Nova Scotia

Some living in U.S. eye Canada for health care, but not everybody can get in

Immigration lawyers say many seniors who hold dual citizenship decide to return to Canada during their golden years because of the cost of health insurance. But for Americans with no ties to Canada, moving north with the hope of accessing affordable health care isn't that simple.

Denial because of medical inadmissibility 'really quite crushing for people'

Deborah Millar-Jervis and her husband, Robert Jervis, moved back to Canada in 2016 after struggling with the rising cost of health insurance in the United States. (Submitted by Deborah Millar-Jervis)

Deborah Millar-Jervis and husband Robert Jervis were faced with a choice.

They could continue paying roughly $1,600 US a month for health insurance or leave the United States and move to Canada.

The staggering, and rising, cost of their insurance did not include doctors visits, dental care, prescriptions or the deductible amount they had to meet before accessing coverage.

So, four years ago, the couple packed up their home in Blaine, Wash., and moved four hours north to Penticton, B.C.

"We loved living there [in the U.S.], we had a great place," Millar-Jervis said. "But we just decided that the cost of medical [insurance] in the United States was just prohibitive."

The couple holds dual Canadian and American citizenship, so it was fairly easy for them to move to B.C., where Millar-Jervis is from.

Immigration lawyers on both sides of the border say it's becoming more common for older couples who have lived for years in the U.S. to return to Canada during retirement because of the cost of health insurance. 

But for Americans with no ties to Canada, moving north with the hope of accessing affordable health care isn't that simple — and some say the rules around medical inadmissibility are too strict.

Immigration lawyer Lee Cohen says he'd like to see Canada offer more than one type of permanent resident application. (CBC)

"If there is a health issue with one of the family members, that can be fatal to an immigration application," said Lee Cohen, an immigration lawyer in Halifax.

Recently, a family from Wisconsin shared their plans to move to Nova Scotia after their daughter's Type 1 diabetes diagnosis.

Michael Greene, a partner at immigration law firm Sherritt Greene in Calgary, said if one family member has a serious medical condition, the whole family can be refused: "And, yes, this happens very often."

"It's really quite crushing for people because they get nine-tenths of the way down the road and then they find out they're being rejected," he said.

Medical inadmissibility

For people applying to become a permanent resident in Canada, each family member must pass the medical exam. Applications can be denied if it is believed a person would put excessive demand on the health or social services in their chosen province.

That amount is updated annually. As of June 2018, the number is three times the Canadian average cost for health and social services — $102,585 over five years, or $20,517 per year.

If a family is assessed to exceed that amount, it receives a procedural fairness letter.

"They can challenge the basis for the calculation or the diagnosis of the prognosis," Greene said.

"For instance they'll look at blood sugar and say, 'You've got kidney damage and we think you're going to need dialysis or kidney surgery.' You can sometimes get a doctor to give a competing opinion."

But if the family is unable to show why the cost estimate is too high, the application will be denied.

"People want to come here because they can't get care in their home countries and they think that they can take advantage of our health-care system," Greene said.

"Unfortunately for them, it usually results in disappointment."

Many Americans rely on crossing the border into Canada and Mexico to buy prescription drugs, which are often much cheaper outside of the U.S. (Shutterstock)

Cohen said he has seen applications rejected because a family member is deaf or there is a child with special needs, or there is a history of cancer.

"I think it can be very cruel," he said.

But Cohen said when it comes to calculating the cost of excessive demand on the health-care system, it is often "subjective analysis that takes place — and it's not always an accurate analysis."

Cohen cited an example of a young American couple who approached him a few years ago, wanting to move to Nova Scotia. The female member of the couple had advanced breast cancer, he said, and the application was going to be denied because of it.

But they had strong academic backgrounds, "high-paying" jobs lined up and would be consumers and taxpayers. Cohen said they hired a medical economist to look at their financial contribution to the province.

"At the end of that study, the cost-benefit analysis weighed very heavily in granting permanent resident status to this couple," he said, adding that the couple was eventually accepted.

"What it highlighted for me was the degree to which we pay attention to what we gain by having an immigrant family come into Canada, regardless of the illness — and what we lose by saying no to them."

'It just gets extremely expensive'

But many older families who have the option to move to Canada are doing so, says Len Saunders, a U.S. immigration lawyer based in Blaine, Wash., who is also a dual citizen.

He said insurance premiums in the U.S. increase as people age. Saunders turned 50 last month, which raised his monthly cost by $500 US.

"When people get into their 70s and 80s, it just gets extremely expensive. What I've seen over the last 10, 15 years.… If they're dual citizens, they'll decide to move back to Canada," he said.

Saunders also said the attempts from the Trump administration to cancel Obamacare, which will be heard in the U.S. Supreme Court this fall, as well as the high rates of unemployment because of the COVID-19 pandemic are sending people in search of affordable health care.

U.S. immigration lawyer Len Saunders says when he turned 50, his health insurance went up to $2,500 U.S. a month.

"Costs have risen substantially," Saunders said. "So you're going to see a lot of people looking up to Canada for a much cheaper alternative to the U.S. health-care system."

Millar-Jervis said there is no doubt in her mind that she and her husband are in "a better position" living in Penticton.

"In the U.S., everything is extra, extra, extra. And sure, it's a great medical system — if you can afford it, if you have the money. And that's why a lot of people don't have it," she said.

"So if you have the option to go to Canada, you go. We have a lot of friends who would still come to Canada if they could."

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