Travel Blog

Ontario Government Drug Benefit Program

Ontario Government Drug Benefit ProgramA bunch of retired and semi-retired guys were having coffee the other day and there was a discussion about what drugs people pay for once they turn 65 in Ontario, Canada. One of our gang did some research and came up with the following answer which I posted on this blog. We would be interested in what other people pay in other provinces in Canada. As well as what people pay in the US and around the world when they turn 65.

Here is the answer I received from one of the group of guys who did a little research and sent it to the rest of us.

Guys, upon further review, I can now confirm that at 65, we will have most of our prescribed drugs paid for by the Ontario government.  However since we will all exceed the ‘poverty test’, we will have to pay the first $100 annual deductible.  So when you are paying for your prescription, you tell the pharmacist that you are now in the ODB program. He/she will access the govt. database to confirm your age and coverage and then set up your account accordingly. They will then bill them the cost for the prescription less the cost of the deductible.

Ontario Government Drug Benefit Program – Personal Health Insurance

If you have your own health insurance, the pharmacy will then bill any deductible and the small dispensing fee to the insurance company as they do today (or you pay and forward the receipt to the insurance company yourself).

Once you have used up the annual deductible, the insurance company is only billed the dispensing fee…  I checked and my personal  health plan insurance does cover the deductible amount. Each person should evaluate their own insurance coverage to confirm what they will pay vs their personal health insurance.

Personally  I think this is a really good deal for anyone living in Ontario, Canada, especially if you are retired. Not all drugs are covered. Most of the common drugs that are on the generic list are covered and the generics are certainly covered. If you are taking a specific drug now and close to turning 65, you may want to check with your pharmacist to see if these same drugs will be covered. Or whether you will have to switch to a generic.

Personal Drug Plans

Even your personal drug plan that  you use prior to 65 will want you to use the generic drugs. They are much cheaper than the non generic drugs. Sometimes they can be half the price or more which saves everyone a great deal of money. At 65, even if you have to pay for your own drugs always go for the generic drugs to save you hundreds of dollars a year.

Generic drugs are just as effective as the regular drugs and have been tested for all of the side effects that regular drugs go through. This is a pretty standard approach and can save consumers hundreds of dollars sometimes on a single prescription.

Drugs purchased in the states by Canadians while they are traveling are usually covered by their own health insurance plans. The receipts need to be submitted to the insurance company when you return to Canada. In addition if you need to see a doctor to obtain a prescription while traveling outside the country, most insurance companies want a call to them first before you go to the doctor. Failure to do so may cause the claim to be denied.

We also heard from several Americans that many businesses are limiting them to 29 hours a week so that they do not qualify for benefits. Previously before Obamacare the cut off was 39 hours. Now these people receive less hours and they still do not receive benefits. They now make less money and do not receive benefits. At least in Canada, once you are over 65, Ontario picks up the drugs with a $100 deductible. For more information about health related issues, click here.


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