Régie de l’Assurance Maladie Québec
Turning 65
Persons who turn 65 and reside in Québec are automatically registered for the public plan, administered by the Régie. They therefore have no steps to take unless they have maintained insurance with Sun Life.
About private plans
Many private insurers continue to offer prescription drug coverage to persons age 65 and over who were already covered by such a plan.
When persons who turn 65 remain eligible for a private plan offering basic prescription drug coverage, they have a choice to make. They may decide to be insured:
- Only by the public plan, administered by the Régie;
- By the public plan (first payer) and by a private plan offering supplemental coverage (second payer); or
- Only by a private plan offering at least the basic coverage.
Before deciding, they must ask their private insurer about the various options available and their cost.
Joining only the public plan
Persons who choose to join only the public plan don’t have to contact the Régie. They must, however, be aware that their decision to give up their private plan coverage is irrevocable.
Persons insured by the public plan must indicate on their income tax return that they were covered by that plan during the year and must pay the premium applicable to their situation. To find out the amount of their premium, they must complete Attachment K to their Québec income tax return.
Joining the public plan and retaining the supplemental coverage offered by a private plan
When a person turns 65 and remains eligible for a private plan offering prescription drug coverage, the amount of the person’s premium usually increases. In most cases, the person chooses to join the public plan, administered by the Régie, to obtain basic coverage. The person may also wish to take out supplemental coverage offered by his or her private insurer.
Supplemental coverage does not replace the basic coverage of the public plan, but may add to such coverage, for example, by paying the cost of drugs not insured or the portion of costs not reimbursed by the public plan. When a person has supplemental coverage for prescription drugs, the Régie acts as the first payer and the private plan as the second payer.
Persons who have basic coverage under the public plan and supplemental coverage under a private plan must indicate on their income tax return that they were covered by the public plan during the year. Since they had basic coverage under that plan, they must pay the premium applicable to their situation. To find out the amount of their premium, they must complete Attachment K to their Québec income tax return.
Retaining only the basic coverage of a private plan
Persons who choose to retain the basic coverage of their private plan must contact the Régie to cancel their automatic public plan registration. Otherwise, they would be covered by two basic plans, which is prohibited under the Act respecting prescription drug insurance. Before cancelling their public plan registration, they must make sure their private plan indeed offers basic coverage at least equal to that provided by the Régie.
Persons who have basic coverage under a private plan must indicate on their income tax return that they were covered by a private plan during the entire year. They don’t pay the public plan premium.
Retirees & employees turning 65 who are residents of the Province of Québec please see RAMQ website.