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[jfchandler]

Thanks for the comment Jazzbo... I'm certainly willing to view this with an open mind... but...

An LTC has the advantage of one making relatively modest monthly payments, and saving one's capital resources for hopefully better-earning uses.

A bank annuity, if we're thinking about the same thing, involves one putting up a substantial amount of capital at the outset, and then basically locking that into the annuity. And, the amount of the annuity would need to be large enough to generate an income flow sufficient to cover monthly care expenses.

I'm thinking, the amount of capital one would need to put into such an annuity would need to be pretty darn large in order to generate a sufficient income stream to accommodate long-term care expenses, even in Thailand.

And then, what about the years when hopefully one doesn't need any long-term care?? What is happening with the annuity proceeds during that period?

And further, right now, I'd imagine the return that any Thai banks would pay on an annuity would be pretty miserably low. And I'm guessing they'd also be taxed in Thailand as well.

All in all, it's hard for me to see how an annuity would be any kind of advantage over a traditional LTC policy, which one could price and match the benefit amount to be suitable for expenses in Thailand.

[jazzbo]

well JFC I suggested some variation on an annuity (maybe without the big upfront load and with periodic contributions) because as of today, annuities exist in the USA and Thailand; and LTC at least in Thailand and in the mode described TTBOMK does not exist... and again, finding something like 24 hour live-in care will not be that expensive in Thailand vs. Western countries.

[jfchandler]

Re the availability of LTC here in LOS...

I had a state government based LTC back in the U.S., but I dropped it when I moved here, because they would not pay any benefits outside of the U.S. -- why, I can't figure, because in the case of Thailand, as you pointed out, any obligation would clearly be less costly than the comparable service provided in the U.S. And I'd think most non-U.S. residences would involve lower prospective costs compared to U.S. services.

In checking with my pretty good Thai insurance broker here, she searched around, and came up with some life insurance options that included some care benefits ... but nothing Thai based that was solely LTC...

However, my ex in the U.S. is/was an insurance broker, and while she personally doesn't deal with LTC, she checked and advised me that a number of different international insurance companies offer LTC policies that supposedly would pay benefits regardless of where they live, including outside the U.S. ...  That's the topic, I need to get more info on through personal research and checking.

[dieter1]

jfchandler

yes, you are right. There is a big chance, that you will need Long-Term-Care outside the hospital.
And someone has to pay for this. (beside the bills for the hospital)

"I presume the reason for that situation in Thailand is society here still thinks of those kinds of care obligations being handled by relatives (or simply not being provided at all). "

As in  other societies (western) the old family system in Thailand  is eroding (disintegration) at a  very fast speed ! Family members are already split up and are not living together anymore. It is sometimes even worth, compared to western societies, cause many parents do not live together with their (young!)children any more. Parents move to the big cities , leaving their children back.

And: The young adults, do not have that many children like their parents. So in the future, they will be not many young people, who can take care for the old ones. And, beside this, most people will be still poor, so will not be able to pay for long-time -care.

[jazzbo]

Kuhn D.: Yes, you are right. There is a big chance, that you will need Long-Term-Care outside the hospital...And someone has to pay for this. (beside the bills for the hospital)

A Kiplinger report in the USA says the chance that a person in the USA over age 65 sometime needing LTC is about 70%. So IMHO when an event has a 70% chance of occurrence, you really are talking more about financing than insurance... which is why I tend to look at LTC as closer to an annuity situation than true insurance especially since such LTC product is not currently available here in the Kingdom...

... but there may be options.

[BSJ]

jfchandler, on 2009-11-26 12:11:26, said:

I'm not a lawyer, but I believe they mean, 20M baht is the maximum they will pay for my covered medical expenses for anything and everything under my coverage with that policy, however long it may be in effect.

BSJ, on 2009-11-26 03:19:07, said:

Hi jfchandler, you said "Age 50 male, 5 million baht maximum per event, 20 million lifetime,".  The 20 million (baht?) lifetime....is that your lifetime?  Or do you mean lifetime of the policy?

Thanks for clarifying that!

* For those in the U.S.A. that think a national health scheme is the panacea to all ill's (no pun intended),  you may be sadely mistaken!

[sceadugenga]

sanook2me, on 2009-11-18 09:13:52, said:

I didn't see fingers crossed and hope.. on your survey.

No one would be that stupid, and if they were they would never admit it anyway...  

[dieter1]

jazzbo

yes, I think you are right: If there is a 70 percent chance , you do not need insurence, you need a way of financing !

(especially, because for insurance, you will have to pay for their profit, for bureaucracy etc.)

In my country, it is a kind of "insurance", everybody has to have. Mostly it is kind of non-profit state regulated insurance.
You have to pay for the old ones know and hope, that the next generation will pay for you (or is able to pay for you) when you will need it. They call it contract of generations (because it simple means, that young people pay for the old people)

In fact these kind of insurance do have a smaller percentage of using money for bureaucracy, compared to profit orientated insurance.

[timekeeper]

Jingthing, on 2009-11-18 15:18:54, said:

In retrospect, based on the anemic response to this poll so far, it seems titling this  "Grand" was a tad bit presumptuous. I am curious to know roughly what percentage of expats here carry ANY kind of health insurance good in Thailand. If I had to guess I would say under 50 percent.

i have top coverage plan with William Russell
its worldwide but i choose to exclude USA as it discounts the plan significantly
i pay £104 a month

[jfchandler]

If you're going to talk about an insurance company and their pricing, you really need to add what age range that premium applies to, and some kind of info on the extent of the policy's coverage in terms of either per event maximum or nightly hospital benefit, and including or excluding OPD.

Otherwise, tossing in 104 pounds a month is pretty meaningless...

timekeeper, on 2009-11-29 08:25:02, said:

i have top coverage plan with William Russell
its worldwide but i choose to exclude USA as it discounts the plan significantly
i pay £104 a month

[Jingthing]

joelietz, on 2010-03-13 02:12:59, said:

I wonder who you're insured with because that sounds like an excellent policy you signed onto. I'm retired and I have regular medicare coverage and also a good medicare supplement plan that just provides extra coverage. I want to retire in Thailand but I'm not sure if American policies actually cover much over here. I have to do a lot more research before I settle here for good, I think.

tonititan, on 2009-11-18 15:27:01, said:

I am fully covered by my employer (and my dependents would be too, if I had any).  The coverage is excellent.  I go to one of the nicer private hospitals, and my insurance almost always covers everything.  No complaints here.

US Medicare covers NOTHING outside the US.

[thaiericsweden]

A few points that members should note when looking at local health insurances.
Cheaper overall premiums with corresponding lower coverage limits.
Health cover benefits are very generous when compared to premiums charged.

Many plans include a range of sub-limits to costs of treatment, such as Surgeons Fees, Hospital General Expenses, Room and Board, Ambulance….etc.
Premium rates do not reflect the actual cost of insuring persons at each age group because premium rates are not adjusted annually to compensate for changing medical costs and inflation.

Renewal Premium rates are not guaranteed. If you are a healthy person with no claims, you can expect to pay the same premiums as other persons in your age group.
If you are sick and have claims that have cost the insurance company money, your renewal premiums will be loaded by a percentage based on the size of the claims incurred by the Insurance Company.
These loadings can range anywhere from 10% to 25% by reputable companies and 10% to over 100% by a few less-than-reputable companies.
Loadings are applied each year as a factor to the basic premium you pay.
In later years, these loadings are compounded for each significant claim paid by the Insurance Co.
In a worst-case-scenario, you could be paying a higher premium for a "cheap" local health insurance than a million dollar plan from overseas.

Renewal of your Local Health Insurance is not automatic. The policy is year by year. If the Insurance Company decides not to renew your policy, they have the right to refuse renewal. This is allowed by the Office of Insurance Commission.

Local Health Insurances have time limits on travel outside of Thailand; some companies limit you to 90 days travel each year.

[HampiK]

Insurance i think is a very difficult part.

I also checked many insurance already. I have to agree with some posters, that you need an insurance for the bigger problems, lets say above 100'000 Baht.
I am lookiing for something still not to expensive (cheaper than 150$ per month) if cheaper then better, but should be a good one, and also make sure, that they would give you a renew if you become 60 and older.

I checked a few out.. but it seems very complicated.. Good for me i still have a few years (5) till i need this.. but want to start look, so i can put this in my calculation.

[bbradsby]

Thanks to the OP, great subject!

Currently looking for a healthcare solution, and am considering self-insurance/no insurance depending on your definition. In the US, as an entrepreneur, am paying USD $900/month for me, wifey & 10 year old son... all healthy. ridiculous. So, if I put 12 months' worth in an interest-bearing instrument now, and pay half $500/month, I could cover pretty much anything via cash payment to a local expat hospital. I call that self-insured, with a bonus to my son when I head off to that great Temple BBQ. And NO buying into the insurance racket.

Few other items:
First, the best insurance here will still not get you physically to a hospital with Western-spec cardiologist on-time if you have a heart attack, based on emergency response system here and the typical traffic. No one here can or works to get out of the way of an ambulance!  If this is a risk for you, address it as best you can!

Second, if you do have a motorbike accident and go to a local clinic, be sure to track your wounds' progress daily - I almost lost a leg or worse due to some miniscule gravelly bits not being completely cleaned out from a low-speed biff. Can you say gangrene?

Best,

-bruce bradsby

[jazzbo]

Your definition of self-insured is essentially betting against the house -- who in large measure are the actuaries at Lloyd's of London...  You are betting that you can build up a large enough reserve to cover you and your family before any eventuality strikes...

Excellent coverage for three 60 year-olds in Thailand is available for a lot less than $900 per month let alone your health family... maybe you should re-assess your coverage.

[bbradsby]

jazzbo, on 2010-08-28 18:07:46, said:

...Excellent coverage for three 60 year-olds in Thailand is available for a lot less than $900 per month let alone your health family... maybe you should re-assess your coverage.

My insurance at US $900 at present is for Stateside coverage. I've gone through in-patient overnight stay procedures at one of the best expat hospitals in BKK, paying cash - and it was equal credentials, better facilities, better service, private room, better attitudes all 'round, better looking nurses and more of them taking care of me, as compared to my comparable experiences in the San Francisco Bay Area hospitals. Much cheaper!  

So if I put one years' worth of premiums in a CD or similar, and add monthly contributions, I should be golden very soon. Possibly a catastrophic coverage (high deductible) policy here in LOS until a threshold balance is achieved would be advisable.

-bruce

[jazzbo]

Once again ... there are many who not only are 'golden' and have in cash exceeding what you call a 'threshold balance' but could donate a new wing to the hospital and they still buy health insurance as they see it as a prudent deal -- as you will often hear here -- up to you  

... there is always the random possibility especially with a wife and son that 'very soon' is not soon enough ...

BTW it is my personal opinion that purchasing out-patient coverage in Thailand is silly given the cost of treatment -- you are just 'swapping dollars' with the insurer. I purchase in-patient coverage only in Thailand and it has served me well.

Edited by jazzbo, 2010-08-30 05:05:27.

[samran]

jazzbo, on 2010-08-30 05:00:06, said:

Once again ... there are many who not only are 'golden' and have in cash exceeding what you call a 'threshold balance' but could donate a new wing to the hospital and they still buy health insurance as they see it as a prudent deal -- as you will often hear here -- up to you  

... there is always the random possibility especially with a wife and son that 'very soon' is not soon enough ...

BTW it is my personal opinion that purchasing out-patient coverage in Thailand is silly given the cost of treatment -- you are just 'swapping dollars' with the insurer. I purchase in-patient coverage only in Thailand and it has served me well.

Agree. Complete inpatient coverage is essential though, in my book. My daughter recently needed care that approached $600-700K all told. Gawd knows where we'd be without good coverage.

[Pib]

Tricare Standard Overseas (for U.S. military retirees and their dependents).  Pays 75% of allowable costs; your cost share is 25%.  A few items are reimbursed at 100%/no cost share.  No yearly premium with an annual deductible of $150 per individual/$300 for entire family.  And there is a yearly family catastrophic cap of  3,000 USD.  Generally, you can use any hospital/doctor without preapproval.  You have to pay the 100% of the bill when checking out of the hospital,  but there are about 10 hospitals in Thailand (mostly in Bangkok) that have an agreement with Tricare that the hospitals will not require 100% payment on checkout; instead, you pay 25% of the bill, they issue you a total bill for claim submission purposes, and will wait X-amount of months for you to submit your claim to Tricare for your 75% reimbursement...then you go back and pay the hospital the outstanding amount...or they start legal action against your.    This reimbursement agreement is on a preapproval basis with the hospital.     But generally, Tricare Standard boils down to 75% reimbursement for allowable charges after the yearly deductible is met; and usually 100% payment on hosptial/clinic checkout unless the hospital/clinic are willing to trust you and wait for you to file your claim, get reimbused, and pay the outstanding bill amount.