Section 12 – Social Programs and Benefits
In general, any person residing in Quebec must be covered by basic medical insurance, either through a private insurance plan (often available through an employer) or through the government plan22.
Under the government drug insurance plan, the maximum payable includes an annual premium, a deductible and a co-insurance portion. These amounts are reviewed on July 1 of each year. Exceptionally, due to the COVID-19 crisis, the amounts reviewed on July 1, 2020 will be in effect until December 31, 2020. The amounts will be reviewed again on January 1, 2021 for the period starting on that date and ending on June 30, 2021.
The annual premium takes account of a taxpayer’s ability to pay and has to be paid with the tax return. The premiums have to be taken into consideration for those who have to make tax instalments.
The following table summarizes the maximum amounts payable for the various components of the government program:
|July 1 to December 31, 2020||Annual premium (per adult, based on income)||Monthly deductible||Co-insurance (% of drug costs)||Maximum monthly contribution|
|General||$0 to $648||$21.75||37%||$95.31|
|Individuals 65 years of age or more who do not receive GIS23|
22 Every person under age 65 who has access to a private plan must join it. Persons 65 years of age or older have various options. The RAMQ site provides a questionnaire to ensure taxpayers are covered by the proper program: http://www.ramq.gouv.qc.ca/en/citizens/prescription-drug-insurance/Pages/prescription-drug-insurance.aspx. 23 Amounts reduced for persons 65 years of age or over who receive the GIS.
When the maximum monthly contribution is reached, the person no longer pays for drug purchases for the rest of the month.
The following persons do not have to pay any premium or any other amount:
- Children of persons insured under the government program under 18 years of age or from age 18 to 25 who do not have a spouse, who are enrolled in full-time studies and who are living at home;
- Persons over 65 years old who receive almost the total maximum GIS (between 94% and 100%);
- Last-resort assistance recipients (social assistance).
The premium, deductible and co-insurance payments made by taxpayers who purchase prescription drugs qualify as medical expenses for both federal and provincial purposes. For federal purposes, in view of the fact the premium is only paid during the year following the taxation year to which it relates, it is only eligible for the medical expense credit in the year following the year to which it relates. For Quebec purposes, taxpayers wishing to do so may claim the premium as a medical expense by choosing a 12-month period that includes December 31 of the year to which the premium refers to claim their medical expenses.
The Ontario Drug Benefit Program (DBP) (basic program) is a prescription drug insurance plan available to persons who are 65 years of age and older24. Although there is no annual premium, there is an annual deductible that varies based on family income. An additional amount is added to the deductible for each prescription. Different programs are available for individuals suffering from specific illnesses25.
The Ontario Health Insurance Program + completely covers the cost of all medications funded by the DBP for children and youth aged 25 and under who are not covered by a private plan. There is no deductible or co-payment.
The Trillium Drug Program supplements coverage for persons who are not eligible for the Ontario DBP. However, they have to pay a deductible that is based on income.
Lastly, the Ontario Seniors Dental Care Program26 (OSDCP) provides routine dental care coverage for individuals aged 65 and over with a maximum annual income $19,300 $ ($32,300 for a couple). The coverage period is August 1 to July 31 of the following year. Taxpayers must enroll in order to benefit from the program. For subsequent years, eligibility will be automatically confirmed once tax returns have been filed.
Lastly, a new program will be put in place by the end of the summer of 2019, to cover dental care for individuals aged 65 and over with an annual income of $19,300 or less in the case of a person living alone or a combined income of less than $32,300 for a couple of seniors.
24 Persons living in a long-term or special care home, persons registered for the home care program, the Ontario Works program or the Ontario disability support program may be eligible even if they are not 65 years of age. 25For additional information, consult: http://www.health.gov.on.ca/en/public/programs/drugs/. 26 For details about the program, consult: https://www.ontario.ca/page/dental-care-low-income-seniors.
New Brunswick residents must have drug insurance; those who are not covered by a private plan must enrol in the New Brunswick Drug Plan. The premiums are payable monthly and total $200 to $2,000 annually, based on the family income of the preceding year. Children under 18 years of age do not pay premiums, but one parent must have enrolled in the plan. All plan members must pay a 30% copayment, ranging from $5 to $30 based on their income, up to a maximum amount per prescription27.
For its part, the New Brunswick Prescription Drug Program offers coverage to low-income individuals, clients of the New Brunswick Social Development department, and others suffering from certain medical issues28.
27 For additional information, consult: http://www2.gnb.ca/content/gnb/en/departments/health/MedicarePrescriptionDrugPlan/NBDrugPlan.html. 28 For additional information, consult: http://www.gnb.ca//0212//intro-e.asp.
This document is up to date as of September 3, 2020 and reflects the status of legislation, including proposed amendments at this date.