Medical insurance

[Kenny202]

Have a long term plan to live here but I am becoming concerned re medical costs. My friend went to the RAM Hospital here and payed 20k thb for 2 nights mosquito bite infection treatment. I live in a village area and using cheaper government medical isnt enticing. For anything major need to go to the large city hospital and for me thats 3 referals from mooban clinic to Amphur to city. Id be dead by the time the paperwork was finished. I am 52 and healthy. Spoke with AIA today and policy starts around 30k thb per year. Wasn't 100% clear on all aspects but they say the guarantee they will only put the premium up by 10% every 5 years and will insure me up until I'm 80. Was a lot of stuff where I'm not sure if the agent wasn't clear and as usual wouldn't admit it but a lot of the cover didn't seem to be guaranteed ie "up to company". He even said at one point if something or other happened, (obviously expensive) they would ditch me but give me my premiums back. Anyone have any experience with them or their reputation?

[DonaldBattles]

All private insurance policies are renewed yearly and subject to the whims of the issuer. Rest assured that insurance companies do not like to insure old people. When you get past 76 your policy fee will be so large that you probably choose to not renew it. My was 500 Baht per day. Health insurance for people older than 60 is a big problem. The government is now looking at combining the 3 major health programs they have. Once this is rationalized I think there will be another opportunity for expat residents to purchase a government policy. I expect this to occur by the end of next year. This also includes migrant workers. Recently the government decided to insure stateless people. The previous government policy that covered us for one year was good and affordable at 2200 Baht. I think some form of this at a high price will be renewed.

[Sheryl]

In Thailand, the regulatory framework for health insurance is quite weak and insurers can indeed drop you at any time for any reason. It doesn't often occur but it can, and guaranteed if it happens it would be when you were in greatest need, for example had developed a serious chronic illness with large ongoing costs. The other problem with local policies is that they often have ridiculously low coverage limits. The 20K bill you refer to is in no way indicative of what it would cost to be treated for major trauma (as in a bad motor vehicle accident, always a risk here) or catastrophic illness (thing heart attack, stroke etc involving long ICU stay, multiple surgeries etc). Even at government hospitals bills for things like this can easily exceed 1 million baht and 3 times that at private hospitals. I have seen people with local policies exhaust their maximum reimbursement within a matter of days and then been left completely without cover.

The solution to both issues this is to get an internationally issued expat policy, of which there are many. The laws of the country where the insurer is based govern what they can and cannot do and in Western countries this usually precludes dropping you if you have kept up the premiums and not committed fraud...no matter how ill you become or how high your expenses. In addition, even the lowest end international policy will have at least USD 500K as annual limit, often a million or more, which is more than enough. At 52 you will have wide choice of policies (there are international companies who will insure much older people - some even past age 90 - but fewer than the number available to you now).

Best to go through an insurance broker as they can give you comparative lists of different policies. One important thing to look at unless you have large cash reserves is whether a particular insurer has direct payment arrangements with hospitals in Thailand and if so, which ones.

The premiums for international policies may seem higher but are not when balanced against the level of cover offered. Thai insurance policies are actually pretty bad value for money in that regard, due to the very small pool of customers (Thai citizens having universal coverage already). In addition -- and unlike most local policies - international policies usually offer options whereby you can lower the premium if you accept a certain deductible and/or copay.

I think the previous poster is overly optimistic about when a government scheme open to resident expats will come into effect, it is IMO years away though it may well happen some day. It has nothing to do with the rationalization of the 3 existing health schemes for Thais, which has been under discussion already for many years, but subject to intense political wrangling as these schemes are managed by different state entities. Migrant workers from neighboring countries are already covered, though they have to be legally registered and pay a modest fee to get it.

[Kenny202]

Thanks Sheryl. I actually meant the fee was around 30k thb a year....Not the level of cover. Having said that the level of cover was pretty low ie around 80k a day covering various things but main one was 60k baht per day for surgeon.

I tried bupa and a few of those Sheryl but they were talking $2500 US for basic cover. Can u reccomend anyone or PM me?

[thaiduncankk]

In my experience there is not a lot wrong, treatment wise, with the Government hospitals, and a lot of doctors actually work in both the Government and private hospitals.

OK, the conditions are nowhere near the private standards, but as long as you are getting decent treatment, I, personally, do not mind using the Government hospital.

I had to stay in for a week with a foot infection. I received 3 large doses of antibiotics daily, along with other medications, was fed everyday, (yes, not the Ritz, but palatable), excellent service from both doctors and nurses alike, and the total bill was 7,600 baht. With my experiences with RAM in my early days years ago, 1 anticipate this would well have exceeded 100,000 baht. I could have paid extra per day for a private room, but with Thais constantly visiting their relatives all day, I actually found them lovely people who were very friendly and helpful towards me, and it took away the monotony of being in a hospital bed for a week.

20,000 baht for mosquito bite infection is extortion, bearing in mind you probably received identical medication administered at Government hospitals.

[Sheryl]

Thanks Sheryl. I actually meant the fee was around 30k thb a year....Not the level of cover. Having said that the level of cover was pretty low ie around 80k a day covering various things but main one was 60k baht per day for surgeon.

I tried bupa and a few of those Sheryl but they were talking $2500 US for basic cover. Can u reccomend anyone or PM me?

Yes I know you meant fee. But what is the per incident cover cap? I doubt it is 80k/day coverage nor 60K/day for surgeon - usually only room rates are listed per day. And even if it is (doubtful) there will still be an overall cap. Are these perhaps the coverage limits per episode/hospitalization? Because if so, not worth having.

You are not going to get decent coverage at age 52 for less than $2,500 a year unless you take a high deductible and/or copay. As I said before, best to work with an insurance broker. Think through first how much you can afford to pay.

Taking a lower premium in exchange for a deductible and copay will pay for itself in premium savings over the long run, if you have only infrequent claims. Of coursem you need to have the maximum amount iof potential out of pocket cost awavilable in cash ready at hand to do this.

Note that the copays usually have a maximum. For example, the policy that I have has a $750 deductible plus 20% co-pay after that up to a maximum out of pocket of $5,000 per year. This means that I have to pay the first $750 entirely myself and then 20% of the next $21,250 in costs (per year not per event) but if it reaches to more than $22,000 in a single year they are then paying 100%. I played with the numbers a bit and found it was more advantageous to me to accept copay than no copay and higher deductible, given that for a simple hospitalization not involving ICU care and with either no surgery or a relatively simple/routine surgery the cost in a private hospital would usually not exceed $7,000. So in such a scenario I would pay the $2,000 (the 750 deductible plus 20% of the remainder) and the insurance would pay $5,000. Whereas if I took 0 copay and $5,000 deductible I'd pay $5,000 and they'd pay only $2,000.

Many insurance companies have online calculators where you can find out the premium cost under different scenarios of deductible and copay. These are some of the international expat policies that have direct billing arrangements with Thai hospitals, listed in ascending order of cost:

Cigna (Silver Plan)

AXA PPP (Standard Plan)

Gloability Health Essential Plan

A+ Asia (underwritten by Allianz and AXA) Essential Plan

There are many others as well but I think those 4 are the least expensive. Note that except the last one which is limited to SE Asia the others cover you worldwide except for USA, so if you for example take a holiday to another country, you are still covered including costs of getting you back to Thailand if decent care is not available in the country where you fall ill/get injured (which in the case of places like Laos and Cambodia is an absolute necessity!). And the levels of cover are very high in all these policies is very ample - equivalent of 16 million baht a year on up.

You can google those policies and play around on the sites to see what premiums would be.

But if you are looking for something with premium less than $1,000 a year and sufficient coverage to be worth having, I can save you time -- even with deducibles and copays it does not exist, not internationally and not in Thailand either. There are Thai policies with such low premiums, but they have such low levels of coverage that I don't see the point in having them.

[Kenny202]

In my experience there is not a lot wrong, treatment wise, with the Government hospitals, and a lot of doctors actually work in both the Government and private hospitals.

OK, the conditions are nowhere near the private standards, but as long as you are getting decent treatment, I, personally, do not mind using the Government hospital.

I had to stay in for a week with a foot infection. I received 3 large doses of antibiotics daily, along with other medications, was fed everyday, (yes, not the Ritz, but palatable), excellent service from both doctors and nurses alike, and the total bill was 7,600 baht. With my experiences with RAM in my early days years ago, 1 anticipate this would well have exceeded 100,000 baht. I could have paid extra per day for a private room, but with Thais constantly visiting their relatives all day, I actually found them lovely people who were very friendly and helpful towards me, and it took away the monotony of being in a hospital bed for a week.

20,000 baht for mosquito bite infection is extortion, bearing in mind you probably received identical medication administered at Government hospitals.

this could depend possibly on which hospital u go to I guess. As a paying farang can I go to any govt hospital I choose or do I have to go to my local Amphur hospital?

[Sheryl]

Paying out of pocket you can go to any government hospital you like, anywhere.

It is only those covered by one of the government health schemes that are limited to the hospital they are registered at and need a referral from them to be treated under the plan elsewhere.

That said, government hospitals are government hospitals and unless they have a private channel (which an increasing number now do, especially in big cities) you will have to run a gauntlet to get to a specialist. One that often starts with a medical student. This process may well take several days and it is rare for a visit to a tertiary level government hospital to take less than a full day. If you live nearby and have more time than money this may be fine, but if you have to travel far, and/or if time for you is money, then private hospitals may actually be cheaper for you all things considered.

To give you an idea what I mean: I brought a Cambodian friend who needed open heart surgery to a major government teaching hospital. She had all test results/reports from Cambodia but that did not mean anything, we still had to start from square one. It took a full 5 days, 6-8 hours a day on each of them with endless waiting and lines, to finally get face to face with a cardiac surgeon. After which she had to go on to a waiting list to get the echocardiogram done required for them to decide she needed surgery and schedule her for it (then more waits of course).

All of that could have been done in a few hours on a single day at a private hospital.

You can usually get a head start on the process if you come with referral letter in hand from a lower level government hospital. So while it is not required if you are paying out of pocket, if you know you need specialist care it may be worth your while to give the local hospital a visit first.

[chubby]

even with obamacare, i sometimes wonder, if private insurance, private hospital in thailand, your still better off the being less than 65 in the USA , depending on what diagnosis and fate comes ones way .......