Medical insurance for snowbirds

“Do I need additional medical insurance while I’m in the U.S.?”

It’s one of the most frequently asked questions of snowbirds — and an important one to answer.

With U.S. medical care costs sky-high (and rising), even a simple doctor visit can put a serious dent in your bank account. If you’re unfortunate enough to require an extended hospital stay, your finances can suffer permanent damage.

The problem is, many snowbirds are complacent about such possibilities. In fact, according to a 2013 survey by TD Insurance, only about half of Canadians aged 50 and over even bother to check their medical coverage before leaving for vacation. And only 16% call their insurance providers to determine if they need to update their health care policies.

It’s time for this attitude to change. Because what you don’t know about your medical coverage while in the U.S. — or what you assume — may end up hurting you.

Do you need additional health insurance?

Simply put: yes. Technically, all Canadians are covered under their provincial plans for any time they’re overseas, but coverage is extremely limited.

In Ontario, for example, OHIP only covers the first $400 of medical expenses incurred in the U.S. And that doesn’t include ambulance, prescriptions, or auxiliary expenses. If you’re a BC resident, your provincial plan will only cover $75 a day for hospital stays. Other provinces offer slightly different coverage, but the bottom line is this: it won’t come anywhere near covering the cost of a visit to a U.S. hospital.

Where to find a policy

So, what’s the best way to obtain additional coverage? A quick web search will give you names of several companies that specialize in policies for snowbirds: kanetix.ca, CARP.ca and snowbirds.org are good places to start comparison-shopping.

Costs depend largely on your age, your general health, where you’re going, and proposed length of stay. Another important consideration is any pre-existing medical conditions.

What to look for in a policy

Unlike car insurance, where most policies are generally the same, private health insurance can vary widely in both costs and policy specifics. Make sure to pay attention to the following areas when you go shopping:

Deductible

A typical deductible on medical insurance ranges from $100 to $500 — call it the cost of a doctor’s visit. Most policies offer the option to buy out the deductible, so your net cost will be zero if you have a claim; but that option can be expensive. Also watch out for policies with “per claim” deductibles, which charge every time you visit a doctor. Instead, opt for a “per policy” deductible.

Amount of coverage

Most policies are available in a variety of coverage amounts: $1-million, $3-million, and $5-million are fairly common. Differences in premium rates, oddly, are often relatively nominal.

Single trip or annual coverage

Do you travel to the U.S. multiple times during the year? If so, you may want to explore an annual policy — it will be less expensive than taking a new policy every time you travel. But, if you typically make one trip in the winter, single-trip coverage is likely the better deal. If you plan to stay longer than 30 days, then compare both types of coverage. An annual policy may end up being cheaper.

Exclusions for pre-existing conditions

By far the most important part of any private health insurance policy for snowbirds, who tend to be older, relates to conditions the insurer won’t pay for. Most private policies exclude undisclosed pre-existing medical conditions, or require pre-existing conditions to be medically stable for some time prior to departure. Such conditions are usually rigid. For example, if you change medications, or visit a specialist during the given time period, it could be enough to exclude you from coverage.

If you have a pre-existing condition, it’s possible to find insurance but it will cost more than a regular policy. Or, the insurer may offer to cover you for everything except issues arising from your pre-existing condition. Either option is better than assuming you can fail to disclose and still have your policy honored. That won’t happen. There are plenty of stories of snowbirds who failed to disclose pre-existing conditions and were denied coverage after racking up tens of thousands of dollars in U.S. medical bills.

High risk activities

Are you covered if you go paragliding off the Florida coast? Or spelunking in the cenotes in the Yucatan peninsula? What about ziplining through the Costa Rican rainforest? If you’re the active, adventurous type, you’ll want to know exactly what kinds of things you’re allowed to do, and what you’re not.

Remember: all those nightmares you’ve heard about the cost of health care in the U.S. are true. When considered as part of the overall cost of your trip, medical insurance is a small price to pay to avoid a financial disaster.