Seniors' pharmacare program and 5 things Nova Scotians should know
Major changes coming April 1, 2016
On Jan. 15, the provincial government announced changes to the seniors' pharmacare program.
Since then, CBC News has received dozens of emails, phone calls and messages regarding the changes. Here are five of the most frequently asked questions, and an explanation from Marina Keeping, manager of administration for the program.
Why some couples may pay more
Starting April 1, premiums will be based on income rather than the current one-price-for-all model. How much a senior citizen will pay also depends on whether they are single or part of a couple.
But the combined incomes can lead to much higher premiums for some seniors living as a couple. Their family income may push them into a higher premium bracket than if they enrolled separately as singles.
Marina Keeping said the province has charged single and couple rates since the beginning of the program.
"A lot of different programs do use single versus married in terms of calculating income — the belief being that it is not as costly for two people as it is for one person to live," she said.
"If a household requires $100 for one person, it's not going to require $200 for two people."
How is income determined?
Program administrators use the amount found in the "Line 150, Total Income" field on tax returns to determine an applicant's income and how much of a premium they should pay.
But some seniors told CBC News that figure might fluctuate year-to-year because of investment changes. They say it isn't a true measure of actual income.
Keeping says she isn't sure if Line 150 is the best measure, but she said pharmacare isn't the only program to determine income that way.
"I do know that [Line] 150 has been what the program has used from the beginning," she said.
Keeping said seniors who feel their income isn't accurately represented could appeal for a change.
"All you have to do is contact pharmacare and we'll ask you to provide us with something to show what your current income really is and then we would set your premium based on that amount."
Can I appeal my premium amount?
Although there is no formal appeal process, Keeping said any senior wanting to challenge their premium amount could do so.
"If you believe that the income that we're using is not an accurate reflection of your current income then we absolutely encourage you to bring forward what you have to show us otherwise," she said.
"We would make an adjustment based on that."
Income supplement exemption
The Guaranteed Income Supplement is available to people the federal government considers low-income seniors. All seniors eligible for the supplement used to be automatically exempt form paying pharmacare premiums, but not anymore.
The change, according to Keeping, will bring a "greater element of fairness" to the program.
"Often times we do see two households [with the] same income but because one is eligible for the Guaranteed Income Supplement they didn't have to pay a premium," she said.
"And the folks next door who do not get the Guaranteed Income Supplement had to pay a premium. Now everyone will pay a premium based on whatever their income is."
She said about 76 per cent of those who were exempt — about 59,000 seniors — will still be exempt. The remaining 14,000 seniors will begin to pay premiums in April.
Maximum penalty triples to $3,000
Seniors who do not join the program after they turn 65 years old have to pay a penalty. The same goes for those who drop out of the program but want back in later. Those people have to pay 1.5 times their premium for five years.
Under current rules, that means $636 a year rather than $424 a year.
But starting in April, those paying the maximum rate of $1,200 a year will have to pay $1,800 a year for joining late or rejoining the program. Over a five-year period, that means the maximum penalty will almost triple from $1,060 to $3,000.
There's also a 90-day waiting period for those who join late or rejoin the program.
Keeping said a penalty is needed to keep the program healthy.
"It's to help the program along," she said. "Because if people only joined when they got sick and had a lot of drug costs, you can imagine there'd be a huge strain on the program.
"It's like any insurance plan, everyone contributes to the whole."
Keeping noted that unlike private plans, pharmacare wouldn't restrict coverage for those buying into the program late, or returning to it.
"There is the penalty in terms of what you pay for premium but you're not going to be excluded from any of the drugs that are on the formulary. So all 6,800-plus medications are going to be available to you," she said.
"There's no cap. There's no ceiling. There's no limitations on your enrolment."
Keeping said seniors with questions or concerns can call 1-800-544-6191.
"There is a lot of misinformation out there right now and people are worried and that is so unfortunate because there is some good news in this," said Keeping.
"Sixty-six per cent — almost 80,000 people — are going to pay the same or less come April 1."
- An earlier version of this story incorrectly stated the current penalty for joining the pharmacare program after the age of 65 or rejoining it after dropping out was $12,720 over a five-year period and it would go up to $36,000. In fact, the current penalty over a five-year period is $1,060 and it would go up to $3,000.Feb 02, 2016 9:43 AM AT