Health insurance: Your thoughts on deductibles and cost share

[DUS]

Hi,

 

I will need to sign up to a health insurance company and after lots of research have more or less reduced the list of providers to 1, Cigna. Whilst this almost sounds like "Job done! Mission accomplished!" I still haven´t come to terms with how to decide on the various premium options, i.e. the option of setting the amounts for annual deductibles as well as annual "out of pocket" cost sharing. 

 

Now, I can´t get my head around how to approach finding the right level of deductibles and/or cost share. So, whilst everyone is different and has different sets of priorities I would love to hear some thoughts on how I could approach that decision from a rational perspective. What are the questions that I should ask myself when deciding on these 2 variables? Any thoughts and comments will be greatly appreciated. 

 

In order to make it a little bit more transparent, here are just a handful of options (there are lots more available with CIGNA) that are currently presented to me:

 

 

Annual deductibles / Cost share in % up to 1,480  / Annual premium to pay

 

0 / 0 / 2,123

550 / 0 / 1,626

1,100 / 0 / 1,445

2,200 / 0 / 1,210

 

 

550 / 10% / 1,499

1,100 / 10% / 1,336

2,200 / 10% / 1,120

 

 

In the end, CIGNA offers deductibles of up to 7,400 per year plus cost share options of 10, 20 and 30% of up to a max of 3,370 out-of-pocket. In the end it is a massive list of possible combinations and that´s where I struggle. How to evaluate all these options from a "financial perspective"? Would you go for high deductibles and high OOP cost share just in order to bring down the annual premium so that you have cover for nothing but the most serious illnesses? Or would you personally opt for a more "balanced approach", meaning accepting higher annual premiums in return for lower annual deductibles etc? Well, at the moment I am so confused that I´m not even sure you guys understand what I try to say. :-)))

 

Lastly, another question re the maximum annual coverage: How much did you go for with your own policies? With CIGNA the options are GBP 650k, 1,3mn and unlimited. My feeling is that 650k should be enough for even the most expensive treatments here in Thailand but is that so?

 

Would be terrific to get your thoughts and comments on these questions.

 

Cheers

DUS

 

 

 

 

 

[lopburi3]

630k would not cover many procedures here in Thailand - my cost for one 10 day hospital stay/operation was more than one million baht and another of 400k for a one night stay - and many people have such bills.  So unless you plan to use the cheapest hospitals would probably select unlimited as two other options would not provide catastrophic protection and as one event could wipe the allowed yearly payment.  I would use deductible and cost share at higher levels rather than limit yearly coverage.

[DUS]

6 minutes ago, lopburi3 said:

630k would not cover many procedures here in Thailand - my cost for one 10 day hospital stay/operation was more than one million baht and another of 400k for a one night stay - and many people have such bills.  So unless you plan to use the cheapest hospitals would probably select unlimited as two other options would not provide catastrophic protection and as one event could wipe the allowed yearly payment.  I would use deductible and cost share at higher levels rather than limit yearly coverage.

630,000 Pounds is roughly 27mn TBH. Not enough?

[Blinky62]

630,000 Pounds is roughly 27mn TBH. Not enough?

€'s and Baht confusion!!!!


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[HampiK]

I think it depends, what your thinking is about your health. When you expect to have nothing then I would go with a higher deductible maybe 1'100 with 30% own cost-share.

 

You always should calculate the deductibles and cost-shares that you are able to pay this amount. If you have enough cash on hand, that you not have a problem to pay then you can safe some money as long you not have an incident. Normally I would guess if you have nothing for about 2-3 years you already are better of with higher deductibles. But if you have something every year which is near your deductibles or higher.. .then you are better off with almost 0 deductibles.

 

I am also checking for myself, which I need in November.. Cigna is as well on my list of the favorites... But at the moment AXA PPP is little bit better than the Cigna in my opinion, as long you not have any pre-existing conditions. Because AXA exclude everything and Cigna is a little bit more flexible with this.

[lopburi3]

9 hours ago, DUS said:

630,000 Pounds is roughly 27mn TBH. Not enough?

Sorry was reading too fast when got to that point and indeed missed the GBP and believed we were talking baht.  In that case it would probably be a good choice.

[DUS]

On 17.8.2017 at 7:44 AM, lopburi3 said:

Sorry was reading too fast when got to that point and indeed missed the GBP and believed we were talking baht.  In that case it would probably be a good choice.

Ok, good to know. Happy to hear that 27mn should provide sufficient cover.

 

Now, if I only were able to make "financial sense" of all the various options on offer (deductibles etc). But HampiK provided some valuable input already. Thanks for this!

[coops]

Would definitely have helped to specify what currency you're using... I kind of guessed you were using US $ by default until the GBP total coverage part.

 

Just to state the 'obvious' but the "GBP 650k, 1,3mn and unlimited" refers to life time allowable total coverage... and an expensive chronic illness will add up with the prescription drugs - so the 650k in UK sterling is ok-ish... but maybe the 1.3m would be more advisable?

 

It won't be easy to decide how much deductible and % pay etc... 'up to you' it really is (!) but i'd be tempted to discard the 10% options just to make the final choice 'easier' ;-)

 

I'm lucky enough to have Cigna insurance through work ( no deductible, no co-pay or whatever that's called - outside the USA) so the side of the decision was already taken - but can tell you i've not had any issues with Cigna and no need to 'pay and claim back'.

[DUS]

4 hours ago, coops said:

Would definitely have helped to specify what currency you're using... I kind of guessed you were using US $ by default until the GBP total coverage part.

 

Just to state the 'obvious' but the "GBP 650k, 1,3mn and unlimited" refers to life time allowable total coverage... and an expensive chronic illness will add up with the prescription drugs - so the 650k in UK sterling is ok-ish... but maybe the 1.3m would be more advisable?

 

It won't be easy to decide how much deductible and % pay etc... 'up to you' it really is (!) but i'd be tempted to discard the 10% options just to make the final choice 'easier' ;-)

 

I'm lucky enough to have Cigna insurance through work ( no deductible, no co-pay or whatever that's called - outside the USA) so the side of the decision was already taken - but can tell you i've not had any issues with Cigna and no need to 'pay and claim back'.

 

Hi coopys,

 

Thank you for your comments! It´s great to hear that you haven´t had any issues with regards to any claims you made.

 

As for your "obvious", I´m not so sure you are correct. Cigna specifically speaks of "overall annual benefit" as well as "Annual benefit - maximum per beneficiary per period of cover", with the latter, "the period of cover" always being 12 months. Where did you get the idea/info it was a lifetime allowance?

 

DUS

 

 

Annual beneft - maximum per beneficiary per period of cover

[coops]

It's specifically stated as 2 million US lifetime per person - but that is on my plan... if yours is genuinely a maximum per year then the lower limit makes more sense

Edited August 19, 2017 by coops

[impulse]

While the cover and premiums are important factors, you also need to ask existing and previous customers which ones are going to drop you like a rock or jack up your premiums when you're diagnosed with something that's going to require years of expensive treatment.  Just when you need it most.

 

 And it's one thing to be covered under an employer policy where your bad years are offset by dozens (hundreds?) of your co-workers who are healthy.  It's very different when you're on an individual policy and they're running the numbers on you alone.

 

Sadly, I don't have the answers.  But coming from the land of the free, home of the brave, a lifetime of fighting with insurance companies has taught me some of the questions that people covered under national health systems never had to learn.

 

Caveat emptor.  Get some input from actual customers who have had massive claims over several years, not just numbers from the brochures.

 

[DUS]

5 hours ago, coops said:

It's specifically stated as 2 million US lifetime per person - but that is on my plan... if yours is genuinely a maximum per year then the lower limit makes more sense

 

Ok, thanks for your clarification. I will check again with the insurance company but it seems to me that the lifetime allowance is a specific agreement between the insurance company and your employer. 

[notrub]

I am also looking at health insurance here.  I have a retirement visa.  I have heard that this will be compulsory before long.  True?  I am 69 and healthy.  Your figures with costs etc are in what currency please?  I have been told by a German doctor that Cigna is the best bet here in Thailand.  Thanks for any info.

[DUS]

The premiums quoted above are in Euros but the coverage I quoted (650k) is in British Pounds.

 

Obviously, premiums will differ depending on age. 

 

As far as your question re compulsory health insurance is concerned: to the best of my knowledge this (as of today)'is only in conjunction with the new "10 year visa" introduced just recently. 

[simon43]

I always thought that deductibles were a good idea, to keep the insurance premium cost down.

 

But  2 years, whilst working in Thailand, I had a BUPA Thailand policy, with no deductible.

 

At some point, I became ill with what seemed to be Dengue fever.  Had I opted for an insurance policy with an excess/deductible, then I would have stayed at home and tried to recover without the assistance of a hospital.  But the fact that I had zero deductible meant that I went straight (staggered straight) to Phuket International Hospital and was admitted straightaway, being placed on IV drips and taken good care of by the cute nurses.

 

So for me, having a deductible sounds like a good idea on paper, but isn't really a good idea, in that it encourages me not to seek medical treatment for an illness that might turn out to be rather serious.  With zero deductible, you can just go to the hospital and be admitted for tests.  

 

Note - hospitals are very happy to admit you, rather than provide these tests as an outpatient, because they know that many medical insurance policies will not pay out for OP tests/treatment.

[DUS]

11 minutes ago, simon43 said:

 So for me, having a deductible sounds like a good idea on paper, but isn't really a good idea, in that it encourages me not to seek medical treatment for an illness that might turn out to be rather serious.  With zero deductible, you can just go to the hospital and be admitted for tests.  

 

Note - hospitals are very happy to admit you, rather than provide these tests as an outpatient, because they know that many medical insurance policies will not pay out for OP tests/treatment.

It's a fair point you're making here. Having said that unless you opt for OPC you will always have to foot the bill for a consultation and treatment as an outpatient yourself (regardless of any deductibles etc).

 

I have a friend who is paying a high premium for OPC with his insurance company so that he won't delay going for a consultation just to avoid paying for it. Personally, I think the premiums the companies are claiming for OPC are unattractively high, especially given the fairly cheap cost for a consultation and basic treatment here in TH.

 

If we were talking about a 20-30% increase on top of the general medical insurance coverage then I might seriously consider OPC. But with OPC premiums being almost as high as the "main" insurance I cannot see myself opting for it.

[impulse]

2 minutes ago, DUS said:

It's a fair point you're making here. Having said that unless you opt for OPC you will always have to foot the bill for a consultation and treatment as an outpatient yourself (regardless of any deductibles etc).

 

I have a friend who is paying a high premium for OPC with his insurance company so that he won't delay going for a consultation just to avoid paying for it. Personally, I think the premiums the companies are claiming for OPC are unattractively high, especially given the fairly cheap cost for a consultation and basic treatment here in TH.

 

If we were talking about a 20-30% increase on top of the general medical insurance coverage then I might seriously consider OPC. But with OPC premiums being almost as high as the "main" insurance I cannot see myself opting for it.

 

And a lot has to do with personal choice and the discipline (and wherewithal) to suck it up and go in even if you have to pay out of pocket.  Different folks have different needs and different idiosyncrasies.  For me, being 100% covered feeds into a little bit of the hypochondriac in me.  But that's just me. 

 

 

[cmsally]

I always thought that the high cost of Outpatient on insurance was due to things such as kidney dialysis, which is often done on outpatient basis. I don't know for sure but seemed logical as something like that is costly and long term.  ??

[DUS]

42 minutes ago, cmsally said:

I always thought that the high cost of Outpatient on insurance was due to things such as kidney dialysis, which is often done on outpatient basis. I don't know for sure but seemed logical as something like that is costly and long term.  ??

You need to check with the individual insurance company. As for CIGNA chronic diseases/treatments such as kidney dialysis as well as diabetes will be covered without OPC as long as it isn't  a pre-existing condition.

[scubascuba3]

The thing to do is ask how much your premiums will be in 10/20/30 years when you need it most. See if its still affordable and worth it for you, everyone is different.

[DUS]

4 minutes ago, scubascuba3 said:

The thing to do is ask how much your premiums will be in 10/20/30 years when you need it most. See if its still affordable and worth it for you, everyone is different.

Hehe.... yes, if your crystal ball gives you the answers to those questions then please let me know. I might want to buy one of the same brand as well then.... ;-)))

[simon43]

When I went to the hospital with a fever, the doctor wanted to do some out-patient tests, (which would not be covered by my insurance).  I explained this and the doctor immediately said 'We must admit you for these tests...'  :)  The subsequent cost of these tests (and my stay in the hospital) were 100% paid by my insurance company - no need even to prepay and claim back later.

[impulse]

59 minutes ago, simon43 said:

When I went to the hospital with a fever, the doctor wanted to do some out-patient tests, (which would not be covered by my insurance).  I explained this and the doctor immediately said 'We must admit you for these tests...'  :)  The subsequent cost of these tests (and my stay in the hospital) were 100% paid by my insurance company - no need even to prepay and claim back later.

 

You do know your insurance company monitors your social media posts?

 

Just kidding.  Or am I?

 

 

 

[simon43]

You do know your insurance company monitors your social media posts?

 

Not a problem.  It was a medical decision to admit me....

[up-country_sinclair]

Right now I'm seriously considering going with Cigna Silver with a high deductible ($3,000) and high cost share (30%, OOP $5,000).

 

I'm 50 years old and in very good health. I know that could change in an instant, but up to this point in my life I have had very few health issues that required medical care.  The main reason I'm getting health insurance is that I don't want my savings wiped out if something does go very wrong.  Of course I don't want to pay $8,000, but at this point of my life I think this is a reasonable path to take.  But I'm willing to listen if you think I'm not thinking clearly or being foolish. 

 

Another poster on this thread recommended that people should talk to other people who have experience with the insurance company that they're considering.

 

Does anyone here have direct experience with Cigna and Thai hospitals?

 

Thanks very much.  

 

 

Edited November 1, 2017 by up-country_sinclair

[lopburi3]

No experience with that insurance but paid 1.1 million baht for about 10 days/op in Thai hospital last year and about 100k in follow up tests.  Paid 380 thousand for one night stay/op a few years ago.  Paid 100k that same year for another 3 day stay/op.  Paid another 70k for IOL/cataract removals.  Another 100k plus for various skin cancer removals.  

 

If you get older you are very likely to have expenses - although you may (with luck) have some years before they start to hit.

[Sheryl]

All the reports I have heard from people with Cigna Global have been positive and I switched to it myself a year ago, in my case $750 deductible and 20% copay up to maximum OOP $5000.

 

How much deductible you should accept depends  on how much money you can afford to put aside for health care costs  and  be able to replenish.

 

In thinking that through it is important to note that, while they guarantee lifetime cover, they do not guarantee  to cover you at a lower deductible/co pay than what you originally apply for. In practice, if you later want to reduce your maximum OOP and have had no claims or only claims for clearly one-time things, they will usually agree, but they may very well refuse if you have developed any chronic conditions or had claims of a type likely to recur - or, they may agree but exclude those conditions from the lower OOP.

 

So think not just of what you can afford now but what you will be able to afford 20, 30 years from now.

[Pinot]

I find this thread tough to follow. 

 

My wife has recently become a representative of one of the largest healthcare insurers in LOS. I'd be happy to give a quote to anyone with a couple of choices in plans that are more economical than stated above (I think) . I need your name, age and email address. 

 

I've just bought a policy that covers up to a million baht per incident. I'm 67 and the total cost is 74,000 baht a year and includes an accident and death policy. 

[impulse]

55 minutes ago, Pinot said:

I find this thread tough to follow. 

 

My wife has recently become a representative of one of the largest healthcare insurers in LOS. I'd be happy to give a quote to anyone with a couple of choices in plans that are more economical than stated above (I think) . I need your name, age and email address. 

 

I've just bought a policy that covers up to a million baht per incident. I'm 67 and the total cost is 74,000 baht a year and includes an accident and death policy. 

 

As I understand it, the issue with Thai based insurance companies is that there is no guaranty they won't drop you like a rock if they figure you're going to need expensive services going forward.  Which leaves you with no insurance and a (now) pre-existing condition that will prevent you from getting anyone else to cover that condition.

 

I'd hate to find myself with cancer that may require years of treatment only to be dropped by my insurer when my annual policy comes up for renewal.  And good luck finding another policy that will cover it.

 

Again, I'm not holding myself out as an insurance guy, but most posts I've read seem to indicate that Euro based insurance companies are subject to higher standards when it comes to continuing to cover people who come up with long term health care issues.  (Edit:  I'd be interested in feedback about N. American based companies, but I don't read too much input about any of them, good or bad)

 

Anyone else have more insight?

 

Edited November 2, 2017 by impulse

[lopburi3]

Not for open membership but have US Blue Shield/Blue Cross insurance which allows direct payment to selected hospitals here and have had good experience with them.  But if paying fully myself (and allowed which do not believe any open to public) cost would be about $750 per month (single) or $1500 (two) for unlimited/unrestricted coverage so it should be good.  Overseas they use AXA as their agent.

Edited November 2, 2017 by lopburi3