Health Care for Seniors in Ontario: It’s More Affordable Than You Think

December 17, 2018

Whether you’re close to retiring, or already enjoying the freedom of retirement, you probably know that savings are limited and future health care costs are a constant worry. In fact, 32% of Canadians between the age of 45 and 64 have nothing saved for retirement and will have to figure out how to pay for their health care as they age.^[1]

This guide will reassure you that when you do reach that stage of your life, your savings can go a long way. As an Ontarian senior, there are many publicly funded and affordable private health care options that will allow you to maintain a quality standard of life.

Publicly Funded Health Care for Seniors

For residents of Ontario, the publicly funded system (ie. the government) covers quite a significant number of health care costs – from medications and diagnostic screenings, to home care services and accommodations in long term care facilities.

In Ontario, when we pay our taxes, nearly 39% of each dollar is given to the Ministry of Health and Long-Term Care and put towards our publicly funded healthcare system.^[2] Those tax dollars are then divided amongst 8 segments, including:

Local Health Integration Network (LHIN)
Ontario Health Insurance Program (OHIP)
Provincial Programs and Stewardship
Population and Public Health
Health Policy and Research
eHealth and Information Management
Information Systems
Ministry Administration

Ministry of Health and Long Term Care (MOHLTC) funding distribution pie chart View Larger

To learn more, check out our guide Healthcare in Ontario: How does it Work and How is it Funded.

We’re going to focus on the first two segments, Local Health Integration Network (LHINs) and the Ontario Health Insurance Program (OHIP), since most of the healthcare services that seniors require fall within these two categories.

Local Health Integration Networks (LHIN)

The LHINs plan and integrate local health services in communities across Ontario. The province is divided into fourteen LHINs to ensure people have properly coordinated care, regardless of where they live. To find out which LHIN you are part of, you can enter your postal code here.

Ontario Local Health Integration Network Map

The LHINs are responsible for the coordination, integration, and funding of hospitals, long-term care homes, home care services, community support agencies, and more. This means that if you qualify for any of the publicly funded healthcare services that are coordinated by the LHIN, they will be free of charge.

Let’s take a closer look at some of the LHIN coordinated services that seniors might need: home healthcare services and long-term care facilities.

Home Healthcare Services

Seniors often want to stay in the comfort of their own homes as they age, but don’t always have the support to do so. This is a concern not only for you, but for your children as they want to ensure that you’re comfortable, safe, and healthy if your physical abilities begin to decline. For those that qualify, publicly-funded home care services are the perfect solution. The home-care services that are funded by the LHINs include:

health care professionals helping seniors icons

To start the process of getting home care services, you would follow these steps:

1. 1. Call Your Local Health Integration Network (LHIN): You will be connected with a care coordinator. This is the person that will assess your situation, determine if you qualify for LHIN-provided services, and arrange the home care services that you need.To get started, you can either contact the LHIN online or by calling 310-2222.
  2. Discuss Your Needs: Your designated care coordinator will then conduct an interview with you (via online or by phone) to discuss the services your LHIN can provide and what’s available in your community.
  3. Arrange for a Home Visit: The care coordinator will make a visit to your home to assess your health and living conditions. If you do qualify for publicly-funded care, the care coordinator will then create a plan to meet your specific healthcare needs.
  4. Receive Care: The LHIN will coordinate an application for your care. Several home care companies have contracts with the LHINs; one of these organizations will be selected to provide your care.

Long-term Care Facilities

Eventually, there comes a time in everyone’s life when the decision to stay at home or look for alternate living arrangements will arise. While retirement homes aren’t publicly funded, the living costs for long-term care facilities can be subsidized by the government. Even if looking for alternate living arrangements isn’t an immediate decision or expenditure, it’s good to know that if the time comes, there is help from the Ontario government.

But first, it’s worth pointing out the differences between long-term care facilities vs. retirement homes. In retirement homes, seniors pay a fee for their accommodations and live without the assistance of healthcare providers. Retirement homes are great for retirees that are in good health and want to maintain their independence; however these accommodations are not publicly funded. So, if you’re worried about your finances, retirement homes might not be the best option for you.

long term care facility icon

In long-term care facilities however, the cost for accommodations is subsidized by the government and there are healthcare providers present at all times. However, long-term care facilities aren’t meant to be a cheaper alternative to retirement homes; these facilities are specifically meant for seniors that can no longer live in their home because of injury, ageing, disability, or another health condition. If home care has been ruled out as an option, long-term care facilities are an alternative with 24-hour nursing and personal care.

The cost for a placement in a long-term facility is a bit tricky; there are many conditions that determine how much is subsidized and what fees you’ll be responsible for. The maximum cost (if you don’t receive any government subsidies) for the various types of long-term care accommodations are as follows:^[3]

Ontario long term care facilities costs View Larger

With such a high percentage of seniors that don’t have enough saved to pay for healthcare costs after retiring, you may be one of these people thinking, “Whoa! I can’t afford that!” But don’t worry, these are only the maximum amounts, and the Ontario government offers subsidies to help lower the costs.

If you’re unable to afford paying for a basic room, you may be eligible for the Long-Term Care Home Rate Reduction Program, a subsidy of up to $1,848.73 a month to pay for the basic accommodation long-term stay.

Your eligibility for the long-term care government subsidy involves:

The type of accommodation you wish to have (only basic rooms are covered, not semi-private or private rooms)
Your net income (view how your net income is calculated)

* You must already be receiving all of the federal and provincial benefits that you are eligible for, including: OAS, ODSP, GIS, and GAINS.

For a complete outline of the application process, including the necessary forms and information required, visit the long-term care accommodation costs and subsidy webpage.

Ontario Health Insurance Plan (OHIP)

Every resident of Ontario has likely heard about OHIP, but might not know the extent of what the program includes. That little green card sitting in your wallet is essentially your ticket to so many publicly funded health care services, including:

Visits to the doctor or nurse practitioner
Hospital stays and visits
Dental surgery
Optometry eye-health services
Podiatry foot-health services
Ambulance services
Travel for northern-Ontario residents
Physiotherapy services

Visits to the doctors or nurse practitioner

OHIP covers visits to doctors and nurse practitioners. Specifically, this includes:

Visits to a walk-in clinic
Diagnosis and treatment for common illnesses and injuries
Referrals to health specialists
Support in managing chronic conditions such as diabetes and high blood pressure
Writing prescriptions for medications
Regular check-ups

doctor and nurse practitioner icons

Hospital stays and visits

If you need to go to the hospital, the majority of costs will be covered by OHIP. These costs include:

Doctor and nursing services
Accommodation and meals; however, if you want a semi-private or private room, you’ll have to pay for that yourself or through private insurance
Diagnoses services such as blood tests and x-rays
Medications for patients while in the hospital
Some prescribed medications for out-patients

doctor in front of hospital icon

Although most out-patient medications aren’t covered, that’s not to say that all prescription costs are the responsibility of the individual or private insurance company. The Ontario Drug Benefit (ODB) program covers the cost of more than 4,400 medications, which you can search here. You may be covered by the Ontario Drug Benefit program if you are:

Age 65 or older
Living in a long-term care home
Receiving community care services or home care
Enrolled in the Trillium Drug Program

You’re also covered by ODB if you are enrolled in Ontario Works or the Ontario Disability Support Program. If you find that the ODB program does not cover the medications that you are taking, they may be covered through the Exceptional Access Program (EAP).

Dental surgery

Basic dental costs are not covered by OHIP, however if a dental surgery is complex, it may need to be done in the hospital. In this case, OHIP will cover the costs. The types of dental surgeries that are covered by OHIP include:

Fracture repair
Tumor removal
Reconstructive surgeries
Medically necessary tooth removal surgery

Although OHIP does not cover basic dental costs, there are programs available for seniors that don’t have dental insurance or the income to receive dental care. Some districts – for example the Region of Peel – have a Seniors’ Dental Program which covers dental services such as cleanings, fillings, and dentures.

There’s also the Ontario Disability Support Program (ODSP) that allows you and your spouse to receive coverage for basic dental services if you suffer from a disability, or if you are taking prescribed medications that negatively affect your oral health.

Optometry eye-health services

OHIP covers the cost of one major eye exam every 12 months, plus any minor eye assessments if you are over the age of 65. However, OHIP does not cover the following:

Retinal imaging
Laser refractive surgery
Eyewear such as glasses, contact lenses, low vision aids, vision therapy, and medications to manage diseases of the eye and surrounding tissues.

optometrist giving eye exam icon

Even though the services above aren’t covered by OHIP, there are other publicly-funded optometry programs that may be able to assist with the cost. These programs include:

Podiatry foot-health services

OHIP will cover between $7-16 of each visit to a registered podiatrist, up to $135 per year, plus $30 for x-rays.^[4] However, you will be responsible for the remainder of the cost for each visit. Surgeries performed by a podiatrist are not covered by OHIP.

Ambulance services

If you are in need of transportation to the hospital, OHIP will cover part, or all of the costs of the ambulance ride. The amount covered will depend on certain conditions, like if the ambulance service was deemed medically necessary. If your ambulance transportation costs are not fully covered, you’ll be required to pay a co-payment fee of either $45 or $240.^[5]

ambulance icon with health bag

Travel for northern-Ontario residents

For individuals living in the more remote regions of Ontario, accessing healthcare might not be so easy. If you have to travel long distances for specialized care and live in a remote region, you may be eligible for the Northern Health Travel Grant.

Physiotherapy services

Physiotherapy services are fully covered by OHIP for those that qualify. In order to qualify, you must meet one of the following conditions:

Over the age of 65 with a referral from a physician or nurse practitioner
Recently discharged from the hospital from an overnight stay, with a referral from the hospital physician

Privately Funded Health Care for Seniors

Although the government funds many health care services, not everyone qualifies for these services. And if you do qualify, you may require additional care. Paying privately for your health care needs can be affordable, and there are a wide variety of services offered by organizations. Because you are paying privately, there is such an abundance of services to choose from – from private home care, to healthcare technologies and much more.

Private Home Care

The same services that are publicly funded by the government can also be purchased privately. However, when paying privately, you get to choose the frequency, length of visits, the agency to provide the visits, etc. The cost of private home care depends on the actual service required and the chosen provider. For example, the average cost for a Personal Support Worker (PSW) is between $25-$35 per hour.

You may not need home care at this moment, but it’s always good to know your options for when the time might come. Choosing a private home care provider can be an intimidating process, which is why we created the guide Home Care in Ontario: How to Choose a Provider That’s Right for You to make sure you have all the information needed before making a decision.

Health Care Technologies

Health care technology is a growing industry, with so many emerging technologies to watch out for. Things like virtual reality, artificial intelligence, and 3D printing are all being incorporated into client care. However, one of the most innovative healthcare technologies is that of remote patient monitoring. Remote patient monitoring allows individuals to have their vital signs monitored by a remote team of healthcare professionals.

One of the leading remote patient technologies in Canada is Cloud DX. The connected health kit includes all of the necessary devices to take vital sign readings, along with a tablet to view the results and connect with your doctor. Your vitals can be monitored remotely by physicians, caregivers, family members, and anyone else in your circle of care. With the Cloud DX, you can set reminders for medications, set target values for vital sign readings, and set warnings for when these readings are outside of normal range.

That’s right – by taking your own vitals at home and having them monitored remotely by your physician, your need to go to the doctor or hospital can be greatly reduced. That means less transportation costs, less time taken out of your day, less stress, and most importantly, the satisfaction of being in control of your own health.

BONUS: Senior Discounts & Money Saving Tips

Ok, so paying for healthcare as you age isn’t as scary as you thought it would be. But every dollar counts if you’re retired and your income has likely been reduced. Luckily, from bus fares to groceries, senior discounts are available almost everywhere in Canada.

Here are some senior discounts and helpful money saving tips so that you can enjoy life to the fullest while living on a budget.

Senior Discounts

Traveling Discounts: Visit your children and grandchildren using Via Rail Canada’s 60+ discount program for seniors. Enjoy your trip!
Public Transportation Discounts: Get a senior discount for public transportation. For example, the TTC charges $3.25 for adults and only $2.20 for seniors over the age of 65.
Hotel-Stay Discounts: Many hotel chains offer deals for seniors. For example, if you’re 62 or older, you can save 15% or more at a Marriott hotel worldwide, seven days a week.
Movie Theatre Discounts: Movie theatres offer great discounts for older film buffs. Cineplex reduces the price of a ticket from $12.99 to $8.50 for seniors.
Totally Free Stuff! That’s right, free. Check out all of these free samples for senior, including skin care, food, and denture cleaners.

To see even more discounts available for seniors, check out this comprehensive list: Canadian Senior Discount Guide: The Ultimate List

budget and money saving icons

Money Saving Tips

Use Bargain-Hunting Websites: Bargain-hunting websites and apps like RedFlagDeals provide up-to-date information about discounts throughout Canadian websites and retail stores.
Check Fuel-Saving Apps: Save on fuel by using GasBuddy to check the prices of gas at nearby gas stations. Just type in your city or postal code and check the prices on-the-go.
Install a Coupon Plug-In: Honey is an easy-to-install browser extension that automatically finds and applies coupon codes at checkout. All you have to do is shop online like you normally would and let Honey do all the work.
Take Advantage of Group Deals: Get discounts on products, events, vacations, and more by using Groupon.
Make a Budget: Your budget in retirement will be different than your budget while working. If you need help, the Government of Canada provides resources for budgeting during retirement.
No-Fee Banking: Go with a no-fee banking account. RBC, BMO, and CIBC offer free bank accounts to individuals age 60+, and Scotiabank offers the same deal at age 59.
Take Advantage of Price Matching: Many stores, most notably Walmart, offer price matching. All you have to do is bring in a flyer or advertisement from another store with a lower price, show it to the cashier at check out, and the store will match it.
Grow Your Own Food: Not only does growing your own food help save money, but gardening has been shown to reduce stress, decrease dementia risk, boost moods, and help combat loneliness.^[6]
Visit Your Local Library: Your local library has books, videos, DVDs, and CDs that you can borrow and take home free of charge – there’s no need to spend your own money to buy these items if they’re available at your local library.
Use Compact Florescent Lamps: Instead of using old-fashioned lightbulbs, if you replace the bulbs in your entire house with compact fluorescent lights, you could save $100 or more in a year.

Remember, Don’t Panic!

Hopefully, by the end of this guide you’ve realized that the costs of healthcare as you age aren’t too intimidating and shouldn’t be keeping you awake at night. As Canadians, we’re very fortunate to live in a country that takes care of its ill, ageing, and injured citizens. Through the publicly funded system along with affordable private care options, you should be able to get all of the healthcare services you need without having to sacrifice your standard of living. Now go out and enjoy your retirement and remember not to panic – everything is going to be fine.