Will NS Pharmacare Cost You More?

Posted 08 Feb 2016 by Melissa Allan


Pharmacare is a program offered by the province of Nova Scotia that allows both seniors and families access to a drug care program at an affordable price. The family Pharmacare program is open to anyone with a valid Nova Scotia Health Card. The program is designed to provide relief to families who either do not have insurance coverage or require more prescription drug coverage.

 

AS OF FEBRUARY 18TH, 2016, THESE CHANGES WILL NO LONGER BE IMPLEMENTED. SEE THE CBC's ARTICLE HERE: 

http://www.cbc.ca/news/canada/nova-scotia/seniors-pharmacare-changes-halted-1.3453190

 

There is no cost to join the family Pharmacare program but there can be a large deductible which is based on your family income and the number of dependents you have. For further information you can visit their website at http://novascotia.ca/dhw/Pharmacare/family-Pharmacare.asp.

The seniors Pharmacare program is utilized much more than the family program and is available to seniors age 65 and older. (You should contact Pharmacare three months prior to your 65th birthday to request and enrollment package.) If you do not enroll into this program within 90 days of your 65th birthday you will be considered a late applicant and have to pay additional fees.

In April, 2016 the provincial government is implementing the following changes to this program that may affect you and/or a loved one:

  • The current copayment (amount of each prescription you pay out-of-pocket) is being reduced from 30% to 20% per prescription up to a maximum of $382 per year.  
  • All seniors must agree to disclose their annual reported income to the province of Nova Scotia. Before these changes, those on the Guaranteed Income Supplement (GIS) didn’t have to disclose their income.
  • Seniors on the GIS will no longer be automatically exempt from the annual premium to participate in this program since it’s now income-tested for all income levels.  It’s important to sign off on the consent of your income to remain in the program.
  • The annual payment for 2015 was $424 per person but if you were on the GIS you didn’t pay anything.  However with the new rules in 2016 the annual premiums will be based on the following:  

 

For Single Seniors:

Confirmed Income Level:

Annual Premium (April 1st – March 31st)

Below $22,986

No premium will be charged

$22,986 to $35,000

Less than $40/month, based on income

$35,000 to $75,000

$40 to $100/month, based on income

More than $75,000

$100/month

 

For Senior's Couples:

Confirmed Income Level:

Annual Premium (April 1st – March 31st)

Combined income below $26,817

No premium will be charged

Combined income of $26,817 to $40,000

Less than $40/month for each person, based on income

Combined income of $40,000 to $100,000

$40 to $100/month for each person, based on income

Combined income of more than $100,000

$100/month for each person

It’s important to note that the premiums are due on April 1st of each year are based on your previous year’s income. However, your income taxes are only due on April 30th of each year so be sure to pay your premium on time. If you are currently registered in the program and you have already signed off on the consent to release your income to Pharmacare you will get a letter in the coming months outlining what your premium will be for 2016. There is a very good chance you would not have reported your 2015 income before the time their letter is mailed out; Pharmacare confirmed that if this is the case, they will base your premium on the most recent tax return and then reassess when you file your 2015 taxes. For example: You get a letter in March 2016 outlining your Pharmacare premiums due but have not filed your 2015 taxes.  They will base your premiums on your 2014 taxes and then adjust the premiums after your 2015 taxes are filed. 

It gets even trickier as not everyone files their taxes on-time (even though they should!).  If this is the case, and you choose not to file your income tax return, they will base your premiums on the income from your bank statements, etc.  You will have to call Pharmacare directly to verify what they would require if you don’t have a current income tax return and want to participate in the program. We, of course, recommend you be up to date on your tax filing for many reasons but this is another one to add to the list!

If you would like more information on either program or how this compares to a private policy let us know as we’d be happy to help out.