1 in 5 Canadians lack medical insurance – what you need to know

Have you ever been standing at the pharmacy, clutching a prescription, when the pharmacist tells you the cost and your heart sinks? It’s a situation far too many Canadians face every year.

According to data from the Government of Canada, 67 per cent of Canadians reported taking or being prescribed medication within the past 12 months, and one-fifth of Canadians did not have insurance to cover medication costs.

With rising living costs, many Canadians without coverage might not be able to afford out-of-pocket fees, and with 21 per cent of Canadians lacking insurance, they often face difficult choices like skipping doses or delaying treatment.

Given the importance of prescription drugs in maintaining health, understanding how coverage works can ensure you are not left in a vulnerable position when you need medication.

How does prescription drug coverage work?

Licensed healthcare providers prescribe prescription drugs to treat specific health conditions. In Canada, the cost of prescription drugs is usually not covered unless the patient is hospitalized, depending on the provincial healthcare policies. 

Provincial drug programs and private insurance plans can help with prescription costs outside of hospital settings, but some people still end up paying out-of-pocket. Many Canadians rely on private insurance, provided through employers or purchased individually, to help reduce these expenses. 

With private insurance, the provider covers part of the medication cost, and the patient pays the rest.

What does Ontario coverage include? 

Each province in Canada has a public prescription drug program, which provides partial or complete coverage for residents. However, eligibility and coverage vary across provinces, meaning not all residents are automatically entitled to drug coverage. 

For instance, seniors, children, or low-income individuals may receive more coverage in some provinces. In contrast, others may need to pay for medications on their own.

In Ontario, the Ontario Drug Benefit (ODB) program provides coverage for seniors aged 65 and older, individuals on social assistance, those receiving long-term care and people with specific health conditions. Under this program, eligible residents can access many prescription medications at no or low cost.

However, for residents who do not qualify for these programs, the cost of prescription drugs is generally out-of-pocket unless they have private insurance.

Why is prescription drug coverage important?

Prescription drug coverage is crucial in Canada because it helps to reduce the financial burden of accessing necessary medications. 

Without proper coverage, Canadians may struggle to afford medications, which can have serious consequences for their health. Studies show that many Canadians are already making difficult choices due to the cost of prescription drugs.

A 2021 poll conducted by Heart & Stroke and the Canadian Cancer Society found that nearly one in four people skip doses, split pills, or do not fill or renew a prescription due to the cost of the medication. Such actions can lead to worse health outcomes and increased medical complications.

Private health insurance that includes prescription drug coverage ensures individuals do not bear the full cost of their medications. Insurance coverage can make medications more affordable and accessible, improving overall health outcomes and reducing the financial strain on individuals and families.

You can find a plan that best suits your needs with CAA Protect. It offers coverage for prescription medications and ensures you get the medications you need at affordable rates. Call 800-709-5809 or book an appointment online today to find the best plan for your needs.

Have a health and dental insurance question? To speak to a professional who can guide you to the right coverage from the right insurer at the right price call us at 1-800-709-5809 or email us at info@caaprotect.ca