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Most forms of government health insurance, administered under the Canada Health Act, including Health Insurance BC, The Ontario Health Insurance Plan (OHIP), the Alberta Health Insurance Plan (AHIP) and others do not cover time in a retirement home or nursing home.
However, you may qualify for government funding for home health care or similar personal care.
In the province of Ontario, you will need to contact your Local Health Integration Network (LHIN) outlet. Your local center will determine if you qualify for government-funded home care.
However, there are many different kinds of private health insurance that do provide coverage of nursing for the elderly.
Some insurance programs that provide coverage of nursing homes include the following:
The University Health Insurance Plan (UHIP) is used by many universities across Ontario, covering employees and their families. UHIP covers "a portion of the cost of standard ward accommodation, when a covered person needs regular medical supervision as well as nursing and personal care on a 24-hour-a-day basis."
While stays in a retirement home or nursing home get very little or no coverage from provincial health insurance plans under the Canada Health Act, there is some help available in special situations, depending on what province you live in.
In Ontario, the Ontario Health Insurance Plan covers any and medically necessary visits to any Long Term health Care facility, for assessment and treatment of Ontario residents.
If you require routine visits to a Long Term Care facility you are still covered:
- For up to eight visits per month for patients in chronic care and convalescent hospitals;
- For up to four visits per month for patients in nursing homes and other retirement homes covered by long-term care legislation.
In Alberta, there is a program called Special Needs Assistance for Seniors. This offers a one-time only lump-sum payment to aid low-income seniors with the cost of appliance upgrades, minor home repairs and some medical costs. This program also has a cap of $5000 per household. You can learn more here.
In other provinces, including British Columbia, Nova Scotia, New Brunswick and elsewhere there is no known coverage by provincial government health insurance plans but you should absolutely make inquiries to learn all your options for certain.
Private insurance or benefits plans: You will have to consult with coverage from your employer in order to find out if nursing care or even home care is covered by your insurance benefits.
Home Care Services Coverage
Home care services are typically funded in many different ways by:
- The government (provincial and/or local governments)
- Non-profit organizations who receive donations to deliver these types of services
- Private insurance, group benefits or other benefit plans (for example, private health insurance provided through employers)
- You (for example, when you pay for services yourself)
In reality, health insurance may not cover you
If you do not have access to private health insurance coverage and do not qualify for assistance, you will have to pay for a retirement home stay out of your own pocket. Since luxury retirement homes can cost anywhere from $4000 to $15000 per month, you or your parents will simply need to have significant assets and/or income in order to afford the best quality homes for seniors.
Don't balk, though. Figure out how you can afford it! Many people are surprised to realize that their monthly costs for living at home are about the same as a single monthly fee - even at very high end retirement homes – that covers everything including food, lodging and daily activities.