Prescription Drug Insurance at Age 65

What You Need to Know About Prescription Drug Insurance in Quebec After Age 65

Under the law, all permanent residents of Quebec must be covered by prescription drug insurance. The main options available are the public plan administered by the Régie de l’assurance maladie du Québec (RAMQ) and private group insurance plans.

If an individual has access to a private prescription drug plan, they are required to enroll. However, what happens when someone covered by a private plan reaches age 65?

Automatic Transition to the Public Plan at 65

Upon reaching age 65, individuals are automatically enrolled in the RAMQ public prescription drug plan. No action is required to make this change.

Options for Those Still Eligible for a Private Plan
If an individual remains eligible for private group insurance, they have the following options:

Keep the RAMQ Coverage While Maintaining Private Insurance as a Secondary Payer:
- Medications are first reimbursed by the RAMQ, based on public plan conditions.
- Some insurance companies partially reimburse any additional costs not covered by the RAMQ.
- Drugs not covered by the RAMQ but eligible under the private plan may be covered by the insurer.
- Additional benefits (such as travel insurance, paramedical care, etc.) remain active if included in the private contract.
- This option requires paying both the annual RAMQ premium (deducted from the income tax return) and the private insurance premium.
Opt Out of the RAMQ Drug Coverage and Keep Only Private Insurance:
- The insurer fully reimburses medications according to the private contract’s terms.
- This option may involve an additional cost (monthly surcharge). Check with your insurer.
Opt Out of Private Insurance and Stay Covered Only by the RAMQ:
- Medications are reimbursed exclusively based on the RAMQ’s conditions.
- Additional private insurance benefits (such as travel insurance, paramedical care, etc.) are canceled.

Important Notes
These options may be available for both the primary insured and their dependents when they turn 65, depending on the insurer’s conditions.