle said:


> 1. That's all well and good....
> 2. but most insurance individual plans have maximums to ensure that the those unexpected large costs don't end up getting paid by the insurance company.
> 3. You can either pay the lower costs of the all the drugs.......


*1.* What is well & good?

*2.* Sure they are not unlimited plans, I mean money does not grow on trees for the insurance companies either. 

I don't know what would be the lowest drug max. for a basic health only plan, but I would say around $5K/year per insured. I have no clue as to the premiums for such a plan mind you, but all I'm saying is that when it comes to health [excluding dental], you don't know what's awaiting you as you get older, ie: heart disease, etc., and I don't agree that you have to do it all alone either, that's why there is insurance. 

*3.* I know for a fact that certain drugs can be very expensive, even for migraines. 

For myself [even when far from retirement], I certainly would not want to be without health coverage for even 1 year, never mind 8, and especially between late 50's and mid 60's as per the OP's case.


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## marina628 (Dec 14, 2010)

We are a small company and we pay $60,000 a year in insurance premiums for our 20 or so staff ,roughly $250 a month each.The average employee is 37 years old with a family and even with basic medical needs like treating kids for a cold , chiropractor ,bit of massage or glass our employees said they would pay this premium themselves rather than lose the plan.Until you have a illness you probably assume you can risk not having private insurance.For example basic insulin supplies are $300 -$500 a month and more and more people are developing Diabetes .


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## Toronto.gal (Jan 8, 2010)

marina628 said:


> Until you have a illness you probably assume you can risk not having private insurance.


That's true.

There are key differences obviously between the underwriting method [pricing] of group vs individual insurance, but at the end of the day, it's all about risk [much of which is unforeseeable, no matter one's age], and the higher the risk [older], the higher the premiums. 

OP has 2 years to decide, but just keep in mind that to maintain your health coverage after termination/retirement, and without any interruption in coverage, you may be able to purchase health insurance without medical evidence if your current insurance is portable, and if you apply within 60 days from date of termination.


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## OptsyEagle (Nov 29, 2009)

What is well and good is my agreement that these things can get expensive. There is no argument there, but it doesn't change the fact of reality that you are going to pay that cost yourself. Either as it happens or over time with the personal insurance plan...and that time will not be very long and usually it ends up being in advance (since they don't cover pre-existing conditions).


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## RedRose (Aug 2, 2011)

*Thank You* for your well wishes and kind advice re CCAC and such. I will follow up with them too.

I guess I will NOT be buying any Health Insurance then at this point.

I was just thinking to pay say $184 a month as opposed to paying $400 to $500 a month for meds and other allied health care.

Difficult decisions again. :cower: :biggrin:


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## jimbob.seeker (Sep 12, 2013)

Thanks to everyone who replied so far.

I was just wondering if anyone has direct experience with Follow Me Health Insurance from Manulife.

Any comments (within the bounds of what is allowed on the forum) on "Follow Me" would be appreciated.

Follow Me is billed as "The individual insurance plan that starts when your employee health benefits stop".


Thanks,
JimBob


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## RedRose (Aug 2, 2011)

*JimBob,* In hindsight now, I wish I had taken that Follow Me plan. I believe you have 60 days to sign up after you retire.
Just my humble opinion take it.

We were with Manulife and when my husband died I lost coverage. I could have taken it within 60 days but my head was turned elsewhere with other financial concerns.

I never took the Health insurance plan with my job years ago as we were covered with his. I did n't see the point of both having insurance.

Now I am semi retired and work now and then, I am not considered a full time employee so I cannot apply. I work for a Municipal government.

*Jim Bob,* I hope you receive more responses.

Rose.:chuncky:


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## jimbob.seeker (Sep 12, 2013)

*Thanks RedRose*



RedRose said:


> *JimBob,* In hindsight now, I wish I had taken that Follow Me plan. I believe you have 60 days to sign up after you retire.
> Just my humble opinion take it.
> 
> We were with Manulife and when my husband died I lost coverage. I could have taken it within 60 days but my head was turned elsewhere with other financial concerns.
> ...



Thanks for your response RedRose!

Good Luck!


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## jimbob.seeker (Sep 12, 2013)

It's been a few years since I've been on this forum. I've been retired for over a year now and I wanted to post an update on my quest for retiree health insurance, in case the information is useful to anyone else.

First of all, let me say a big thank you to all that responded to my original post. I received many very informative and helpful responses. RedRose, I hope you are doing well.

After evaluating many Extended Health Care (EHC) and Dental Insurance plans for retirees, I eventually chose to continue EHC coverage under my wife's expensive, but very excellent company group plan for early retirees (under 65). The cost of the premiums is paid by the retiree. The major reason for this decision was that no "new" plan will cover "pre-existing medical conditions". If there is one, I did not find it. Because my wife and I have been covered by the same group plan for over twenty five years, this is (hopefully) much less likely to be a problem. The cost is high now (about $9,000/annum for family coverage) but once my wife turns 65, the cost of the premiums drop to $1,500/annum because the plan will no longer cover prescription drugs. Since Ontario Drug Benefit (ODB) coverage kicks in at age 65, this should not be a major problem. I am aware that there are limits to ODB coverage so I will be looking into this further as we approach 65.

We decided to forego the dental coverage and take our chances with no dental insurance.

I suspect that group retiree health insurance would be the best bet for people in my situation, if they are willing to pay the price and if it is available to them. Fortunately, my wife stayed with the same employer for many years and qualified for her company's group early retiree health insurance plan. I did not qualify for my company's plan because I fell short in the number of years of service. I also noted that my wife's company's retiree health insurance provides better coverage than my own, but the cost is higher. I didn't qualify for my own anyway.

In an effort to find cheaper insurance, I looked at as many plans as I could and it seemed to me that none came close to what I wanted. Here are my main objections to the plans (outside of group plans) I researched. 

>Pre-existing medical conditions not covered
>Yearly cap on drug claims is less than the annual premium cost
>80% or less drug reimbursement
>Lifetime caps on expenses

Health insurance is one component of the worry free retirement that we were striving for. Even though it is expensive, my wife and I think it's worth the price.


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## paul00hbrt (Apr 9, 2017)

AltaRed said:


> I think it is good to have some level of an extended health plan post-retirement, at least until 65, and perhaps longer (I don't know about Ontario's ODB plan and what it covers beyond some level of prescription drugs compensation), so cannot help you there.
> 
> Regarding dental coverage, my view is that unless you and/or your spouse have below average dental health, dental plans are not worth the money. The reason is that carriers have to make money on them in aggregate across all their policy holders, and thus premium income has to exceed payouts. Only you can make that judgment, i.e. if you think caps/crowns are going to start to hit you in a big way, then perhaps go for a dental plan.
> 
> ...


I must agree.


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## ian (Jun 18, 2016)

Everyone's health situation is different. When I retired we did look at the follow me program. I am fortunate. My employer pension provides us with $1500. in health spending a year, plus catastrophic drug coverage (we pay the first 3K per year, they pay 90 percent after that).

Cannot comment on prescription drugs because there is such a variance between individuals. Here in Alberta, the Alberta Gov't provides seniors/dependents with Blue Cross. It pays for 70 percent of any prescription drugs and I believe the max. that anyone pays is $30 per script. We will be covered in two months time. Not an issue since are prescription costs, at the moment are minimal. I suspect that within the next few years all Provinces will move toward some form universal Pharmacare-something the Canadian Medical Assoc. has been advocating for years.

We did look at dental and eyecare. Our conclusion was that for this coverage insurance was grossly overpriced. If you are considering dental look very closely at the annual limits and specifically at exclusions and reimbursement limits on procedures like root canals and crowns. We found that the exclusions and annual limits negated the high dollar items that were our primary concern. The second thing we did was switch to a electric toothbrush. The differences, for us, have been substantial. Better checkup, far less plaque, bleeding gums etc. We moved to a 9 month checkup and may elongate that to 12 months.

We did the same review for eye care and eye wear. Again, the annual limits for the policies that we were considering, did not make the program worthwhile. Especially since after 65 our eye exams are covered by our Provincial health insurance and we buy our eyeglass prescriptions from Costco.


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