Steve McGuinness
Special to Niagara Now/The Lake Report

Most Canadians, when asked to define a key difference between life in Canada versus the U.S., will answer “free health care.”

Of course, health care is not truly free in Canada. There are just no fees charged directly to patients for basic services like doctor visits or hospital surgeries.

That’s because under the Canada Health Act, provinces are required to maintain universal health plans offering their residents medical coverage. The provinces receive significant social transfer amounts from the feds in return.

In Ontario, wages and salaries are also subject to a payroll tax (the Employer Health Tax) to fund medical care, supplemented by general tax revenues.

If revenues from these sources are insufficient, the government plan does not become insolvent, because provincial governments can run deficits and issue debt.

Costs have been escalating as our population ages, causing some formerly covered services to be “de-listed” from eligibility.

Those who work may receive these services as an employee benefit under a group health insurance plan arranged with a plan provider, like an insurance company. Generous employers may also extend these benefits to retirees for life or a fixed period.

The coverage under these employer group plans may include dental, pharmacare (prescription drugs), major medical (stays in upgraded private and semiprivate hospital rooms), vision, physiotherapy, chiropractic and even out-of-country travel.

If your employer doesn’t offer medical benefits, you may be eligible for plans at reduced costs through other groups, like your union, a professional body, a university alumni association or even your auto club.

Depending on your age and income, our governments may also offer other selective health benefits. Older Ontarians qualify for the Ontario Drug Benefit program. Lower-income and older Canadians may qualify to join the Canadian Dental Care Plan.

Ontario seniors are automatically enrolled in the Ontario Drug Benefit after turning 65. It covers most of the cost of 5,000 prescription drugs.

While there is a $100 annual deductible and a co-payment of up to $6.11 per prescription, the Seniors Co-Payment Program can waive the deductible and reduce the co-payment to $2 for eligible low-income seniors. Obesity management drugs, like Wegovy, are not yet covered.

Meanwhile, to qualify for the Canadian Dental Care Plan, your adjusted family net income must be less than $90,000 on your prior year tax return. It covers most routine dentistry.

Some Ontarians also qualify for vision care coverage based on age: children and teens can undergo optometry exams annually and seniors every eighteen months. Others are generally not covered.

Most requisitioned lab tests (like blood analyses) are also covered in Ontario. One notable excluded test detects prostate cancer, despite Niagara MPP Wayne Gates’ persistent efforts to change this.

Because not all of your medical needs may be currently covered, you should consider purchasing an individual health plan from a private insurer to close any gaps.

The premiums paid and certain other medical costs you incur can be creditable against income tax when they exceed the lesser of three percent of your taxable income for the year, or $2,833, in 2025.

In his Bay Street career, Steve McGuinness was a senior advisor to large financial institutions and is now retired in NOTL. Send your personal financial planning questions to him at smcgfinplan@gmail.com.