Health insurance: Your thoughts on deductibles and cost share

[Firefan]

Personally I would pick as high an deductible as I could afford (cash/credit card on hand). Not sure I would bother with the cost share part. I insure for the catastrophic (bankruptcy) level event - not for the small stuff, which I can handle without any big impact on my financial situation. Cheers! 

[4MyEgo]

3 hours 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. 

Sounds high IMO

[Sheryl]

2 hours ago, impulse said:

 

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?

 

 

This is basically correct except they do not drop you but rather raise your premiums so high (on an individual basis, not talking about age related hikes that affect everyone) that it forces you out.

 

BTW Pinot1 million baht is too low unless you are prepared to only use government hospitals

 

I don't know of any N American expat policies. US based policies are ridiculously expensive and focused on people living in the US. (The percent of US citizens who settle abroad is much lower than it is for people from the UK etc. Americans who want to retire in a warm climate are  likely to move within the US ) and I haven't heard of any Canadian expat policies (which doesn't mean there aren't any )

[impulse]

2 hours ago, lopburi3 said:

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.

 

Does that provide coverage in the USA?

 

I'm on an extension of a great (Euro based) health care plan, but it provides coverage just about everywhere except back home in the USA.  The upside is that it's about half the cost you've spelled out.  The bad news is that it complicates the decision of when to repatriate now that my Thailand work is over...  Especially with them messing around with Obamacare, which looked pretty good for covering pre-existing conditions.

 

[4MyEgo]

I went through the entire research thing for myself and what I found for someone at age 55 with a pre-existing condition which has had not changed, no issues in 10 years, the insurancer's won't touch me, not even with a 2 year non claim period or an excess, suffice to say I am not going to pay some insurer 80,000 baht per annum at 55, which increases every 5 years to exclude my pre-existing condition.

 

I figure that as I am in good health 'touch wood" and have at least 10 years in front of me before I start needing procedures, self insuring will provide me with about 1 million in the bank by then, and if something happens before hand well S..t happens as they say, I will just have to take it out of my savings, won't I.

 

So far two years here, a skin cancer on my face cut out by a plastic surgeon and has heeled with no scar, which cost me around 5,000 baht, a chest x-ray, a drip, both times a few hours in a public hospital for under 1,000 baht, so I am up 154,000 baht thus far 555 as opposed to having insurance cover, however if I didn't have extra funds to back me, I wouldn't recommend it.

[impulse]

7 minutes ago, Sheryl said:

BTW Impulse 1 million baht is too low unless you are prepared to only use government hospitals.

   

My 4x bypass was 2 million baht, all in.  (Would have been cheaper, but the insurance company negotiated and payed it and I let them...)

 

So I wouldn't consider 1 million baht to be adequate at all.  I suspect you're crediting another guy's post to me.

 

Edited November 2, 2017 by impulse

[lopburi3]

2 minutes ago, impulse said:

 

Does that provide coverage in the USA?

 

I'm on an extension of a great (Euro based) health care plan, but it provides coverage just about everywhere except back home in the USA.  The upside is that it's about half the cost you've spelled out.  The bad news is that it complicates the decision of when to repatriate now that my Thailand work is over...  Especially with them messing around with Obamacare, which looked pretty good for covering pre-existing conditions.

 

Yes - that is the reason for the high price.  But as said it is a policy for US Government employees with provisions for overseas treatment for those assigned or living overseas.  I doubt they have an open type program as they are mostly state plans rather than national.

[impulse]

2 minutes ago, 4MyEgo said:

So far two years here, a skin cancer on my face cut out by a plastic surgeon and has heeled with no scar, which cost me around 5,000 baht, a chest x-ray, a drip, both times a few hours in a public hospital for under 1,000 baht, so I am up 154,000 baht thus far 555 as opposed to having insurance cover, however if I didn't have extra funds to back me, I wouldn't recommend it.

 

Everyone's mileage varies, but I hadn't had a medical expense over $100 in the 10 years before I came to Thailand at age 54.  In the past 6+ years, I'm running right at $1,000 USD per month if you average it out- with most of that in one week and a 4x bypass.

 

I sure didn't expect it...

 

[impulse]

Just now, lopburi3 said:

Yes - that is the reason for the high price.  But as said it is a policy for US Government employees with provisions for overseas treatment for those assigned or living overseas.  I doubt they have an open type program as they are mostly state plans rather than national.

 

Cover in the USA does explain the high pricetag, though.  Last time I had private, self funded health insurance in the USA it was over $800 a month and that was over 7 years ago.

[Sheryl]

1 hour ago, Firefan said:

Personally I would pick as high an deductible as I could afford (cash/credit card on hand). Not sure I would bother with the cost share part. I insure for the catastrophic (bankruptcy) level event - not for the small stuff, which I can handle without any big impact on my financial situation. Cheers! 

You can usually get as much reduction in premium through  a lower deductible plus copay as with a very high deductible and it will usually be in  your interest to do so.

 

See example below - you would save more on bills up to  about 750,000 and the majority of hospitalizations do not exceed that. Above that threshold you pay just $750 more.

 

Health care cost in baht	5,000 deductible no copay	$750 deductible 20% copay up to 5000
50,000	$1,429	$886
100,000	$2,857	$1,171
200,000	$5,000	$1,743
300,000	$5,000	$2,314
400,000	$5,000	$2,886
500,000	$5,000	$3,457
600,000	$5,000	$4,029
700,000	$5,000	$4,600
800,000	$5,000	$5,171
900,000	$5,000	$5,743
1,000,000	$5,000	$5,750
1,500,000	$5,000	$5,750
2,000,000	$5,000	$5,750
2,500,000	$5,000	$5,750
3,000,000	$5,000	$5,750

 

 

[Sheryl]

15 minutes ago, 4MyEgo said:

I went through the entire research thing for myself and what I found for someone at age 55 with a pre-existing condition which has had not changed, no issues in 10 years, the insurancer's won't touch me, not even with a 2 year non claim period or an excess, suffice to say I am not going to pay some insurer 80,000 baht per annum at 55, which increases every 5 years to exclude my pre-existing condition.

 

I figure that as I am in good health 'touch wood" and have at least 10 years in front of me before I start needing procedures, self insuring will provide me with about 1 million in the bank by then, and if something happens before hand well S..t happens as they say, I will just have to take it out of my savings, won't I.

 

So far two years here, a skin cancer on my face cut out by a plastic surgeon and has heeled with no scar, which cost me around 5,000 baht, a chest x-ray, a drip, both times a few hours in a public hospital for under 1,000 baht, so I am up 154,000 baht thus far 555 as opposed to having insurance cover, however if I didn't have extra funds to back me, I wouldn't recommend it.

Did you try Cigna Global? Hard to believe no insurer will issue you a policy for pre-existing condition which has been stable for 10 years.  Though if the condition is cancer they might exclude that specific condition.

[4MyEgo]

9 minutes ago, impulse said:

 

Everyone's mileage varies, but I hadn't had a medical expense over $100 in the 10 years before I came to Thailand at age 54.  In the past 6+ years, I'm running right at $1,000 USD per month if you average it out- with most of that in one week and a 4x bypass.

 

I sure didn't expect it...

 

Got to feel for you, but at least your still with us, and yes insurance would have been worth it in your case, I had a single stent put in 10 years ago, and they don't won't to cover that pre-existing condition, even though my Cardiologist said your good for 20-30 as long as you eat right and excercise, so as much as its their right, its mine also, hopefully when I go its with a big bang so no out of pocket expense for me...lol

[JLCrab]

29 minutes ago, Sheryl said:

 

This is basically correct except they do not drop you but rather raise your premiums so high (on an individual basis, not talking about age related hikes that affect everyone) that it forces you out.

<snip>

This is a recurrent theme on here. It may be a discretionary call by the insurer but does it make a difference in their decision as to whether you have been a policy holder for for 3 years or for 20 years?

[impulse]

32 minutes ago, 4MyEgo said:

even though my Cardiologist said your good for 20-30 as long as you eat right and excercise, so as much as its their right, its mine also, hopefully when I go its with a big bang so no out of pocket expense for me...lol

 

Mine told me something similar, just before I insisted on going onto the next level of testing.   2 days later, I had the bypass.  That was 2 days waiting for the insurance company to approve the charges, BTW.

 

Lesson learned:  Get a second opinion in Thailand, even if the news is good.

 

[Sheryl]

30 minutes ago, JLCrab said:

This is a recurrent theme on here. It may be a discretionary call by the insurer but does it make a difference in their decision as to whether you have been a policy holder for for 3 years or for 20 years?

No. It is based on whether your "risk profile" has changed i.e. if they know you are likely to have future large claims because you have developed a chronic condition.

 

They do it because they can, the regulatory framework for health insurance i  Thailand is pretty loose and allows it. Not the case in most Western countries...after all it essentially subverts the entire purpose of insurance.

[Sheryl]

5 minutes ago, impulse said:

 

Mine told me something similar, just before I insisted on going onto the next level of testing.   2 days later, I had the bypass.  That was 2 days waiting for the insurance company to approve the charges, BTW.

 

Lesson learned:  Get a second opinion in Thailand, even if the news is good.

 

Having needed one stent you are at risk for future cardiac events (remember the stent is in one vessel only).

 

Also at higher than average risk for ischemic stroke as same underlying mechanism.

 

But I would think they'd insure with exclusions.

[4MyEgo]

56 minutes ago, Sheryl said:

Did you try Cigna Global? Hard to believe no insurer will issue you a policy for pre-existing condition which has been stable for 10 years.  Though if the condition is cancer they might exclude that specific condition.

Yes, that's what I though.

 

I have not had an issue since 6 June 2007 when I had the chest pain and the only way they could tell if my symptoms were a heart attack was to go in, so they went up and through my vein in my inner thigh and had "to perform primary angioplasty to the proximal left anterior descending artery" (reading straight of his letter to my GP) and I was advised that they unblocked the artery which had a clot blocking it, apparently it was a 95% blockage, or so I was told by his assistant, and if I went to sleep when the pain had subsided, I wouldn't have woken up, so good that I went to the hospital. 

 

My blood pressure, cholesterol and all other blood reading have been perfectly normal, talk about being hard done, yes.

 

I don't think I have tried Cigna Global, although I believe the broker I used did try Cigna and was advised that no, they wouldn't cover it but MSH International did, so I went with them only to read the exclusion when I got the policy, so I let the broker have it between the eyes for his misrepresentation/slip up in his words and got my money back after 2 months.

 

If you think they are worth a go, I might try them.

Edited November 2, 2017 by 4MyEgo

[4MyEgo]

20 minutes ago, impulse said:

 

Mine told me something similar, just before I insisted on going onto the next level of testing.   2 days later, I had the bypass.  That was 2 days waiting for the insurance company to approve the charges, BTW.

 

Lesson learned:  Get a second opinion in Thailand, even if the news is good.

 

Fortunately for me I was treated by an Australian Cardiologist in Sydney at the time of the event, i.e. 2007

[Rimmer]

An off topic post has been removed

[JLCrab]

1 hour ago, Sheryl said:

No. It is based on whether your "risk profile" has changed i.e. if they know you are likely to have future large claims because you have developed a chronic condition.

 

They do it because they can, the regulatory framework for health insurance i  Thailand is pretty loose and allows it. Not the case in most Western countries...after all it essentially subverts the entire purpose of insurance.

So now you say it is because you have developed a chronic condition. OK. Well I would still say that is a discretionary call. However, at least for BUPA, they are now owned by Aetna so, if that is the case, maybe that will change.

[Pinot]

3 hours ago, 4MyEgo said:

Sounds high IMO

I haven't found anything close, far cheaper than BUPA

[4MyEgo]

27 minutes ago, Pinot said:

I haven't found anything close, far cheaper than BUPA

I think I jumped in a little quick, didn't realise your age was 67, thinking 57, and its got life insurance so its not bad second looking

[up-country_sinclair]

12 hours ago, Sheryl said:

Hard to believe no insurer will issue you a policy for pre-existing condition

 

Would the removal of two small Basal cell carcinomas be considered a pre-existing condition that denies me coverage for other types of cancer?

Edited November 2, 2017 by up-country_sinclair

[impulse]

22 hours ago, Sheryl said:

Having needed one stent you are at risk for future cardiac events (remember the stent is in one vessel only).

 

Also at higher than average risk for ischemic stroke as same underlying mechanism.

 

But I would think they'd insure with exclusions.

 

Once again, you're confusing me with another poster.  I never got stents.  Other than high cholesterol, I never got any warnings before my bypass adventure.  All the more disturbing because I did quarterly EKG's and annual stress tests (in Thailand) for the 3 years preceding my surgery.

 

Posting this not so much to disagree with you, as to warn anyone in a similar situation in Thailand- get a second, independent opinion!

 

Edited November 3, 2017 by impulse

[JLCrab]

I had a chat with my BUPA rep. I said that there is a farang website where the Moderator of the Health Insurance forum says that BUPA and other Thai insurers will jack up the rates so high on an older person, even in good standing, following a big claim so that the policy holder will be likely drop the policy. 

 

She said: That's OK. They say a whole lot worse on (Thai language) Pantip.com
 

Edited November 3, 2017 by JLCrab

[Sheryl]

On 11/3/2017 at 12:55 AM, up-country_sinclair said:

 

Would the removal of two small Basal cell carcinomas be considered a pre-existing condition that denies me coverage for other types of cancer?

For non-skin cancers, it should not. But quite likely the policy will exclude skin cancers.

[up-country_sinclair]

^ Thanks.

[LuckyG]

On 11/2/2017 at 12:23 PM, Sheryl said:

You can usually get as much reduction in premium through  a lower deductible plus copay as with a very high deductible and it will usually be in  your interest to do so.

 

See example below - you would save more on bills up to  about 750,000 and the majority of hospitalizations do not exceed that. Above that threshold you pay just $750 more.

 

Health care cost in baht	5,000 deductible no copay	$750 deductible 20% copay up to 5000
50,000	$1,429	$886
100,000	$2,857	$1,171
200,000	$5,000	$1,743
300,000	$5,000	$2,314
400,000	$5,000	$2,886
500,000	$5,000	$3,457
600,000	$5,000	$4,029
700,000	$5,000	$4,600
800,000	$5,000	$5,171
900,000	$5,000	$5,743
1,000,000	$5,000	$5,750
1,500,000	$5,000	$5,750
2,000,000	$5,000	$5,750
2,500,000	$5,000	$5,750
3,000,000	$5,000	$5,750

 

 

What would the premiums for a TipTop Healthy 56 year old male, non-smoker, based on the total out of pocket risk shown on this chart?  and who is the insurer?

[up-country_sinclair]

On 11/10/2017 at 5:46 PM, Sheryl said:

For non-skin cancers, it should not. But quite likely the policy will exclude skin cancers.

 

I contacted Cigna and filled out the application, and they sent me a policy with the following exclusions:

 

SKIN LESIONS/ CHANGES and any associated or related conditions or symptoms and any complications (this exclusion can be reviewed at your first renewal)

 

Does this exclusion seem straightforward or are they leaving themselves a lot of wiggle room?  I've heard many horror stories about insurance companies, so I want to make sure that the above isn't a catch-all that include every type of cancer imaginable.

 

Thanks again for your assistance, Sheryl.  I don't have much experience in these matters, so it's greatly appreciated.

 

[stevenl]

9 hours ago, up-country_sinclair said:

 

I contacted Cigna and filled out the application, and they sent me a policy with the following exclusions:

 

SKIN LESIONS/ CHANGES and any associated or related conditions or symptoms and any complications (this exclusion can be reviewed at your first renewal)

 

Does this exclusion seem straightforward or are they leaving themselves a lot of wiggle room?  I've heard many horror stories about insurance companies, so I want to make sure that the above isn't a catch-all that include every type of cancer imaginable.

 

Thanks again for your assistance, Sheryl.  I don't have much experience in these matters, so it's greatly appreciated.

 

It clearly refers to skin issues only.

 

Don't forget to remind them about the review of this exclusion at the first renewal.