When does it become time to put money aside in a separate account and self insure?

[Yellowtail]

I had great insurance while I was working in Thailand and for a year after I retired. 

 

I looked at what I had spent over the last twenty years and looked at what I would have to spend to get decent coverage I decided to self-insure. I saved and I can't imagine something that would cost more than I could afford. 

 

I also have Thia social medicine, but don't really use it. 

[Sheryl]

  On 6/29/2023 at 9:03 AM, newnative said:

    This is something I have certainly struggled with.  I moved to Thailand in 2010 and I took health insurance with April International out of Paris in 2012.  I chose the cheapest 'Essential' plan.  My only pre-existing condition was elevated cholesterol.   I can't remember what I was paying then--maybe around $1400 a quarter--but my premiums rose every year.  By 2021, I was paying around $2340 a quarter, depending on the dollar to euro exchange rate.  

    I inquired about reducing my premiums and I adjusted my plan to 80/20.  April pays 80% and I pay 20%.  At some point I had dropped outpatient coverage to save money and I think that year I added it again. I  The new premium was around $2180 a quarter for 2022.

    This year I aged up to the over 70 bracket and I had a huge jump from around $2180 to around $2900 a quarter.  Mind you, this is a quarter, not yearly.  So, $2900 times 4 quarters equals $11,600 a year.  About 412,000 baht at current exchange rates.  

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I am the same age and have the same policy but my latest premium is much less than half what you report. (With a $500 deductible). 

 

You must have some extras tacked on, or have been assigned a premium liad at enrollment due to gome pre-existing condition. . Just hospitalization would not cost anywhere near this amount. 

[London Lowf]

  On 6/29/2023 at 2:57 PM, Sheryl said:

Especially if one of them is diabetes. 

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Thus far I've escaped that one but some of the others would have been life-changing if not detected early - pick two!

 

Luckily, I'm reasonably secure (albeit not rich) and I have zero dependants and so I can blow my net worth if push comes to shove.

 

One thing I consider - I've had the best meal, best sex, best game of squash, best workout, best cycle ride, best swim that I'm ever going to have and I am content with the life that I've led and the way that I've treated those around me. I'd like to hang around for another ten years (my father was 93 last week) but I had a NDE about fourteen years ago and, as a direct result of that, I have no fear of death.

 

 

[Sheryl]

  On 6/29/2023 at 5:05 AM, mokwit said:

Seems you can't insure for what yo really need to - over 70 health care needs and end of life/debilitation.

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You can. But you have to start while younger and still healthy.

 

The problem is that retirees, by definition, tend to already be older when they move to Thailand and often already have health conditions. 

 

 

[London Lowf]

  On 6/29/2023 at 3:01 PM, Dan O said:

The term "Self Insured" is an inaccurate term in my opinion as it implies that you have sufficient assets set aside just for Medical Emergencies. Oddly there is no guide or directive that shows how many assets you must have set aside for "Self Insurance".  Self pay is a more accurate term to be used unless you have assets segregated exclusively and sufficiently to cover the major medical expenses that could occur, which I'm betting most people dont.

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True!

[London Lowf]

  On 6/29/2023 at 3:18 PM, Sheryl said:

You can. But you have to start while younger and still healthy.

 

 

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Yes, but the problem for many of us is that we had free/subsidised health insurance while we were in employment and then, just as that is no longer on the table and you look for alternatives, no-one is interested!

[Sheryl]

  On 6/29/2023 at 6:22 AM, London Lowf said:

I sometimes look at things from an unusual perpective.....

 

Insurance is gambling - the underwriter/actuary has calculated the chances of you making a claim and offers you a premium that they reckon will make them money - they are a business, after all.

 

By paying the premium you are effectively punting on the fact that they got their figures wrong and that your chances of getting sick are higher than they think - that's the only way you can "win".

 

 

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That is not quite it.  The insurer  has calculated what they are likely to have to pay out for claims across the whole pool of insured people by age group (understanding that there willl be people with no claims, small claims and some with very large claims in that mix) and base that along with their administrative costs and profit to set premiums. The only assumption about  individual policy holders is that they are at average risk for their age at time of initial enrollment (hence the importance of knowing of any prior or pre-existing conditions). The insurer fully expects to take a "loss" on some policies and that is fine  as long as the overall payouts for all policies is not higher than projected for a sustained period of time.

 

Getting this calculation correct is complex and there are insurers out there new to the game who badly underestimate (or intentionally underprice at first to lure in new customers). . These end up either going bankrupt or having to drastically raise rates dcross the board. The longer the insurer has been in business and the larger their pool of insured persons, the less risk there is of this. 

 

When one decides to get insurance of any type it is with the understanding that odds favor paying more on premiums over the life of the policy than receiving in benefits but that there is a possibility of the opposite happening and that which group you will be in, is impossible to predict.

[London Lowf]

  On 6/29/2023 at 3:37 PM, Sheryl said:

When one decides to get insurance of any type it is with the understanding that odds favor paying more on premiums over the life of the policy than rectmeiving in benefits but that there is a possibility of the opposite happening and that which group you will be in, is impossible to predict.

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So, basically gambling.

 

Casino profit margin is based on irrefutable mathematical odds, but they do sometimes have a losing night and do not lose sleep over it - the odds will come back to them. I worked in that business* world-wide for twelve tears and only ever knew of one casino that gave back their licence as they could not make money - but I'm sure there were rats to be smelt there!

 

* Hence my attitude towards "insurance".

[newnative]

  On 6/29/2023 at 3:15 PM, Sheryl said:

I am the same age and have the same policy but my latest premium is much less than half what you report. (With a $500 deductible). 

 

You must have some extras tacked on, or have been assigned a premium liad at enrollment due to gome pre-existing condition. . Just hospitalization would not cost anywhere near this amount. 

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   Thank you for your reply, Sheryl.  Yes, I did have a pre-existing condition of an elevated cholesterol level when I enrolled in 2012.  That is still all I have, nothing else has developed, and I control it with a daily statin pill.  I don't have any add-ons such as dental but I do have both hospitalization and outpatient coverage.  I don't know if the cholesterol problem and being a male would explain the difference in what you pay.

    I asked April about adding a deductible and they said I had the 80%/20% coverage and I took that to mean that having a deductible was not available.  They have told me several times that my coverage is 'from the first euro'.   I will ask again about switching to a deductible rather than the 'first euro' type of coverage.  I also asked April about changing to just Thailand coverage rather than international and they told me I was already just covered for the Asian Zone, not the World.

     Something a bit interesting.  On a different thread discussing alternatives to Pacific Cross, someone mentioned WRLife health insurance.  I checked the site, which allows you to select a country, tell them your name, age, and then chooses the coverage you want to get a quote--nothing about any pre-existing conditions, just name, age and country.  I said Thailand, age 71, and I wanted the 'Serenity' plan with hospitalization and outpatient with a $2 million dollars coverage limit, $1000 deductible.  The instant quote I got was $11,638 a year, surprisingly close to the $11,600 a year I am now paying with April.  If I went with a limit of one million dollars, the quote drops to $6,388 a year.  I don't know anything about this company; I would think the quote would change once you actually applied and plugged in any medical pre-conditions.

[save the frogs]

  On 6/29/2023 at 3:46 PM, London Lowf said:

So, basically gambling.

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remaining uninsured is (also) gambling. 

 

[Jingthing]

  On 6/29/2023 at 4:49 PM, save the frogs said:

remaining uninsured is (also) gambling. 

 

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Yeah.

Getting out of bed in the morning is a gamble.

 

[BenStark]

  On 6/29/2023 at 4:27 PM, newnative said:

The instant quote I got was $11,638 a year, surprisingly close to the $11,600 a year I am now paying with April.  If I went with a limit of one million dollars, the quote drops to $6,388 a year.  I don't know anything about this company; I would think the quote would change once you actually applied and plugged in any medical pre-conditions.

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And at what age they refuse to insure you?

 

I hear that French insurers not can kick you out at any age, or on the base of long term ailments.

[alien365]

What I see from you guys is that the premiums will continue to go up and up to the point that I won't be able to afford to insure myself. I'm 40 and I'm already accepting the self/non insurance route. I may as well continue saving now rather than lose all the premiums I'd pay for 20+ years to be at the same point. 

[Sheryl]

  On 6/29/2023 at 4:27 PM, newnative said:

   Thank you for your reply, Sheryl.  Yes, I did have a pre-existing condition of an elevated cholesterol level when I enrolled in 2012.  That is still all I have, nothing else has developed, and I control it with a daily statin pill.  I don't have any add-ons such as dental but I do have both hospitalization and outpatient coverage.  I don't know if the cholesterol problem and being a male would explain the difference in what you pay.

    I asked April about adding a deductible and they said I had the 80%/20% coverage and I took that to mean that having a deductible was not available.  They have told me several times that my coverage is 'from the first euro'.   I will ask again about switching to a deductible rather than the 'first euro' type of coverage.  I also asked April about changing to just Thailand coverage rather than international and they told me I was already just covered for the Asian Zone, not the World.

     

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The cost difference would largely be explained by the OPD cover which I  do not have. Male sex and pre-existing hypercholsterolemia might add a bit more but the OPD is the main factor.

 

Note that  April hospitalization-only cover includes day surgeries as well as outpatient cancer care (chemo etc) and dialysis. It also covers outpatient care related to a subsequent hospitalization (I think up to 30 days before admission) and outpatient care related to a hospitalization  up to 30 day after discharge. 

 

With the most costly OPD covered and given that including elective OPD cover more of less doubles the premium it goes not make sense to me to have it. 

[Furioso]

Before I left the U.S.(Las Vegas) last year I sold my car to a older guy, who was definitely well off but we talked about getting screwed by medical/dental/optical costs, along with inflation in general.  I won't delve too deep but they basically lie to your face and in a somewhat sneaky/sophisticated way charge you 100's over what they initially advertised. Seriously, they'll get you in their chair and try to charge you 600 USD for a "special" teeth cleaning, which really isn't necessary. 600 USD for eyeglasses too, if they can get away with it. I mean, it never ends and they don't take in consideration if your poor or desperate, they're practically screaming "GIVE ME YOUR MONEY YOU STUPID CUSTOMER!" 

 

Anyway, this older gentlemen who was buying my car was a great guy, very energetic, had 2 kids in their late teens/early 20's. I offhandedly said "Don't let these jokers win, just beat them at their own game". He looked at me, furrowed his brow and said "how can I do that?" I said "take a vacation to Mexico once a year, take care of all your needs then".  Well, he about had a heart attack, he said he's been to Mexico a few times, even once to have a veterinarian look at his 2 shizu's. He said how great they treated him and his dogs, he never thought about teeth cleaning, eyeglasses, medical checkups, etc.

 

Of course in his case he can probably drive to Mexico in one day..but as someone mentioned in this thread, India isn't too many hours away by plane. Medical is definitely cheaper there. Heck, I get the feeling here in Thailand that all the Thai's get their medical for free, subsidized by falangs paying millions of baht which is way, way over freaking priced. 

 

My point is, look for other opportunities to take care of your health needs. Sure, there's always a chance you have an emergency here and have to go to the local hospital..but you can do almost everything else someplace else. 

[mania]

I agreed with many who say  insure because even if you can self insure once you use it then it is depleted

 

But...While that is true, when I consider further I realize even with insurance a deficit will happen

 

Meaning if I have insurance & have a heart attack & need a stent it seems more than likely the next year they will try to price me out of the policy.

 

At that point if I try to buy at another insurance company coronary problem is preexisting & thus priced again out of reach or not available at all.

 

Also as Sheryl said double tough as many are retiring to Thailand at a 60+ age & not seen as a good risk to insurers to begin with

 

I know someone who just had a stroke due to a clot moving to his brain. A CM hospital took him in no insurance but would not do anything in this time sensitive event (he already couldn't speak) till funds were shown. Luckily his step daughter could handle the problem & they did retrieve the clot from his brain & he is 100% ok now

 

To their credit the hospital performed well. The price was 600k baht & involved 3 day stay

 

[Sheryl]

  On 6/29/2023 at 6:28 PM, mania said:

I agreed with many who say  insure because even if you can self insure once you use it then it is depleted

 

But...While that is true, when I consider further I realize even with insurance a deficit will happen

 

Meaning if I have insurance & have a heart attack & need a stent it seems more than likely the next year they will try to price me out of the policy.

 

At that point if I try to buy at another insurance company coronary problem is preexisting & thus priced again out of reach or not available at all.

 

 

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This "pricing out" based on claims is unique to Thai companies. Western country insurance regulations do not allow it, premium is not affected by your claims history.

To me, a policy which can raise your rates based on claims history (on top of the ordinary inflationary and age increase) defeats the whole point of insurance. But Thailand's insurance regs allow it, so most of them do it.

And indeed, people do get priced out and then unable to get another policy.

 

This alone is an overwhelming reason to stick with internationally issued policies. Premiums will go up with age (though to a much lesser extent than the Thai policies in the older age brackets - I have seen some  where the premium at say age 80 actually equalled the maximum coverage, which is absurd). But this is predictable, and there will be no add on charge because you had a claim or developed a chronic health condition.

 

Some Thai insurers also cancel policies at a certain age. And I have heard of some introducing exclusions after the fact, i.e. year 1 you develop a certain condition and have a claim related to it, year 2 that condition becomes an exclusion. Western insurance regs would not allow that either.

[Furioso]

  On 6/29/2023 at 6:28 PM, mania said:

I agreed with many who say  insure because even if you can self insure once you use it then it is depleted

 

But...While that is true, when I consider further I realize even with insurance a deficit will happen

 

Meaning if I have insurance & have a heart attack & need a stent it seems more than likely the next year they will try to price me out of the policy.

 

At that point if I try to buy at another insurance company coronary problem is preexisting & thus priced again out of reach or not available at all.

 

Also as Sheryl said double tough as many are retiring to Thailand at a 60+ age & not seen as a good risk to insurers to begin with

 

I know someone who just had a stroke due to a clot moving to his brain. A CM hospital took him in no insurance but would not do anything in this time sensitive event (he already couldn't speak) till funds were shown. Luckily his step daughter could handle the problem & they did retrieve the clot from his brain & he is 100% ok now

 

To their credit the hospital performed well. The price was 600k baht & involved 3 day stay

 

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18,000 USD for a 3 day stay is insane. 

[Sheryl]

  On 6/29/2023 at 7:52 PM, Furioso said:

18,000 USD for a 3 day stay is insane. 

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Length of stay is largely irrelevant. Room charges are the least of cost of hospital care.

 

In the case referenced, he may have been administered a clot busting drug or other delicate neurosurgical intervention. These are expensive.

 

With an acute heart attack, angiography and stent will run that much or more (depending in number of stents needed) but if stenting is successful, the stay will be short.

 

Many similar examples of high cost/low stay duration hospitalizations.

 

Conversely you could be hospitalized for several weeks and still have a modest bill, if no surgery or expensive procedures were involved.

[mania]

  On 6/29/2023 at 7:25 PM, Sheryl said:

This alone is an overwhelming reason to stick with internationally issued policies. Premiums will go up with age (though to a much lesser extent than the Thai policies in the older age brackets - I have seen some  where the premium at say age 80 actually equalled the maximum coverage, which is absurd).

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True & why the Int policies as you say are better,

I have looked at April INT & looks pretty reasonable overall

[mania]

  On 6/29/2023 at 7:52 PM, Furioso said:

18,000 USD for a 3 day stay is insane. 

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Yes maybe but realize it included going in thru groin to retrieve a clot in the brain.

After which he regained normal speech & movement of his right side

I think most western countries would be well over 100k USD

 

But I think many expats also get a false sense of prices because of minor interactions/diagnostic tests etc done in Thailand

 

But when the  the price is the price. Whether that means the difference of walking/speaking again due to stroke or life or death due to bypass etc it will be a little late to complain/negotiate a better deal or even go hospital shopping

 

[mania]

  On 6/29/2023 at 8:32 PM, Sheryl said:

In the case referenced, he may have been administered a clot busting drug or other delicate neurosurgical intervention. These are expensive.

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Ah yes I forgot he also had the clot busting drug but due to time between onset it did not work do they went in thru the groin & luckily retrieved it in his brain. I saw the picture of the retrieved clot. Barley larger than a BB looked like they use the same catheter used to install stents etc

 

Pretty impressive work I thought & he was lucky that hospital was equipped to handle that IMHO

[metisdead]

Some offensive posts have been removed.

[jerrymahoney]

I moved to Thailand in my early 50's. My family was not happy. But one reason they acquiesced was that I was able to get a personal insurance policy (BUPA Thailand pre-Aetna) that was becoming exorbitantly expensive in USofA.

 

That was almost 20 years ago and I am still insured in Thailand. 3 inpatient claims paid no problem.

[scubascuba3]

  On 6/29/2023 at 6:28 PM, mania said:

I agreed with many who say  insure because even if you can self insure once you use it then it is depleted

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Many need to self insure anyway due to the pre-existing conditions excluded in their flakey insurance.

 

Another thing annoying with insurance is they will exclude pre-existing conditions but won't reduce the premium to compensate

[Gottfrid]

Asking when at the age of 61???? That train left a couple of decades ago. I would say, at the age of 19-25.

[Scouse123]

  On 6/29/2023 at 10:35 PM, Gottfrid said:

Asking when at the age of 61???? That train left a couple of decades ago. I would say, at the age of 19-25.

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19-25 would have been a non starter considering I am British and we had the NHS.

 

Of course we would have given no attention at all to private or self insurance when our hospital costs were free

[Mike Teavee]

I decided to get Health Insurance around the time they made it mandatory for the Non-IMM OA holders as I felt that there was a high risk of them applying it to Non-IMM O holders at that time.

 

Figured it would be sensible to get on the ladder "Early" so took the (Pacific Cross "Visa Friendly") policy out the day before my 55th birthday & this year (day before my 57th) the renewal was <30,600 for $100K cover (excluding out-patient & has a 100K deductible). 

 

I keep 2 years spends (updated a few times per year depending on dividend income/fx rates) in the bank anyway so am sort of also self-insured should something bad happen & the Insurance doesn't pay out. 

 

End of the day we all have our own levels of risk, for me the risk in being forced to get Health Insurance later in life (as happened to the Non-IMM OA holders) was the nudge I needed to get Health Insurance whilst I could. 

 

 

Edit: I appreciate this doesn't answer the OP question so for that I would just say that as with any long term savings, you're always already too late so best start catching up now. 

 

[newnative]

  On 6/29/2023 at 5:54 PM, Sheryl said:

The cost difference would largely be explained by the OPD cover which I  do not have. Male sex and pre-existing hypercholsterolemia might add a bit more but the OPD is the main factor.

 

Note that  April hospitalization-only cover includes day surgeries as well as outpatient cancer care (chemo etc) and dialysis. It also covers outpatient care related to a subsequent hospitalization (I think up to 30 days before admission) and outpatient care related to a hospitalization  up to 30 day after discharge. 

 

With the most costly OPD covered and given that including elective OPD cover more of less doubles the premium it goes not make sense to me to have it. 

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     Thanks so much for this information, Sheryl.   The main reason I got OPD was I was worried I would not be covered for exactly the things you mentioned--especially ongoing treatments involved with cancer care, chemo/radiation treatments, etc.  I will look into switching to just hospitalization with a deductible.  Thanks again for taking the time to let me know about this.

[newnative]

  On 6/29/2023 at 5:00 PM, BenStark said:

And at what age they refuse to insure you?

 

I hear that French insurers not can kick you out at any age, or on the base of long term ailments.

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Not being kicked out is one reason I have continued with April International, based in France.