Don’t leave home without it. No, not American Express Travellers cheques but health insurance. With changes to OHIP coverage for out-of-country hospital visits and rising U.S. health care costs, any snowbird who pays a visit to an American hospital will face hefty bills. To make things even more complicated, the recent growth in competing travel health insurance schemes in Canada has created a minefield of policies that must be entered with caution.
Luckily for snowbirds, the newly formed Canadian Snowbird Association is trying to make these changes a little easier to cope with. Formed in March, the Association boasts 8,500 members and is looking for more. They hope to advocate for the rights of snowbirds and collect information on private insurance plans to help seniors make the right decisions.
Communications co-ordinator Don Slinger says he will have a list of appropriate private health insurance policies ready by the end of August. The Association has been meeting with private insurance companies to find out the best plans.
“Snowbirds shouldn’t be in a hurry to get insurance,” says Slinger. “Many insurance companies are using the situation to exploit panic-stricken seniors.”
Slinger warns snowbirds never to go down to the U.S. without extra insurance on top of OHIP. “OHIP is just a drop in the bucket of the cost of a stay in an American hospital. Unfortunately, a lot of people still take the chance.
“I had been going south for 12 years without a problem until a ruptured appendix. It ended up costing me $12,000 for an eight-day hospital stay.
“When we met with the government they weren’t sympathetic. They said snowbirds are a wealthy group and can afford the payments. However, a lot of people are on fixed incomes and won’t be able to afford to go south with these higher costs.”
Slinger advises against buying coverage after arriving in the U.S. The Snowbirds Association emphasizes that it believes in medicare and will fight hard to ensure it provides full coverage for seniors.
Gerry Byrne, a vice-president at non-profit insurers Blue Cross warns against buying U.S. insurance because companies require a medical exam and skim off the healthiest people for full coverage. But Blue Cross itself will introduce rates based on age and medical conditions in September.
American health insurance plans have long been criticized for hurting older seniors and those with ongoing medical conditions. In these schemes, the healthiest seniors pay low premiums while seniors with chronic conditions are saddled with higher rates or, worse still, refused coverage. Unlike medicare – which covers everybody regardless of their health – private insurers are tempted to reduce their costs by covering only the lowest risk group – favouring the young and healthy.
Unfortunately, a quick survey of travel health insurance plans shows this trend to be in full bloom in Canada. Credit card companies, which have recently begun to offer travel health insurance, are revising their conditions. The Royal Bank’s Visa Gold card will drop coverage for seniors over 65 starting Nov. 1. The Canadian Imperial Bank of Commerce and Scotia Bank Visa cards still offer coverage to seniors – but both are revising this. American Express’s annual plan has no age limit, while its per trip plan has a higher rate for seniors between 60 and 74 and doesn’t cover anybody 75 and over.
Suzanne Deul, who helps market the Toronto Dominion Bank Visa card, blames the insurance companies for changes. “Because of high costs, the pressure is on to change policies. We are trying to be more equitable but the insurers want age restrictions. In some ways it could be justified to charge more for people who attract higher costs.”
With so many health insurance companies losing money covering seniors, the challenge for private insurers is to make covering seniors profitable without excluding people. To this end, Robin Ingle, president of John Ingle Travel Insurance, has instituted changes to increase the money available for more expensive hospital stays.
“About one-third of our policy holders are over 65, and we have a lot of snowbirds. This group is only getting bigger, so instead of raising rates and placing restrictions, we increased the number of policy holders to include a broad range of people young and old.”
Ingle blames rising U.S. health care costs for making it unprofitable to provide health insurance to seniors. His company has set up an office in Florida to prevent hospitals overcharging Canadians and has negotiated deals with some hospitals for lower rates. John Ingle Travel Insurance offers special rates for seniors’ groups and gives a 10 per cent discount to members of the Canadian Association of Retired Persons.
Three years ago there were 10 companies in Canada offering travel insurance; now there are over 50.
According to Ingle, many of the neophyte companies are losing money. “I predict the whole industry will shrink because they have had high losses and can’t take care of their clients. I would advise seniors to watch out for companies that might not be around a year from now.”
Ingle says seniors should also beware of glitzy marketing and flashy pamphlets and read the fine print to make sure the policy covers their age and medical condition.
Irene Klatt of the Canadian Life and Health Insurance Association, which represents all private for-profit insurers, advises seniors to look for insurance plans that have toll-free numbers that can be called 24 hours a day in an emergency. This will cut down on hassles with American hospitals which will not admit patients without insurance. The Association also has its own toll-free advice line staffed by seniors from the insurance industry. Klatt warns that her association represents all for-profit insurers and can’t favor one scheme over another but does have a pamphlet that offers advice on choosing insurance.
Insurance, of course, isn’t enough to ensure a healthy stay. Irene Turple of the Canadian Association on Gerontology has some helpful health tips: “Discuss your trip with the family doctor. Make a list of all your medications; and remember – the names of the drugs can be different in the States. If you have an echocardiogram handy, bring it along. Make a health diary listing your medical history. Remember that physicians aren’t all-knowing and if you can provide as much medical information as possible it can make a difference.”
Turple also stresses getting immunized for the flu before going to the States and remembering to cover up from the sun.
Check your prejudices at the door, look beyond your self-interest, and open your mind, because the Grey Panthers are here in Canada.
Joe Moniz, the 26-year-old founder of the Canadian Grey Panthers, is confident that his ambitious plans for a new national seniors’ organization are just what Canadian seniors need.
That’s right: 26-years-old. Modelled on the U.S. Grey Panthers, the Canadian Grey Panthers believe in harnessing the power of all age groups, making the connection that everybody will eventually be a senior and that seniors benefit from a better society for everyone.
“The major difference between us and any other organization is our slogan, “Age and Youth Working Together,” he says. “Look at our pension fund. It’s depleting. I’m concerned about my future as a senior citizen – will there be a pension fund? We want to act now, to bring youth and age together to improve the situation of seniors today and improve our situation in the future.
“Membership is open to all age groups. We want to bring seniors into day care to interact with children. We want to deal with the universities, give people the opportunity to discuss and unite. It’s a different approach, but it can make a huge difference.”
Moniz has already organized the group’s first chapter, in Hamilton, complete with a board of retired university professors and doctors. The group has put together insurance packages that will “blow the others out of the water.”
“All seniors’ attempts at lobbying in the past have been short term,” says a blunt Moniz. “We are the organization that will make the difference. We will lobby provincially, federally, and municipally, and we are non-partisan.
“The reason I’m introducing the Grey Panthers is to keep grey power alive in Canada, and to provide the necessary channels to do so through lobbying efforts. If anyone has problems with local politicians, they can call us, and we in turn let them know the channels they should use. There are a lot of seniors out there being cheated, and it is up to us to help them.”
The Canadian Grey Panthers (which uses the British spelling, as opposed to its American counterpart) will initially concentrate on four issues: pensions, drug plans, affordable housing and long-term care, and will communicate information through newsletters, surveys and meetings.
Moniz promises to make the Panthers accessible to all, no matter what their income. He plans to hit the streets and visit institutions to inform seniors of the group’s presence. As if to prove the group’s potential for excitement, an enthusiastic gentleman from a local retirement home interrupts Moniz during a coffee shop interview. “That’s the best thing I’ve heard from a young person in Toronto,” he says.
The U.S. Panthers were formed by political activist Maggie Kuhn and five friends in 1970. Back then, their name wasn’t as exciting. It was the convoluted and unsexy “Consultation of Older and Younger Adults for Social Change.” In 1972, they adopted the media’s pet name – a grey twist on radical African-American rights organization the Black Panthers.
The radical milieu of political activism was contagious – and the Panthers symbolized its jump from the youth of America to other generations.
“When we formed, we were an intergenerational group,” says Panthers’ U.S. national chair, Charlotte Flynn. “The first issue the group addressed was mandatory retirement. We combat the stigma of ageism, which is making decisions about people based on chronological age. Ageism isn’t just confined to the elderly – ageism exists for young people as well.”
The agenda of the Panthers is just as radical today. Flynn, who is candid about the group’s failures as well as its successes, admits that it isn’t the easiest route to popularity. With membership at about 45,000, the U.S. Panthers have spoken out on now-popular issues like health care, the environment, affordable housing – and taken brave stands against mainstream opinion when it came to the Gulf War and the invasion of Panama.
And they think big. Not content with just influencing the American political scene, the Panthers have taken on the world, gaining official advisor status at the United Nations.
Although involved in a broad range of issues, Flynn says the Panthers are primarily seen as a strong voice for the rights of American seniors.
“We have tried very hard to let people know we are not a special interest group for the elderly,” says Flynn. “But we are always getting called upon to highlight what any legislation is doing to older people.”
With Panther groups sprouting in Europe and now in Canada, the important issue of maintaining the integrity of the Panther name has arisen, says Flynn. She points to the flip side of having a reputation for action: people want to start branches without being interested in the full agenda of the Panthers, using the name for shock value. At the last convention in November 1992, the Panthers formed a committee to act as quality control monitors for the name.
One thing is clear from the ambitious agenda of the Grey Panthers – they aren’t for everyone.
But Moniz’s pragmatic approach seems distinct from the American Panthers. He shies away from some of the American group’s positions, emphasizing a balance between insurance policies and political policies.
“If you read the American Panthers’ position sheet, it’s anti-this and anti-that,” he says. “We aren’t going to take that approach. It would be suicide.”
But he is quick in his praise of the group and its founder Maggie Kuhn. “People may consider her actions to be radical, but they’re not. Look at the achievements. She is one of the top 25 active women in the U.S.
“The Gray Panthers are achievers. They have proven the effectiveness of intergenerational attempts at social justice.”
A quick call to seniors’ groups drew many surpised faces.
“I can’t say anything about them – I don’t know who they are,” responded Murray Morgenthau, executive director of the Canadian Association of Retired Persons (CARP).
Jane Leitch at the United Senior Citizens of Ontario had heard something was happening but wonders why a new group is forming “with so many groups out there.”
One Voice spokesperson Andrew Aitkens says his group is closer to the American Association of Retired Persons than the Panthers in their approach, and that they “have found that there are much more effective ways for advocacy. We don’t march on the Hill at the drop of the hat.”
But Flynn says the Panthers embody a philosophy distinct from all other seniors’ groups. “As Maggie Kuhn said, ‘those of us who are older are the elders of the tribe and should be concerned about survival.’ We look at all issues that deny people the ability to realize their full potential, whether young or old. We are really interested in empowering people rather than being a special interest for the elderly.”
It isn’t the nicest thing to think about, but if accident or illness strikes, you could end up receiving unwanted treatment.
But in 1994 things will change. The living will or advance directive – a document clearly stating a patient’s wishes about how they want to be treated – will become part of the doctor-patient relationship.
A trio of acts passed last December – the Advocacy Act, the Substitute Decisions Act and the Consent to Treatment Act – allow, albeit in rather vague language, for Ontarians to set out in advance which medical procedures they would or wouldn’t accept and let’s them name a proxy in case they are incapable of expressing their wishes.
This vague language – intended to allow patients to customize their wishes – means that writing a living will can prove to be a troubling and confusing experience.
To aid decision-making, the University of Toronto Centre for Bioethics is offering advice through a “model” living will.
The centre’s Dr. Peter Singer has geared the “model” to meet Ontario legislation and to offer a guide for anybody who doesn’t know where to begin.
“We put a lot of detail in the advance directive about states of incompetence people get into, and also the sorts of procedures providers might recommend in those health states.”
Singer sees living wills as an effective tool aiding patients to control their own health care.
“Unless the doctor is a longstanding friend it’s hard to know what patients want. As a practicing doctor, I have run into an incompetent person where their family member has no idea what sort of wishes the person would have wanted. The goal of a living will is to provide the personal care the patient would want.”
But there is a danger. Dr. Singer urges the need for informed and detailed language in a living will.
“If I have a couple minutes to make a decision I need a document that gives me a lot of confidence that this person wouldn’t want this treatment.”
In an emergency, the doctor might not even know of the living will’s existence. Dr. Singer advises giving a copy to your family doctor, lawyer, or proxy, and keep one with you at all times. When so-called “smart” health cards come along, Dr. Singer would like to see the living will recorded on the magnetic strip along with other health information.
David South Consulting 
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