We’re getting soaked

Why is it that so many products and services we seniors need to maintain our aging bodies and manage our lives are so bloody expensive? I guess people in these businesses haven’t been reading the StatsCan reports and think we’re all millionaires. Here are some of the more outrageous examples.

• Eyeglasses. Many of us need bifocals, so the lenses alone can cost from $500 to $1000. But then why does it cost hundreds of dollars more for frames? They’re just a bit of plastic or metal and a few screws, all mass-produced. Did you know that just one company controls most of the market?
• Hearing aids. These can range from $1200 to $4000 and more for each ear. You sometimes have to pay dispensing fees too. Ontario’s Assistive Devices program may subsidize you to a maximum of $500 for each aid. The components actually cost only about $100 to make.
• Orthotics. If you have fallen arches or plantar fasciitis, you might be given a prescription for custom orthotics. They typically cost between $300 and $600. In Ontario, they can be prescribed only by physicians, podiatrists or chiropodists, and provided by podiatrists, chiropodists or pedorthists. There is strong evidence of effectiveness for only a few conditions. There are lots of unauthorized people selling orthotics for conditions that won’t get any benefit. Do your homework.
• Good walking shoes. If you have orthotics, you need roomy, sturdy walking shoes to put them in. These days, a pair can cost from $100 up to $400. Good walking shoes have always been expensive, but in the last few years the price has stayed high while the quality has gone down. Nowadays the treads wear smooth in a year or two, and sometimes even fall off in pieces. Many shoes are now made of synthetic materials instead of leather, and they cause blisters. Often the manufacturer doesn’t even tell you any more what the shoes are made of, not in the shoe, not on the box. They do tell you what the box is made of, though.
• Dentures. It’s pretty common to lose teeth in old age, and then we need dentures. They can cost from $1000 to $30000 or more, depending on whether they’re partial or complete and what techniques are used. Even if you have extended health insurance, dentures are often considered cosmetic and aren’t covered. Explain that to someone who has no teeth.
• Mobility aids. The Ontario Assistive Devices program (ADP) pays 75% of the cost of mobility aids such as manual wheelchairs, power wheelchairs, power scooters and wheeled walkers. You are allowed to buy only ADP-approved equipment from ADP-approved vendors. But the pricing framework does not reflect current costs. An equipment vendor may not be able to provide certain ADP-approved equipment because the maximum funding through the ADP does not cover the wholesale cost of the equipment. Small independent stores selling mobility aids can’t absorb these cost overruns and therefore often cannot provide the prescribed equipment, even though it is on the ADP-approved list.
• Physiotherapy. In 2013 the Ministry of Health delisted non-hospital physiotherapy from OHIP. They also delisted one-on-one physiotherapy in retirement homes. Now some insurance providers are delisting it too. Seniors (65+) can still get coverage if we meet the criteria, which focus on acute care. To get the service, you must go to one of the designated publicly funded clinics. Typically, they provide 20-minute group sessions. You may be put on a wait list to get in. If your condition doesn’t fit the government’s criteria, you’ll have to go to a private clinic and pay for the treatments yourself.
• Extended health insurance. If you were lucky enough to have extended health and dental coverage while you were working, you’re in for a shock in retirement. These plans provide only partial reimbursement for the various services, and limit the number of times per year you can use them. The caps or maximum limits for drugs, dental, vision, hearing and allied health care are generally low. You are really paying in advance for these services, whether you use them or not, plus the administrative costs and profits of the insurance company. So it makes more sense to just budget for these costs, set the money aside, and pay them yourself. If sometimes those expenses are lower than you expected, then the money’s there for you to use for other things.
• Medications in long term care homes. The Ontario Drug Benefit Plan (ODB) allows pharmacies to charge a copayment of $2 for low-income seniors, or $6.11 for higher-income seniors, for each prescription. In practice, most pharmacies waive the $2 fee for seniors living in the community. But in long-term care homes, residents routinely get charged $2 for each prescription. Many prescriptions in these homes are packaged to supply a week at a time, and residents are charged $2 for each weekly package, forcing them to pay at least four times what they would pay in the community. It’s a fantastic windfall for the few pharmacy services that control this market.
• Corporate trustees. Suppose you can’t manage your own finances any more, but don’t have anyone to appoint as your power of attorney for finance. You’d like to find a professional to handle this. Until a few years ago, you could arrange it through a trust company. But now trust companies will take this on only if your portfolio is worth a million dollars or more. Lucky for us we’re all millionaires.