Your Prescription for Health: Provincial Drug Insurance Options

Canadians are privileged to have access to universal health care coverage - from annual physical check-ups to emergency medical services, and more. Provincial health plans include coverage for medications you require while you are hospitalized; however, prescription drugs needed outside of an inpatient care setting are not covered.

In order to assist Canadians with the cost of their prescription drugs, each province has a variety of drug insurance program options available to its residents. The program for which you qualify will depend on a few factors including your age, income level, employment status, and whether you are part of other private insurance plans. Here is a quick overview of each province's drug insurance coverage.

British Columbia - Drug insurance in British Columbia (BC) is available through the BC Pharmacare programs. BC residents under the provincial health plan are eligible for the Fair Pharmacare program, which sets your coverage level depending on your income and establishes an appropriate per-person deductible based on that information. Under Pharmacare, there is a variety of other plans including one for people in Licensed Residential Care Facilities, for children living at home with disabilities requiring prescription care, and for victims of Cystic Fibrosis and HIV/AIDS. There are also plans for individuals receiving income assistance and for those with mental health issues.

Alberta - Residents of Alberta are eligible for the Alberta Health and Wellness Prescription Drug Program, which is available to all who are registered with the provincial health care plan. Low-income families can receive subsidized rates on their coverage. There are plans for people under 65 and for seniors, as well as for children of limited income families. Among the specialty programs are plans for those with rare diseases and for patients under palliative care.

Manitoba - Like BC, Manitoba drug insurance coverage is provided to all eligible residents, with the deductible being based on one's income level. To qualify for Pharmacare, you need only be a Manitoba resident who is registered with the provincial health plan, and do not have existing drug coverage from other government programs.

Saskatchewan - Residents of this province have access to drug coverage through the Saskatchewan Drug Plan. All residents of Saskatchewan who are registered under the provincial health plan and do not receive other government assistance for prescriptions are eligible for the Saskatchewan drug insurance program. The program offers a range of options depending on your needs and income level. Programs are available for low income families, and a special program offering reduced costs is available for seniors.

Ontario - The Ontario drug insurance system offers several different coverage options. The Ontario Drug Program (ODP) provides prescription drug coverage to residents who are 65 years of age or older, living in a long term or special care home, or receiving home care or income assistance. For those residents who do not qualify for ODP, the province offers the Trillium Drug Program, which provides assistance to anyone who is registered with the provincial health plan and does not receive 100% prescription drug coverage under an existing group plan. This plan uses an income-based deductible.

Quebec - All residents of Quebec who do not receive drug coverage from other insurance providers are eligible for the Quebec drug insurance program, Regie de l'assurance maladie du Quebec (RAMQ). Premiums for the plan are determined based on income. In Quebec, you must register for either a private prescription drug plan, or for the public health plan by law.

New Brunswick - New Brunswick drug insurance is available through the New Brunswick Prescription Drug Plan, which provides coverage to eligible residents. There are ten separate plans in the program, offering coverage to seniors, people living with illnesses such as Cystic Fibrosis and HIV/AIDS, patients in care facilities, and children in specific circumstances including those with special needs.
Nova Scotia - Residents of Nova Scotia, who meet the eligibility requirements, can qualify for Pharmacare. The Nova Scotia drug insurance plan is available to individuals receiving income assistance, seniors covered by Medical Services Insurance, and low-income cancer patients. There is also a program for patients with Multiple Sclerosis.

Prince Edward Island - Drug insurance coverage in this province is available through the PEI Drug Programs to residents who meet eligibility requirements. Residents who are 65 or older are eligible for PEI Medicare, while low-income families and their children, people on welfare services, as well as patients with Diabetes or Multiple Sclerosis can apply for the coverage.

Newfoundland/Labrador - Newfoundland drug insurance covers both Newfoundland and Labrador residents who meet the eligibility requirements for the program. The Newfoundland and Labrador Prescription Drug Program is available to residents who qualify for benefits through the Department of Human Resources and Employment, Food Bank recipients, seniors, and select residents who cannot afford prescribed high cost medications. There is also coverage for people with Cystic Fibrosis and Growth Hormone Deficiency.

Yukon - The Yukon drug insurance program provides assistance to a range of residents via several plans. Pharmacare is available to seniors 65 and over and their spouses 60 and over, as well as extended benefits as needed. There is a program for families with children, living under limited income. Drug coverage is also available to those with certain chronic illnesses.

Northwest Territories - You can obtain Northwest Territories drug insurance if you are a resident and if you meet the eligibility requirements. Drug benefits are extended to senior citizens as well as to people facing diseases that are part of the Specified Diseases list. Drug benefits are available through the program to people of Métis descent not otherwise covered.

Nunavut - Residents who meet eligibility requirements can receive Nunavut drug insurance via the Nunavut Health Plan's prescription drug program. Senior citizens, residents who receive income assistance, and individuals facing certain illnesses or conditions are also eligible.

Private drug insurance plans are often available through an employer and should be a person's first choice. There are other nationally-run prescription drug programs that are offered to First Nations members, veterans and current military members, refugees, government employees, and various other groups. For most Canadians, one of the available options, from private to public, will make prescription drugs affordable.

John Martin specializes in family medical insurance and is the content provider for http://www.familymedicalinsurance.ca/.

Ten Services That Save You Money and Time on Medicare and Medicare Part D Prescription Medication

Medicare can be very complicated and confusing especially now with the appearance of Medicare Advantage Plans and the Medicare Part D prescription Drug Plan. Understanding which insurance option and which prescription drug plan would be the best option and save the most money can be a daunting task. Sometimes even after selecting a plan the cost of medications can still be quite expensive and more than what many of us can afford.

Fortunately there are services available that can assist people on Medicare. Many are free and many are not very well known. Here is a list of ten services that can help with understanding your Medicare insurance options or can help with reducing the cost of your prescription medications.

1.Every state is required to have free Medicare Counseling through HICAP/ SHIP. HICAP is an acronym for Health Insurance Counseling Assistance Program. It had formerly been called SHIP which stands for State Health Insurance Assistance Program. Contact the Office of the Aging in your state for more information on HICAP/SHIP.

2.Patient Assistance Programs through the pharmaceutical companies may provide medication at no cost or for a small co-pay. Proof of insurance and financial status often has to be submitted to the manufacturer along with an application signed by both the patient and the physician prescribing the medication. The rules of eligibility vary for each pharmaceutical company.

3.Medicare Savings Program may help pay for some of your Medicare premium or deductible costs. This includes your Medicare Part B monthly premium. Eligibility is based on income. Contact your department of social services or department of human services in your county to apply.

4.The Medicare Extra Help or Low Income Subsidy program will help you pay for some of the Medicare Part D prescription costs, such as the coverage gap, premiums and co-pays. You can apply for this online at www. Medicare.gov or call 1-800-medicare.

5.The Medicare Rights Center offers free counseling and advocacy for people on Medicare. The staff are not Medicare employees. They are extremely knowledgeable about Medicare as well as End Stage Renal Disease (ESRD) Medicare.

6.If you are still working but will be eligible for Medicare soon contact your Human Resources department for free advice.

7.State Pharmaceutical assistance programs may help older adults pay for some of their medication costs. Not all states offer these programs. The criteria for eligibility varies from state to state but are mostly based on your income.

8.If you have served in the military you may be eligible for services and prescriptions under Veteran Affairs. Contact your local office to see if you will qualify.

9.Another excellent resource are the Independent Non-Profit Organizations (INOS). Three examples of INOS are the Healthwell Foundation, the Patient Access Network and the Patient Advocate Foundation. These organizations will often assist people with co-pays for certain medications based on their disease. They also sometimes help with insurance premiums or co-insurances.

10.Ask your insurance plan whether you have a mail order prescription plan. This could save you substantial money on your medications, sometimes reducing the co-pay or co-insurance amount.

Karen Porterfield, MA, LMSW is a hospital social worker who has used all the resources listed above in order to assist people in understanding their insurance options as well as to help them reduce the cost of their prescription medication.
For more information and additional resources visit her website at http://www.understandmedicare.org/