The No Health Insurance Option

[zziffle]

Common wisdom has it that expat medical insurance is a must and that only a reckless fool would live here without it. I'm pretty close to making a firm decision to be one of those reckless fools.

The major problem with relying on health insurance is that it won't be there when you most likely need it. Pretty much every plan kicks you off at 75 and if not, the prices go off the scale. So, you have to self fund your post-75 medical expenses, and these are probably going to be the major expenses. If there was a choice to be made between being fully insured or fully self-funded then the insurance option might be viable. But the fact is our only two choices are self-funding or insurance plus self-funding (for when the insurance stops).

A challenge with self-funding is determining the right amount. One thing to bear in mind is that insured expats will most often choose the most expensive medical care option (such as Ram hospital here in Chiang Mai). When it's our own money being spent, we can be much more prudent and choose somewhat cheaper, but still excellent, care at places like Sripat or Lanna, or one of the good government hospitals where appropriate. And we can buy any necessary prescriptions at much cheaper places than the private hospital pharmacies. Insurance policies often have a 500K or 1M maximum payout. An agent has informed me that payouts over 500K are quite rare. All considered, my guesstimate is that a 2M fund strictly for medical expenses is about right.

I'm 58. Typical basic in-patient only coverage up to age 69 will average roughly 150,000 (less now, more later), ignoring probable rate increases. Coverage from age 70 to 74 is about 350,000 per year at today's rates! It will be more when I reach that age.

12 years at 150,000 is 1.8M. The additional 5 years to age 75 is another 1.75M for a total of about 3.5M outlay.

My tentative self-funding plan looks like this:

Seed with 1M in a term deposit that is not locked in. (Currently 3.75% interest at Bangkok Bank.) Top up with 60k each year. To age 75, this account will have cost 2M and be worth about 3M if there are no draw-downs. As near as I can determine, it is difficult to spend 3M on medical care if you are prudent about selecting your care providers. And remember the cornerstone point here - we need to have this fund for after age 75 regardless of what we do about insurance before then.

One of the good things insurance can do for you is get you care in the event of a catastrophic emergency. Hospital personnel will see an insurance card in an unconscious patient's wallet and know that treatment will be paid for. They may not give treatment if there is no evidence of ability to pay. My plan for this is to carry two financial items with me. One is a credit card with a $20,000 pre-approved limit. The card will be in plastic sleeve that will also contain a note that says in Thai and English - for medical emergencies, pre-approved to $20,000, 600,000 baht. I will also carry my term deposit passbook with me as further evidence of ability to pay. I'm pretty sure these two items combined will be enough to get me in the door.

This self-funded account is cheaper than the insurance premiums, has a high-probability of being adequate, and needs to be done whether I get insurance or not (because the insurance will stop before I do). And it has the added benefit that if I don't use up all the funds my kids get a bonus when I croak.

This only works if I maintain the discipline to stick to the savings plan and resist the temptation to access the funds for seemingly more important projects such as buying a house for a princess.

Any holes in my reasoning???

[JusMe]

You raise some interesting issues, zziffle.

You didn't mention your nationality and whether or not you can access some kind of health care from your home country.

I am "self insured" because, first, I'm pretty healthy, and second, I head back to Canada for half the year. There are residential requirements to remain eligible for Canadian health care.

If I have medical expenses here, I can pay them myself first (usually using a credit card if the price is high enough) and then ask my home provincial government for reimbursement of those costs, as long as I provide full receipts. (I have done this in the past, and provided them either with a credit card copy or did a conversion from baht to Canadian dollars as of the day of the expense.)

This works because medical costs here are low enough to get under the bar provided by my own Canadian province. It most definitely not work if I incurred medical costs in the US. That amount is well over the bar and I'd get reimbursed only up to the bar, so it could be financially catastrophic. Not here in Thailand, though. I just need to be able to cover the initial costs here.

I'm also aware that if I do have some kind of medical emergency, I can get the necessary care here and then immediately return to Canada for anything further needed.

You do raise in interesting issue regarding carrying evidence of being able to pay medical expenses. I'll admit to never having considered that issue.

[flying]

That is interesting zz

Is it really that much there today?

Coverage from age 70 to 74 is about 350,000 per year at today's rates!

I see you said your 58 now

I am 55 & moving over later this year so have started asking various companies there for quotes.

If your insured now would you mind telling what your annual prem is?

Thanks

[zziffle]

I'm a Canadian boy too, from BC.

By way of full disclosure, there's a reasonable chance that by the time I hit my 70s I'll be doing the 6 months in Canada and 6 months under the sun wherever - not necessarily Thailand. One of the motivations for that would be to get back on to the BC Med program during the years when I am most likely to need it. I didn't mention this because it's not relevant to the point of this topic.

I was not aware that offshore medical expenses were reimbursable under the Canadian medical plans. I have friends from BC who travel for six months and take out travel medical insurance when they do. I'll have to ask them why they do that. I believe you, but I'm going to look for verification of this as well.

Cheers...

[JohnC]

The OP s figures are way out, expat health insurance for the under 65 s with no exclusions (diabetes etc) comes it at under 25,000 baht renewable until past 65. Also have you never read reports of people arriving in hospital in a coma no identification, no mobile etc? ever wonder where they all went?

At a recent seminar and insurance broker recommended over 65s to put 1Mil baht in a separate bank account for health care, it would also be prudent to pre-register at a hospital of your choice and inform next of kin/close friends of your choice in the event you are unable to make your wishes known.

[flying]

JohnC

I wondered too because I looked at some quotes like this 1.2 million policy. (120k deductible)

Their site suggests they insure till 80 years old & even that is 83k a year

The policy for my age bracket is less than 20k a year

www.thaihealth.co.th/product_maxi_eng.php

[zziffle]

The OP s figures are way out...

Yes and no. I took those rates directly from the rate table available at www.e-insurethailand.com/download/NZI_Premiums.pdf. I didn't just make them up. Granted, this is for high-end international insurance and cheaper coverage is available. I used this rate table because it was the only publicly accessible one I could find that went past age 70. Note that I used the cheaper in-patient only coverage from the right side of the table. If you want full-meal deal coverage that includes out-patient services at age 70, you can get that for a mere 947,000 per year.I have another quotation for a decent in-patient only plan that runs from US$1,615 at my current age up to a much more reasonable $2,154 at age 70-74. Using the rates from this plan makes my total outlay to age 75 approximately 1M baht. A far cry from the 3.5M for the NZI plan.I think the new numbers from this cheaper plan don't fundamentally change the analysis. The big problem remains - the plan will kick me off at 75 at which point I would need to be self-funded anyway. For folks relying on health insurance I would still like to ask, what's your plan for when they won't cover you anymore?@flyingI would be careful with those rates you linked to. My reading of it is that those rates are for first-year coverage only and not predictive of the rates you will pay on renewal. They are good for one year only and look to be a kind of loss-leader to get you in the door. Note the notes:1. Standard premium for each age band for the first policy year only3. Renewal year premium will be adjusted according to increasing age of each insured person.4. Renewal year premium of each insured person may be charged higher, up to 100 percent of standard premium, according to underwriting experience of the previous policy year.

[Ijustwannateach]

Something that has been pointed out on here before (credit to Heng) is that it is still worth having some kind of insurance active for the sake of an active indicator (current insurance card) that you are solvent for health costs in the event you have an accident or a medical incident that leaves you unconscious and unaccompanied when discovered by rescuers or ambulance. In that case, it is better to have an insurance card that makes you look as if you will not be financially risky, rather than a note (as Heng colourfully put it) saying 'trust me, I'm good for it'. Otherwise your admission and treatment- which may be critically required- may be delayed.

[flying]

@flying

I would be careful with those rates you linked to. My reading of it is that those rates are for first-year coverage only and not predictive of the rates you will pay on renewal. They are good for one year only and look to be a kind of loss-leader to get you in the door. Note the notes:

1. Standard premium for each age band for the first policy year only

3. Renewal year premium will be adjusted according to increasing age of each insured person.

4. Renewal year premium of each insured person may be charged higher, up to 100 percent of standard premium, according to underwriting experience of the previous policy year.

Thanks zz will look closely

I did get a few other quotes from BUPA & Chiang Mai Insurance too.

As for raising per age bracket that I understand as risk & my insurance company here in the US

seem to do the same. I am 55 now & the last 3 years they have raised my premium 10% at each

new year. So 30% already

Insurance companies are almost as bad as lawyers

[zziffle]

I agree fully with the point about the need to carry documents that demonstrate ability to pay - which is why I raised the same point explicitly in my original post on this topic. Reiterating what I said there, I believe that carrying a credit card with the described annotation together with a current bank account book showing 1M+ available would be sufficient to get treatment underway at any private hospital.

But please folks, if you're considering this, make the determination for yourself. I'd hate for someone to take this approach based on my suggestion and for it to turn out that I'm wrong on this score. For myself, personally, I would be comfortable carrying this 'proof' of ability to pay. Please find your own comfort level.

Also note that if you hang around the bars or Pattaya or Phuket a lot, carrying such proof of solvency might get the thieves and muggers excited. Hey, I'm not judging, I'm just sayin'....

[MickeyM]

Excellent discussion, especially by the OP. I am 68 years old and made the same decision to self-insure years ago, after 10 years with NZI, using pretty much the same thought process as the OP. NZI is a broad policy, with good coverage caps internationally, but gets terribly expensive as you get older. (I found the payout caps for BUPA to be inadequate outside of Thailand). I am now well covered in the USA (home), and self insured here, with a good accumulated reserve account.

[JohnC]

Granted, this is for high-end international insurance and cheaper coverage is available

I certainly agree with the point if you want international cover then it is very expensive, I was reading the post in the context of someone retiring and living in Thailand in which case healthcare is much cheaper, group policy's with some of the expats clubs can be had for under 25,000 baht if taken out before 65th birthday. Unfortunately there are exclusions, for example I was refused because of Type II diabetes and hypertension so now if I apply to a different company I have to admit to being refused previously! so its catch 22, cant get insurance and this year reach 65! As a sideline I had a major op a year ago and after shopping around went to the Naval Hospital in Satahip, four hour op, three night stay, total cost under 18000 baht, nursing care was excellent but it was a hospital not a five star resort like some places who charge the earth because they work on the premise that insurance will pay.

[exeter]

An excellent topic and I agree that when you reach 60+ you are generally a no no so self funding is the way to go, the bonus being that if you died in your sleep and did not need it you can leave to someone else which is a big plus.

The health Insurance I have seen here look expensive and dont seem to cover the likely cost and as mentioned when you become a bad risk age off you go and thanks for the money.

The amounts you are suggesting are IMHO ok, most people think you might have just one emergency, might be more who knows. Now getting the cost of operations is not easy to tie down but I was told last year that a heart by-pass operation outside of Bangkok was 1.5m bts so the figure the OP is thinking about is ok, prices will have gone up so it needs to be taken into consideration.

I think to many here are on a hope nothing happens to me mindset. It is prudent to to put something on one side for a rainy day, time may not allow you to get back to the homebase for a quick fix which is free.

[Fishenough]

An excellent topic and I agree that when you reach 60+ you are generally a no no so self funding is the way to go, the bonus being that if you died in your sleep and did not need it you can leave to someone else which is a big plus.

The health Insurance I have seen here look expensive and dont seem to cover the likely cost and as mentioned when you become a bad risk age off you go and thanks for the money.

The amounts you are suggesting are IMHO ok, most people think you might have just one emergency, might be more who knows. Now getting the cost of operations is not easy to tie down but I was told last year that a heart by-pass operation outside of Bangkok was 1.5m bts so the figure the OP is thinking about is ok, prices will have gone up so it needs to be taken into consideration.

I think to many here are on a hope nothing happens to me mindset. It is prudent to to put something on one side for a rainy day, time may not allow you to get back to the homebase for a quick fix which is free.

Agreed, and I heard a similar price for a double bypass surgery in Bangkok.

For my son and I, went with a basic health plan with a term deposit set aside just for ANY emergency. The Thai health plan is cheap at a couple hundred dollars a year, and recognizable at any Thai hospital. That is comforting as there are too many nasty stories of zonked out victims not being admitted until the money is paid, plus as a father I would never want my son to be in the situation - he's about to get his own motorcycle! Only set aside a little over half a million baht in a term deposit for this purpose, and hope to build on it as much as possible before I'm 65 - just less than 20 years to go.

So I feel the local health plan offers a comfort factor, and I hope I never use it (my mindset too).

[zziffle]

The Thai health plan is cheap at a couple hundred dollars a year, and recognizable at any Thai hospital.

What is this Thai health plan? Is it run by the government? Is it available to expats or do you need to be married to a Thai? And lastly, where does one go to sign up?

[flying]

The Thai health plan is cheap at a couple hundred dollars a year, and recognizable at any Thai hospital.

What is this Thai health plan? Is it run by the government? Is it available to expats or do you need to be married to a Thai? And lastly, where does one go to sign up?

Not sure but it could be the one I quoted since it is called Thai Health

That one is available to Foreigners

http://www.thaivisa....ost__p__5029205

Edited February 7, 2012 by flying

[exeter]

An excellent topic and I agree that when you reach 60+ you are generally a no no so self funding is the way to go, the bonus being that if you died in your sleep and did not need it you can leave to someone else which is a big plus.

The health Insurance I have seen here look expensive and dont seem to cover the likely cost and as mentioned when you become a bad risk age off you go and thanks for the money.

The amounts you are suggesting are IMHO ok, most people think you might have just one emergency, might be more who knows. Now getting the cost of operations is not easy to tie down but I was told last year that a heart by-pass operation outside of Bangkok was 1.5m bts so the figure the OP is thinking about is ok, prices will have gone up so it needs to be taken into consideration.

I think to many here are on a hope nothing happens to me mindset. It is prudent to to put something on one side for a rainy day, time may not allow you to get back to the homebase for a quick fix which is free.

Agreed, and I heard a similar price for a double bypass surgery in Bangkok.

For my son and I, went with a basic health plan with a term deposit set aside just for ANY emergency. The Thai health plan is cheap at a couple hundred dollars a year, and recognizable at any Thai hospital. That is comforting as there are too many nasty stories of zonked out victims not being admitted until the money is paid, plus as a father I would never want my son to be in the situation - he's about to get his own motorcycle! Only set aside a little over half a million baht in a term deposit for this purpose, and hope to build on it as much as possible before I'm 65 - just less than 20 years to go.

So I feel the local health plan offers a comfort factor, and I hope I never use it (my mindset too).

I read this that you are 45ish/ Which gives you time to put things in place before they get out of hand or impossible, it always pays to plan ahead and then hope for the best and that you have taken everything into account.

[nong38]

Pay as you go is the fall back position but how do tell the hospital you have the collaterl if you not in good condition when you get dealt the joker.

[chops]

I don't have any health insurance. No problem. Just keep a healthy lifestyle. Very simple. I pay out of my pocket 100% of the time. Using an insurance company only costs more in the long run. Best to have a good emergency fund. It's cheaper that way.

[nong38]

I don't have any health insurance. No problem. Just keep a healthy lifestyle. Very simple. I pay out of my pocket 100% of the time. Using an insurance company only costs more in the long run. Best to have a good emergency fund. It's cheaper that way.

Yes spot on, healthy life style is good, but no good if a dipstick on a motorbike decides on you for the next destination it is not much good!

Healthy lifestyle excellent but hedge your bets, make sure you have cash at the bank for the unexpected, which it sounds like you have, so well done for taking on the responsibility..

Edited February 8, 2012 by nong38

[ExpatJ]

I don't have any health insurance. No problem. Just keep a healthy lifestyle. Very simple. I pay out of my pocket 100% of the time. Using an insurance company only costs more in the long run. Best to have a good emergency fund. It's cheaper that way.

One car accident and a severe injury or severe illness you would be financially ruined unless your emergnecy fund is adequate...may we ask how much is in it?

[PattayaParent]

The OP s figures are way out...

Yes and no. I took those rates directly from the rate table available at http://www.e-insuret...I_Premiums.pdf. I didn't just make them up. Granted, this is for high-end international insurance and cheaper coverage is available. I used this rate table because it was the only publicly accessible one I could find that went past age 70. Note that I used the cheaper in-patient only coverage from the right side of the table. If you want full-meal deal coverage that includes out-patient services at age 70, you can get that for a mere 947,000 per year.

Lots of information available if you search http://www.e-insuret...personal.htm Use the drop down menut to choose different plans and click on premiums and it will give you the costs.

[nong38]

The OP s figures are way out...

Yes and no. I took those rates directly from the rate table available at http://www.e-insuret...ZI_Premiums.pdf. I didn't just make them up. Granted, this is for high-end international insurance and cheaper coverage is available. I used this rate table because it was the only publicly accessible one I could find that went past age 70. Note that I used the cheaper in-patient only coverage from the right side of the table. If you want full-meal deal coverage that includes out-patient services at age 70, you can get that for a mere 947,000 per year.

Lots of information available if you search http://www.e-insuret...pa-personal.htm

Use the drop down menut to choose different plans and click on premiums and it will give you the costs.

If you are over 60 health insurance is no no as this shows. You will be a bad risk, if you joined before 60 you will get some repite although premiums will get ramped up. For me I have travel Insurance I suspect that very soon this will be out of reach and I will be on payg, just have to make sure I have enough, whatever I thnk that might be. One of the unsavoury facts of getting older! Edited February 8, 2012 by nong38

[cmjantje]

Here in Chiangrai I don't need any health insurance at all.

Wiengchai hospital took care about that problem and whenever I go to a doctor, hospital or whatever, I don't have to pay One satang. Including medicine etc. It is, as far as I understand, based on the VIP card which is not available anymore but somehow if you have the right people in front of you they can use this service.

Please don't ask me how it works, my wife knows it at it Does work.

[nong38]

Here in Chiangrai I don't need any health insurance at all.

Wiengchai hospital took care about that problem and whenever I go to a doctor, hospital or whatever, I don't have to pay One satang. Including medicine etc. It is, as far as I understand, based on the VIP card which is not available anymore but somehow if you have the right people in front of you they can use this service.

Please don't ask me how it works, my wife knows it at it Does work.

Lucky you, I suspect there are many would like to be in your position, hope it continues well for you.

[Lite Beer]

I have been looking at this from Kasikorn Bank.

http://www.kasikornbank.com/EN/Personal/Insurance/Generalinsurance/HealthProtect/Pages/Senior_1.aspx

[exeter]

Does not look to bad Lite Beer, however, when you are hitting 70 you are shown the door, the problem does not go away for the older folks out here, then you need a different plan by which time its likely to be pay as you go.

Its agreat pity that more is not done to promote healthcare in mid to later life earlier in the same way as pensions are promoted, bu then again they are not that good value either but are a regular amount you can count till you die.

Edited February 10, 2012 by exeter

[Fishenough]

Come on, it's really not a question of being able to afford the health care, yes there are some that can't with no insurance; but you are a foreigner in a foriegn country. Most often live is pleasant, easy and fun, like a long warm bath. But when things go sideways, eg. your girl friends have turn sour, your truck disappeared, your motorcycle is damaged and has damaged someones loved one, or whatever your in a pickle for, that is what even the most basic insurance is there for. Health wise, because if you don't have your health everything else matters not.

If I wasn't a single dad my option would be so strong, but how many stories of a farang who's live goes completely upside down do you hear or read? A very close friend mine is the person that consulates, and such, call when they need help with someone drowning in the dark side of Thailand. To see the physical and physiological damage that happens to a person when they have no where to turn is quite an alarming sight!

[hhfarang]

I just got to this topic late and skimmed it, so I could have missed it, but the other problem with health insurance that no one mentioned is that pre-existing conditions are not covered. By the time I retired and lost my company health insurance I had been on medication to control blood pressure, cholesterol, and asthma for years. All insurance companies and agents I've talked to cannot guarantee that a claim involving my lungs or cardio vascular systems would be covered because they would be considered pre-existing. I know of several people who paid insurance for years and went to the hospital only to find the insurance company denied their claim as pre-existing.

I'm 62 and have no health insurance for this reason. I will self fund as the insurance would probably be only accident insurance with my medical history.

[belg]

maybe, end it yourself when you are 75 or cannot take care of yourself anymore ?

or going back to your home country for some free social room till you die ?