Returning to Canada, 3 mth OHIP wait

konakat

Hi,

I may be returning to Canada this summer after working in the US for a few years.  The 3 month wait before OHIP kicks in scares the heck out of me.  I'm stage IV and hopefully finishing up my last cycle of chemo in May.  But I'm still getting treatment for the next year (herceptin, hormonals).  What does one do?  I can't see my insurance here paying for healthcare in Canada.  And I can't imagine getting anything affordable to bridge the gap in Canada.

Does anyone have experience with this?  Do I roll the dice and hope I can do without treatment for 3 months?  I really don't know what to do.

Elizabeth

Sierra

Hi Elizabeth

just a shot here

as I have not advice

but.. you could call

Willow and ask them

never know, they might have

had some experience with this

416 778-5000

Best of luck

hugs, Sierra

crazy4carrots

Elizabeth, if you're returning and planning to work, most companies have extended health coverage for which you would be covered immediately.  Not sure about this, but it would seem that if you'll be having herceptin, it will be delivered in hospital and should be paid for.  If not, check with a Social services rep in the hospital, who should be able to help you.  Regarding hormone tx, again check with Social Services;  they should be able to point you in the right direction.  And also remember that these drugs are cheaper in Canada because the gov't negotiates with the pharma companies (basically saying -- if you want to sell your drugs here, this is the price we're willing to pay!).  However, generics are usually not cheaper here.

Also if I remember correctly, you have a sister who is a physician?  Perhaps she can do some early checking around for you.  I know there are support services available (Trillium Foundation, for one) to assist those whose drug costs are outside the "norm".

Best, Linda

barbe1958

Trillium kicks in after a deductible based on your income. You have to have an income in Canada for them to know what to set your deductible at (if that makes sense). You won't have that background. I tried it one year and my deductible was $3,600. I had to pay that out in prescriptions before I could get the benefit. I also had to send them every single prescription receipt I'd had in the previous year for them to approve me! Lot's of work for not much payout.

Most companies that have drug plans have probation periods as well, anywhere from 3-6 months before you earn the plan. I finally got on a drug plan last year and it saves me $500+ a month!

OHIP doesn't cover all the expenses of chemo anyway. But you can contact the drug company directly and they may subsidize it. The chemo department where you go will be able to help you with that. Even if you had a drug plan, most plans don't pay 100% so you'd have an out-of-pocket expense.

There will be lots of resources at the hospital you chose for treatment as someone above mentioned. I would go there as a source first.

Get all the scans and tests while you can in the US as they are so expensive if you're not under a medical plan (OHIP). Good luck and welcome home!

Katalin

There's a slight possibility your new employer might be able to get the waiting period waived.  I have had this done for me before...well, before I was ill....worth considering...

konakat

Thank-you for all the ideas!  And Linda, what a memory you have!!  Once the time gets closer I'll tap into my sister's resources, Cdn Cancer Society, etc.  If and when I return (I feel much more emotionally comfortable being ill in Canada than the US -- not to say that the care, drs and nurses haven't been exceptional here) I may not have a job in hand.  Hopefully that will be short lived since I am still in regular contact with my friends in Canada, some of whom are recruiters for some companies...

I have all my receipts and income info from here, I hope it is recognized as valid in Canada.  If not, oh well....Luckily I'll have a PET-CT in June before I have to move if things don't work out here... 

 Gee, if it's not one thing, it's another...

Thank-you again for your help -- it's nice to know there are some resources out there, and wonderful women here so generous with their advice and help.  I have this thread as a fav and will check regularly if someone thinks of some more options.

Elizabeth

xox

barbe1958

Katalin, Wow! You're a better negoiator than me...I've been in the work force for 35 years and have NEVER been able to get benefits earlier! I guess in an executive position it could be negotiated. 

konakat

Talk about an omen -- I was just checking the OHIP site and just this April there were some amendments to residency -- you can be out of the country working for up to 5 years and keep OHIP as long as you have a couple of years residency in Ontario prior to leaving.  I have over 40 years so I think it will be OK.  I was so scared that my mets would go wild during the 3 month wait and I was going to die waiting.  I can now sleep.  And just worry about the costs of prescriptions...  I'll have to look into the Trillium benefits too.  Oh, what a relief, I can come home!

Anonymous

GOOD! Whew! That was a big question that we don't always think of if one lives outside of Ontario/Canada. Hope things go smoothly with the move!

barbe1958

That's wonderful! You can come home with peace of mind now. I hope your move is a joyous one. 

crazy4carrots

Elizabeth, we all welcome you back with open arms and big squishy hugs!  Am sure you still have your old OHIP card; I still have the original red and white one -- never did get the green one with the photo!

Wishing you the best, Linda

konakat

Yes, I still have the old red and white OHIP card.  I just had a job interview here.  If I don't come back this summer it will be soon -- nothing better than coming home.  :-)

barbe1958

That's wonderful! What city are you coming back to? Do you have a place to stay? What kind of work do you do? Do you have friends still here? I am excited for you! A change can be sooooo refreshing, you can reinvent yourself, let go of crap that people now know and never bring it up in your new place.....sigh. 

konakat

I'm an Ottawa girl.  Spent most of my life there, though I did live in Edmonton for 3 years 20 yrs ago and London ON 15 yrs ago.  All my girlfriends are in Ottawa, Orleans, Nepean...  And my family.  I'm just kinda bummed out having to leave my boyfriend here, the reason I moved to Boston.  But sometimes I could strangle him so I'll hang onto those thoughts to make it easier. ;-)  And the drive from Ottawa to Boston is only about 7 hours -- I used to do it all the time before I moved here.

Yes, I love change.  It was so refreshing when I moved to Boston 2.5 yrs ago and then, 6 months into coming here I found out about by BC...kinda ruined the excitement of being in Boston.  I don't go to any of the big hospitals here, but one in a small town just outside and get the most marvelous care.  I know I'll get the same great care back in Ottawa.  I've made a few good girlfriends here that if there was ever a clinical trial here I wanted to try I could always come back and stay with them. 

Just all the kindness I'm receiving from my Canadian girls here makes me pine for home!  Thank-you so much!!

xox

CapeBretongirl

I'm happy everything has worked out for you.  Ottawa is a beautiful place to call home.  Take care

barbe1958

Yikes! How the heck did you afford treatment in the US???? 

TorchSong

Barbe, you mentioned that OHIP doesn't cover all the expenses of chemo... I'm curious, because all my meds were covered except for the dex and so on--the pre-and post-chemo meds. I did go on Trillium for those and it helped--but not all my other meds were covered. So what does OHIP not cover (besides meds, which it doesn't cover anyway)?

I'm hoping I'm not about to get a whopping bill from the cancer centre!

konakat

Most employers offer health etc. insurance.  The premiums are pretty well the same as what we pay for prescription/dental/vision in Canada through employers there.  I remember I had about $120 off my paycheque/month in Canada.  Same thing here.  In the US I have a $1000 annual deductable and only pay $15 "co-pay" when I see a doctor.  Everything else is free, except for things like cosmetic, etc, as in Canada.  What's nice is that prescriptions are a set price -- 3 tiers -- $7, 20, 35 no matter what they cost retail. 

Insurance companies are legislated to pay for all breast reconstructions too -- they can't get away with saying it's cosmetic.  And they will try!!  They didn't want to pay my surgeon and hospital when I got my ovaries out.  I never knew until my dr told me.  What happens is that the hospital battles the insurance on your behalf.  The drs are good at going for bat for you, writing letters to the insurers, etc.  The problem here isn't greedy drs it's the insurance companies. 

If you lose your job there's a federal program called COBRA where you can pay the premiums your employer paid to keep in the group health plan for up to 18 months.  As a single, I paid $370/month.  When I was laid off I re-entered the US as a visitor so I could stay and continue my treatments.  The US border people were quite nice and understanding about my predicament. 

Cobra gets pricy for couples -- usually about $1200/month, more for families.  Obama just enacted a program where if you lost your job Sept 1/08 or up to Dec 31/09 the gov't will pay 60% of your cobra payments -- that will really help out families.  You always hear about people rushing to get all their health care done when they're laid off and have the 1 month before their insurance ends and then take the risk of not having insurance because they can't afford the cobra premiums. 

Since health care is for-profit here, it's expensive -- since I was diagnosed May 07, my insurance has been billed about $300K.  But I think there's a 1 million lifetime cap.

If you are poor there is the federal Medicare plan.  But health insurance varies state to state.  Massachusetts is good in that they have a state run health plan for people that aren't poor enough for medicare but don't get insurance through their employers.  But there are larger co-pays and deductables.  They also have a high-risk pool of health insurance for people with chronic disease and individual health care insurance is too expensive.  I tell people that what Mass does is pseudo-socialized health care and see -- it's not scary -- it's a good thing -- it would be much better fully socialized.  They hear the word "socialized" here and think communism and very high taxes.  I tell them my taxes aren't that much less here.

I'm told that there are quite a few other states that don't have the state run health care and a lot of people fall through the cracks -- their employers don't offer insurance, they can't afford private plans, etc.  Health insurance in most of the US is just like dental insurance in Canada -- if you get a plan through your employer you're all set.  If you lose your job you're screwed and can only get free dental care if you're on social assistance.

This is just a general summary -- there are lots of permutations, varieties of health plans.  But so far it's been OK, put the cobra payments were hard.

konakat

I forgot to mention that there are no waits for treatment.  I was in surgery in under 2 weeks from dx.  Two weeks recovery from surgery and then chemo.  When I was confirmed with mets I was on chemo the next week. I hope the waittime in ON isn't too bad.

crazy4carrots

Elizabeth, don't believe everything you read in the NY Times!!  Wait times can be lengthy for elective surgeries such as cataracts and joint replacement.  But as long as you're not too remotely located, the seriousness of your diagnosis will usually ensure prompt treatment (prompt meaning within 2 or 3 weeks, outside of emergencies).  Remember that here you need a referral from your gp for a specialist and, depending on who that is, the wait may be longer.  For example, wait times for rheumatologists are quite lengthy, because there are so few of them (only about 275 for all of Canada).

Ontario instituted a Wait Times strategy a few years ago, and it seems to be working well.  Your sister will no doubt have some hands on experience with that.

There may be others here who will "beg to differ" with me, but that has been my (and my dh's) experience.

Cheers!  Linda

barbe1958

I got my bilat mast 6 days after diagnosis. I thought that was fast as my surgeon only operates on Tuesdays, so I got the next slot.

Torchsong, I'm at work and just asked the guy (who's DIL was supposed to pay extra for the chemo drug) which drug was it and he said "the expensive one". Apparently, it was $3,000 a shot and their drug plan only paid 80%. A nurse at their hospital hooked them up with the manufacturer who covered the rest. He has no clue the name, sorry.

I didn't do a recon, but would like lipo to make my torso look proportionate to my flat chest (fat on ribs). My surgeon says that will be considered cosmetic! I'm going to ask for a referral anyway...

crazy4carrots

Torch, just to add:  As long as the drugs were administered to you in hospital (or cancer centre) you won't have to pay anything.

Barbe, I'm wondering if the extra drug your colleague was referring to was neulasta?

barbe1958

Well, she's at a hospital in Mississauga in the oncology department so I don't know why they wouldn't cover it. Is Neulasta to build red blood cells?

crazy4carrots

Neulasta is used to aid the growth of white cells -- one shot given the day after each chemo tx.  OR, in my case I got neupogen -- 12 shots between tx, given at home by my dh.  Neupogen is about the same price (for the 12 shots, that is!), but my extended health insurance paid the full amount.  However, if I hadn't had extended health ins., I was told it would have been covered - somehow.  There are ways, it seems.......

TorchSong

Lindasa, thanks for the clarification!