FUDiabetes

Tandem in Canada

@Beacher
@Jen
What does this mean?

(I have given up trying to figure out the Canadian system !!!)
:smile:

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It means if you live in the province of Ontario (Canada’s most populous province), the provincial government will pay for the entire cost of the pump. It’s good news for Tandem and anyone who wants a Tandem pump. Eligibility is broad. If you don’t already have a pump through the program, an endocrinologist basically just signs a form and the province will pay for it. If you already have a pump purchased by the province, it’s a little bit trickier.

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It’s not too (italics) complicated. We have national healthcare, but the system is not the same across the country as it is administered by the provinces (same as states in the United States). Some provinces cover more things than others, and we do not have a national pharmacare system, meaning that private insurance companies generally cover prescription drugs just as they do in the States (though this varies by province). It is a big misconception that everything is free. Think of it like medicare except it doesn’t extend to drugs in most provinces (only doctors and hospitals), and all hospitals are public (but like public universities - publicly funded, independently administered). Doctors bill the government for services instead of insurance companies or patients, but are not generally government employees (just like medicare). If the province does not cover a service (such as eye or dental care in Ontario), it is just like the States where private insurance or the patient pays.

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No. Likely the US is more complicated. I don’t pretend to understand the US system. I only have to understand the portion of the system that we use.

I think like many things, what one is used to is easier to understand regardless of which is better or simpler or anything like that.

Nice summary !!!

Believe me, most up here don’t have a clue how our system works either!

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Do you show proof of province residency for services or can you go to a different province for a service that a neighboring province would provide better coverage?

Each province issues their own health cards with photo ID (looks like a driver’s licence) and you use it when you go to a hospital or see a doctor. I’m not sure exactly how it works, but if you go to a different province they may not cover you and you would have to pay and submit the invoice to your own province for reimbursement (which they wouldn’t reimburse for if it’s a service they don’t cover, of course). You wouldn’t be able to access ADP services without an Ontario health card and an endocrinologist from Ontario signing the eligibility form. You wouldn’t be able to see an Ontario endocrinologist without a referral from a family doctor in the first place, so someone from a different province couldn’t just make an appointment and get a free pump.

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That all makes sense. Thanks for the explanation.
:smile:

But don’t all provinces have a provincial Pharmacare system? Or are there provinces that don’t? I thought all provinces had one. These programs don’t cover all medications, but although they do vary province-by-province in terms of exactly what is covered, they do cover the basics (sometimes only a portion, like 70%) and they have a reasonable deductable based on income after which 100% of everything is covered. Many people do have private insurance in addition to cover the medications and services not covered by the government.

Should note that ophthalmological care is covered. Just optometry that often isn’t.

I’m in BC and spent seven weeks in Nova Scotia a couple years ago. I was getting allergy shots at the time and was able to go to a walk-in clinic every week (so seven times) and they accepted my BC health care as if it was a Nova Scotia one. I also got a flu shot at no charge. I did call in advance to make sure I’d be able to use my health care and that everything would be covered. But I definitely didn’t have to submit any invoices myself; all that just happened behind the scenes. I’m not sure if this is the same for every province or varies depending on province. (I’ve had relatives visiting from Ontario and Nova Scotia who were able to do the same, just walk into a clinic/hospital and present their provincial card and all the billing was handled by the facility/government, so they didn’t have to worry about that.)

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How does it work when Canadiens move to a new province? Is there a residency period before they are covered?

I know with new immigrants to Canada there’s a three-month waiting period (in BC, at least, this may vary by province). I’m not sure about moving from one province to another… My guess is that your old province of residence would cover costs (in the new province) until the new province considered you a resident. But I could be wrong, since the last time I moved provinces I was five.

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Yes, that’s true, but at least in Ontario it’s more of a low-income assistance program than what I’d call a pharmacare program. The deductable is too high to cover insulin for many. There is now full coverage regardless of income if you are under 24 and just present your health card at the pharmacy - this is what I consider real pharmacare.

I did have to pay out of pocket and submit a form for reimbursement when I lived in Quebec and came back to Ontario, but that’s probably because it was Quebec!

Ontario will also pay 2/3 the cost of supplies (limited to infusion sets or pods), given in a quarterly grant, renewable annually. Exceedingly generous. Some provinces/territories do not pay for pumps, and several only pay for those under 18.

This is so. Provinces and territories set a residency requirement that is not allowed to exceed three months. Meanwhile, the previous province covers most, but not all, costs. For instance, I think Ontario will not pay for ambulance services if you have moved to another province.

Beginning April 1, those under 24 will no longer qualify if they are also covered by private insurance.

Incidentally, the Trillium Drug Program in Ontario is not just for those with low income. Anyone who has medical costs exceeding about 3% of after-tax household income is eligible. Although it does have that stigma. I was enrolled for several years before we had private coverage, and I do not qualify as low income.

Is my math wrong though? I am fortunate that I currently earn a wage necessary to live in the centre of the known universe a.k.a Toronto, but can’t see how insulin costs alone could reach the 3% deductible unless my income significantly dropped. I guess maybe with test strips, but monitoring for health pays for some of those and I don’t really test anymore since I have a Libre (which I don’t think Trillium will pay for).

This is what I’d thought about the Ontario program. The program in BC is for everyone. People with low-income get better coverage than everyone else (more medications covered, no deductable, and 100% of everything covered from the start; while those of us who are not low income have fewer medications covered, a deductable based on income, and often only a portion of medications are covered before that deductable is met), but everyone can enroll. In fact, my health benefits through work require that you be enrolled in Fair Pharmacare to get benefits covered (I guess because they want the province to cover whatever they will cover before anything is submitted to them to cover the rest).

Insulin alone, no, that wouldn’t be enough, unless maybe you went through a vial a day, but there are some super-expensive drugs out there, for instance for cancers, hepatitis C, HIV, Crohn’s and rheumatoid arthritis, which could quickly cripple a person financially. Hep C drugs alone can cost up to $100,000 a year. And the last stats I saw, only about half of Ontarians have private insurance.

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They become Senators.

(Perhaps a joke only hockey-watching Canadians will get.)

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:joy::joy: That’s not true @Beacher there is at least one Chicago hockey fan that got that joke!

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