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Comparing provincial plans

One family, 10 different outcomes

From Monday's Globe and Mail

Public drug plans vary drastically by province depending on a patient's age, household income, number of dependants and whether the person is on social assistance. Rhonda Morey's household income was about $27,500 in 2004, the year of her diagnosis. The 33-year-old woman's husband works in the seasonal logging industry in Newfoundland for 14 weeks of the year, and collects employment insurance for the remaining weeks. The couple have two children, ages 6 and 4. The Globe and Mail called health ministries to find out how much a person in Ms. Morey's situation would have to spend on premiums, deductibles and co-payments before becoming eligible for coverage.

British Columbia

Family income, not age, is the deciding factor in how much coverage one receives. Social-assistance recipients are 100-per-cent covered. If Ms. Morey lived in B.C., she would have to spend $550 out of her own pocket for drugs every year before Fair Pharmacare would begin to reimburse 70 per cent of her drug costs. Once the family spent $825, it would begin to be reimbursed for the full cost of eligible drugs.

Alberta

Because the family's income is considered low in Alberta, it would pay a subsidized quarterly premium of $86.10. (If a family with children had an annual net income of more than $39,250, it would be required to pay a quarterly premium of $123. Seniors and social-welfare recipients are exempt from this premium.) After that, Ms. Morey would still be required to pay for 30 per cent of the cost of each drug, up to a maximum of $25 a drug.

Saskatchewan

Because the family's drug costs are high relative to its annual household income, it would qualify for the province's special support program. Under that plan, income adjustments are made by deducting $3,500 for each dependant younger than 18. With this income adjustment, the family's new income becomes $20,500. Because Ms. Morey's annual drug costs exceed 3.4 per cent of the adjusted family income, most drug costs would be covered.

Alternatively, Ms. Morey's family may qualify for the supplementary health program's Plan Two because she requires several different drugs on a long-term basis. This would mean she would be eligible for benefit prescriptions at no charge.

Manitoba

Given that Ms. Morey is a stay-at-home mother, she and her two children qualify as dependants on her husband, meaning their adjusted family income becomes $18,500. The family would be responsible for 100 per cent of drug costs until it spent $708.55, after which Pharmacare would cover the cost of eligible drugs. Welfare recipients are fully covered.

Ontario

Because Ms. Morey has high prescription costs in relation to her household income, she would qualify for the province's Trillium Drug Program. Based on the family's size and income, Ms. Morey would have to first pay $626 for prescription drugs for the year. After that, the family would be required to pay $2 for each prescription filled, but the cost of the drug itself would be covered. Seniors who have an annual income of $16,018 or more must pay a $100 deductible before they are eligible for drug coverage. Welfare recipients are fully covered.

Quebec

All Quebeckers without a private drug plan are eligible for basic prescription coverage, regardless of age or income, so Ms. Morey's family qualifies. The monthly maximum she would be required to pay for herself would be $73.42. Prescription drug costs beyond that are fully covered for the rest of the month. The annual maximum any person has to spend is $881. Once a person has reached his or her maximum annual contribution, the plan covers all their drug costs from then until the end of the year. Seniors and welfare recipients are exempt from these costs.

New Brunswick

Ms. Morey's family would not be eligible for drug coverage in New Brunswick because only seniors and social-assistance recipients are covered. Even then, seniors who have an annual net income higher than $17,198 must pay a $58 monthly premium, plus a co-payment of $15 for each prescription.

Nova Scotia

Ms. Morey's family would not be eligible for drug coverage in Nova Scotia because only seniors, welfare recipients and cancer patients with an annual net income less than $15,720 are covered.

PEI

Ms. Morey's family would not qualify for the Family Health Benefit Program because her family income is higher than $22,000. Additionally, seniors are required to pay $10 a prescription, plus the pharmacist's professional fee, which can range from $4 to $8. There is no maximum annual contribution.

Newfoundland

Seniors on guaranteed-income supplements are covered, as are social-assistance recipients. Ms. Morey was a special case, eventually qualifying for a drug card through the province after a needs assessment was done by a social worker.

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