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Health insurance: Your thoughts on deductibles and cost share

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DUS    364

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

 

 

 

 

 

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lopburi3    4,708

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.

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DUS    364
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?

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HampiK    145

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.

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lopburi3    4,708
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.

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DUS    364
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!

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coops    78

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'.

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DUS    364
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

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coops    78
Posted (edited)

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 by coops
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impulse    11,992

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.

 

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DUS    364
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. 

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notrub    5

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.

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DUS    364

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. 

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simon43    5,928

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.

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