Ontario Health Benefits for Seniors - ODB, ADP and NHTG

Seniors have the greatest need for healthcare of any age group, which is why it is important that there should be many benefits for seniors that target healthcare.

With so many programs, it may be hard to keep track of all the ones you may benefit from. Therefore, here’s a few potentially lesser-known programs that could help you with medical expenses.

Ontario Drug Benefit (ODB)

The ODB covers most of the cost of around 5,000 prescription drug products.

You immediately qualify for the ODB when you turn 65 years old, although some people will qualify before that for the following reasons:

• you’re living in a long-term care home, home for special care, or a Community Home for Opportunity
• you’re 24 years old or younger and are not covered by a private insurance plan
• you’re receiving professional home and community care services
• you’re receiving benefits from Ontario Works or Ontario Disability Support Program
• you’re enrolled in the Trillium Drug Program.

Seniors receive a letter from the government of Ontario about three months before their 65th birthday to notify them that they will automatically join the ODB on the first day of the month after their birthday.

The program is only for Ontario residents and prescriptions have to be filled in an Ontario pharmacy to be covered.

As previously mentioned, the ODB covers around 5,000 prescription drug products. To check if a specific drug is covered, check the government’s list.

Seniors pay a portion of the prescription drug costs based on your annual income and marital status. The government’s website has the specifics of each group’s deductibles and co-payments, just click the link and scroll down to the section called “What you pay”.

Assistive Devices Program (ADP)

The ADP helps you pay for equipment and supplies if you suffer from a long-term physical disability.

To be eligible for the ADP, you must:

• be an Ontario resident
• have a valid Ontario health card
• have a disability requiring the equipment or supplies for six months or longer.

If you’re already receiving the same equipment or supplies you would need from the Workplace Safety and Insurance Board or from Veterans Affairs Canada, then you cannot qualify for the ADP.

The ADP covers 75% of the cost for the equipment or supplies you qualify for, leaving you with 25% of the bill to pay when you buy the item.

The way to apply for the ADP depends on the equipment or supplies you need. The government has many links to follow for specific types of equipment or supplies on their website that pertain to things like mobility aids, visual aids, and respiratory equipment, to name a few.

Northern Health Travel Grants (NHTG)

When residents of northern Ontario need an appointment with a medical specialist, it tends to mean they have to travel for many hours to get to the nearest city big enough to have the experts they need. This is why the NHTG is very practical.

The travel grant program covers a portion of your travel cost based on the distance from your residence to the nearest medical specialist or ministry-funded health care facility that can provide the required OHIP-insured service.

To be eligible for a grant, you must meet the following criteria:

• you are an OHIP-insured Ontario resident on the date of treatment, and your primary place of residence is in the districts of Algoma, Cochrane, Kenora, Manitoulin, Nipissing, Parry Sound, Rainy River, Sudbury, Thunder Bay, or Timiskaming
• a northern physician, dentist, optometrist, chiropractor, midwife or nurse practitioner has referred you before the travel takes place you are referred to a medical specialist who is certified by The Royal College of Physicians and Surgeons of Canada (RCPSC), or recognized as a specialist by one of the recognized Physician Governing bodies (ie Manitoba Health Specialist Register or College of Physicians and Surgeons of Ontario)
• you are referred for a ministry funded health care facility-based procedure under the HealthInsurance Act performed by a provider in the facility
• the nearest medical specialist or ministry funded health care facility able to provide the type of care or procedure you require in Ontario or Manitoba is at least 100 kilometres from your area of residence.

If you don’t have a northern referring provider, you may still qualify for a travel grant. In such a case, you should contact the Ministry of Health, Claims Services Branch, at 1-800- 262-6524 for more information.

The calculation for how much money you receive is done by doubling the one-way road distance to the closest qualifying specialist or facility, subtracting 100 for the 100 km deductible, and multiplying the resulting distance by 41 cents per kilometer.

If you travel commercially, then you have to keep your original ticket, receipt, or itinerary showing a fare paid, who is travelling, the date of the travel and destination.

Application forms are available from your northern doctor, dentist, chiropractor, optometrist, midwife, nurse practitioner, or online. Click here for the application instructions.

Hearing Care Counselling

Canadian Hearing Services (CHS) is an organization that provides services, products, and education that empower the deaf and hard of hearing to overcome barriers to participation.

They offer free counselling services and supports to people 55 and over who have hearing loss to help them improve communication and remain independent and safe at home.

They provide you, your family, and other caregivers with information and counselling related to coping with hearing loss, including:

• how to use and maintain hearing aids and other listening devices
• preparing for and managing difficult listening situations
• selecting specialized communication equipment like phones, alarm clocks, and television accessories.

They also offer a number of workshops, presentations, classes, and learning groups. A list of workshop topics and other information can be found on their website, under the section called “Sound Advice on Hearing Health”.

To request service, send an email to hearingcarecounselling@chs.ca, call 1-866-518-0000, or use this form.

MedsCheck

This program is a one-on-one interview between you and a pharmacist to review your medications. The MedsCheck medications review is meant to encourage patients to understand their medications and to help ensure they are taken as prescribed.

Unfortunately, since these interviews are in-person and Canada is currently dealing with the coronavirus pandemic, MedsCheck appointments have largely been postponed to a later date. Although, appointments that are deemed medically necessary by the pharmacist are being conducted virtually or over the phone. Ultimately, whether an interview can take place is left for the pharmacist to decide.

More information about how MedsCheck is working during the pandemic can be found on the Ontario Pharmacists Association’s website.

Regardless, MedsCheck will be back to normal soon enough, so knowing about it could still pay off.

To qualify for an interview, you must:

• be an Ontario resident with a valid Ontario health card and currently taking a minimum of three prescription medications for a chronic condition
• agree to the MedsCheck service as the program is voluntary.

You’re eligible for one MedsCheck Annual per year from the date of the original interview. Additionally, you can get a MedsCheck Follow-Up within the annual timeframe as long as the following conditions apply:

• you’ve been discharged from the hospital within the previous two weeks
•     a pharmacist’s documented decision requests it based on:
  • significant changes made to an existing medical profile or the addition of new medication
  • documented evidence of patient non-compliance
• you’ve changed your place of residence and your prescriptions have been transferred to a different pharmacy
• you have a referral from a physician or a nurse practitioner
• you have a planned hospital admission.

For more information on MedsCheck, visit the Government of Ontario’s website.