Many employees may be dreaming of a carefree retirement following many years in the trenches — but they’ll likely have to keep dreaming if they don’t have first-rate, post-retirement health and dental insurance coverage.

Many employers provide supplemental health insurance (drug, dental, extended health and out-of-country medical) as part of comprehensive packages of employee benefits, typically extending to dependant children, spouses and partners. However, this coverage frequently ends at retirement or continues on a substantially reduced basis. The reason is simple — cost.

Read: B.C. tribunal finds reduced benefits for older workers not age discrimination

Compared to active employees, retirees encounter far more health-related issues requiring expensive procedures, devices, equipment and prescription drugs. And drug therapies can frequently continue until death. These may add up rapidly to big costs and many employers don’t want to be burdened with those costs for the life of someone who’s no longer an employee at the organization, let alone to pay for costs related to a retired employees’ dependants, partner or spouse.

If a former employer won’t be paying post-retirement health and dental expenses, many retired employees will be saddled with those often unpredictable costs throughout retirement unless they have insurance to lighten the load. And for retirees who dream of travelling to far-off places, many know they can’t afford to be without out-of-country medical coverage, which can be dirt cheap for young and middle-aged employees, but often becomes prohibitively expensive for retirees in their golden years.

No true universal health care

Canadians are frequently reminded that they enjoy universal health care under the auspices of the Canada Health Act and corresponding provincial-territorial health legislation providing coverage for medically necessary physician and hospital services. The reality, though, is that many dental and health-related procedures aren’t covered by government-funded plan and prescription drugs aren’t generally delivered free of charge.

Read: University of Waterloo includes retirees in pension, benefits governance

Retirees often develop progressively more complex health conditions as they age. Multiple medications are consequently prescribed to manage conditions and control symptoms. Thus many Canadian seniors may require multiple prescription medications daily to manage their health.

Our public health-care system doesn’t generally cover the cost of prescription medications. In my view, pharmaceutical coverage in Canada is an incomplete patchwork of public and private drug plans with formularies that can vary greatly between provinces and territories. Despite supposed universal health care, most Canadian seniors need post-retirement health insurance to cover excluded dental and health-related procedures and medication costs. And thus, for employers, employees and retirees, it’s important to remember that universal health care in Canada means there’s many exceptions and exclusions to covered services and pharmaceuticals.

National pharmacare

The federal government is once again talking about national pharmacare, which is perhaps not surprising with a likely election on the horizon. A national program that would aim to provide access to prescription drugs based on need rather than ability to pay is good news for employers and employees, as well as retirees.

While I believe the ongoing efforts to develop  a national pharmacare are laudable, many Canadians heard this song before and the tune is no longer as sweet sounding. Promises of a national pharmacare program goes back decades. The current government promised it again in the 2019 budget while calling for the creation of the Canada Drug Agency and a national strategy for high-cost drugs for rare diseases. National pharmacare’s priority status was reiterated in the September 2020 throne speech and the fall 2020 economic statement.

Read: Benefits plan members, sponsors cite low levels of knowledge on pharmacare: survey

The delivery of health care, including drug coverage, is currently a provincial-territorial jurisdiction. Creating a national pharmacare program would require a tremendous collaboration among the provinces and territories, yet Quebec is already on record for wanting to opt out. As a result, I believe the feds must provide leadership and, more importantly, financial support to the provinces and territories to successfully create a national pharmacare program that can become an essential and enduring part of our health-care system.

No dental coverage

Another reality of Canada’s universal health care system is that basic dental care is generally not a covered medical service. The federal and provincial-territorial governments cover various dental costs for Indigenous communities, military personnel, children, as well as some economically marginalized individuals. So government money pays for some dental care, but such care is not generally part of Canada’s universal health coverage.

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Dental care was to be included under the original Medicare Act. However, recessions, budget shortfalls and advice from dentists were some of the factors that ultimately convinced the government that childhood prevention was the better route to follow. So we have fluoridated water, childhood brush-and-floss education, but no universal basic dental-care coverage in Canada.

Two-tiered health care

Another ongoing challenge is the timely access to medical specialists in Canada, although disparity varies considerably between provinces and territories. This has resulted in excessive wait times for some wishing to access the health-care system and could potentially lead to a two-tiered system. A study by the Organisation for Economic Development suggested Canada’s problem is partly due to a lack of specialists — a concern given Canada’s rapidly aging population.

In 2005, the Supreme Court of Canada addressed excessive wait times in Chaoulli v Quebec. It found that, for some patients, wait listing delays engaged the right to life provisions under Quebec’s charter which couldn’t be justified. That decision prompted the Quebec government to guarantee access to those procedures with excessive wait times, thereby opening the province to coverage by private insurance and creating more opportunities for the private sector to deliver health care in the province.

Read: 2021 Group Benefits Providers Report: Will the rising tide of virtual health-care offerings lift all boats?

In British Columbia, the appeal from a 2020 decision to dismiss the plaintiffs’ claims in Cambie Surgeries Corporation v British Columbia is slowly making its way to the Supreme Court of Canada via B.C.’s court of appeal. The plaintiffs submitted that it was unconstitutional to prevent patients from accessing private health care when they can’t access timely medical care in the public system. The judge acknowledged that, for some patients, unreasonable wait times engaged their Canadian charter right to security of the person, but concluded that such deprivation was justified because it arose in the context of the B.C. government attempting to maintain a single-tiered health-care system for its citizens.

I believe, universal health care is under attack by those seeking to establish a two-tiered health care system in Canada. Patients with money move to the front of the line, arguably with access to the best physicians and surgeons, and thus may opt out of the publicly-funded system, while retirees on fixed income often must wait their turn to consult with the remaining medical talent. If a two-tier system continues to emerge, then retirees will undoubtedly be happy to have post-retirement medical insurance that permits access to urgently needed medical care in a private surgery.

Health-care reform

While we’re frequently reminded by our government that Canadians enjoy a fully accessible and universal health-care system, the truth is we have something that falls short of that desirable goal. Due to the interplay between federal and provincial-territorial roles in this field, we currently have a patchwork of laws and regulations that provide coverage for medically necessary services with many exceptions and exclusions, most notably in the areas of basic dental care and pharmaceuticals.

Read: The role of technology in improving access to timely care

But Canada’s health-care system also suffers from a shortage of professionals, which has resulted in wait time problems for those attempting to access the health-care system in a timely manner. This, I believe, creates the potential for a two-tiered health-care system to fully emerge in Canada.

To achieve the goal of the Canada Health Act of accessible and universal health care and to preserve a single-tiered health-care system, the federal government needs to work co-operatively with the provinces-territories to achieve true uniformity across the country. Adding a consistent and comprehensive pan-Canadian drug formulary with a unified strategy for rare diseases and including basic dental care as a covered medical service would, in my opinion, represent a good start. But addressing unreasonable wait times and the underlying health-care professional shortage are also essential to preserving the integrity of our health-care system.

These reforms cost money and if these reforms can’t be achieved, our government should stop pretending that we have universal health care in Canada.