Unfortunately, we missed celebrating the one-year milestone because our dream retirement has been hit by an unexpected medical setback. This March, I was diagnosed with Stage 2 breast cancer and required surgery, followed by chemotherapy, radiation and hormone therapy as the prescribed courses of treatment. The surgery successfully removed all of the tumor and the follow-up treatments are almost complete.
Luckily we live in a country where most medical expenses including surgery and hospital stays are covered. What our health care system does not include are costs related to dental care, vision and drugs. While we were working, these costs were paid for by our company health plans. When preparing for our retirement, we realized that stopping work at such early ages meant that we would be on our own for these types of expenses until age of 65, when programs such as the Ontario Drug Benefit Program kick in to help out with some of these costs.
As described in our book Retired At 48, we researched various private health insurance offerings, comparing our known health costs against the premiums.
Invariably, the premiums were close to or even exceeded our expenses. There were also set maximums to the amounts that you could claim against the policy for covered benefits such as drugs, vision, dental, physiotherapy and other services.
Our foresight and good planning in terms of acquiring health insurance paid off when I fell ill. Although OHIP took care of the chemotheraphy drugs, it did not cover any of the medicines prescribed to ward off or minimize the many potential side effects of chemo. This included four injections of Neulasta at around $2800 per shot, used to increase white blood cells and help fight infections. After we covered the $4500 deductible for the "effective" year, the insurance policy paid for any additional drug costs incurred within this same time period. So far this has amounted to almost $7000.
Victory Patient Assistance Program of Ontario. This organization provides "financial assistance and other value-added services when you've been prescribed an oncology-related drug...". Victory got in touch with the drug manufacturer of Neulasta and negotiated for them to pay for the entire deductible. Victory also called Manulife for me and confirmed that Neulasta would indeed be covered by my insurance plan, once the deductible was covered. So in the end, we ended up being reimbursed for the entire Neulasta fee of over $11,000 as well as the costs of other prescribed drugs.
There are a few considerations to take note regarding Manulife's Catastrophic Insurance offering. First, you need to be relatively healthy and in good shape to qualify and they will not cover any "pre-existing conditions", or medicines that you were already taking prior to acquiring the insurance.
The deductible applies to every "effective year", which spans 12 months from the day your coverage begins. My current effective year ran out on August 1 and hopefully, this will be the only year where I will require enough drugs to surpass my $4500 deductible. So I tried to have as many of my prescriptions for drugs filled before this date as possible. This included a hormone drug that I need to take for the next few years. I was not due to start taking these pills until after August 1, but I asked the doctor to write me the prescription in advance so that I could have it filled before my year expired. I also asked for a larger than usual amount to be filled at once, to maximize the expense covered.
Finally, when I had my claim processed, I found out that the processing fees charged by the drug stores were not covered, although it was not the total $10.99 fee which I saw charged on each prescription. I received a bit less than I expected on my claim, but most of the expenses that I submitted were reimbursed.
While it is regretful that I had to go through this ailment, our forethought in planning for such a possibility really helped to ease any additional stress from facing significant financial burden on top of the medical concerns. Being retired, it was also nice that neither my husband nor I had to worry about work-related pressures in addition to everything else. Having my loving and supportive husband available to be by my side through every doctor's appointment and treatment procedure has been more comfort than I can express.
So all things considered, I have not had it so bad. I am now coming to the end of my treatments and am recovering nicely. I've tried to stay as positive and active as possible through it and I now look forward to a full recovery so that I can resume my dream retirement plans. France, I had to put you on hold, but I hear you beckoning... see you next year!