I don't quite understand how this market works, partially a consequence of living in the UK and getting NHS care, although we do have to increasingly queue for it & if service is unsatisfactory, well we have paid for it anyway via taxes. Similar to services in the Soviet Union, which also eventually fell apart.
All off topic, so getting back to the health insurance:
1 For private insurance, what happens if I take out an insurance policy at 60 & then get cancer when I am 62 ? (Or anything else requiring expensive ongoing support) Do the premiums go up like crazy when I am 63 or 65 ? If not, why not, if there is no 2-way binding contract ?
2 Alternatively, if I am tied in long term, what stops them increasing premiums at an unreasonable rate ? Or decreasing service ?
3 Normal insurance prices are based on the risk x cost during the insured term, plus/minus some profit based on competitive pressures in the market. So if I require a new policy at 55, in a competitive market, why would any insurer treat me differently to a customer who has been there 5 years & himself could easily move to another company ? In the case of car insurance, the best prices are usually achieved by moving every year (easy enough in the era of price comparision websites).
4 How much should we actually budget for health coverage during retirement ? I could take early retirement pretty much any time I like, but the main issue is to figure out how much safety margin I need for the risks. Medical costs is a big one.
Expat Health Insurance
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fountainhall
Re: Expat Health Insurance
I'm not an expert, but I have certainly learned a lot after being with three different companies. Let me try and answer your questions. Others will no doubt add their experiences and correct me if I’m wrong.
1. As far as I am aware all new medical insurance policies for those living outside their home countries have a pre-existing condition clause. As I understand it, this covers any condition known at the time the policy is taken out AND any condition which arises within a certain time period after the policy is taken out. I believe that period can change but in my case it was two years in one case and three years in another. So, in your example, you need to double check before taking out a policy.
2. Insurance companies prefer to deal with company policies because with a largish group of people there will be a mix of younger and older, healthy and less healthy etc. So the risk of big payouts is spread. What I was told by International Medical Group as I was complaining about my absurd premium increases is that an individual taking out a policy is put into a batch of other individuals and premiums are dependant on the claims history of that group. Premiums do not depend on each individual case. So if you have a serious long term illness, your history is lumped in with that of the others. Against that you as one of the individuals have no idea who else is in that arbitrary group. It could be they are mostly older people and therefore more susceptible to serious illness. I was told it's the luck of the draw. In my case, I suspect that either the company was merely screwing me, as they had others, in the belief that I might not be able to get cover elsewhere - or take the risk of getting cover elsewhere because there would be a new pre-existing condition waiting period - or, being charitable, I was in a group that happened to have a dreadful claims record, even though I had claimed almost nothing. I suspect, but have no proof, that it was the former in my case, if only because the "agent" told me he had never before seen premium increases of the magnitude of those I faced.
Having said all that, as far as I am aware there is zero guarantee about future premiums or decreased cover. You are in the hands of the insurance companies. And that is as good a reason as any for getting a wide range of advice from existing policy holders and checking with each company on their record of past increases and their projections for future rises in the 5-year bands.
You have a few options to minimize the effect rising premiums. Increase the deductible – i.e. the first Bt xxx of total claims per year. Avoid policies with deductibles per illness. You can also make quite a saving by giving up out-patient treatment. As I mentioned in my earlier post, you can use some of the savings to start your own separate medical fund to pay for this. Outpatient costs can be quite inexpensive in Thailand.
3. It is a fact of life that you are more likely to be ill as you get towards the end of middle age and into older age. My understanding of the medical insurance market is that if you are in your 50s you are far better to lock in to one company and stick with it. Changing policies always means you are stuck with the 2 or 3 year existing condition exclusion. So if you get cancer, have a brain tumour or a long-term chronic illness, you might not be covered. Also the older you are, the less a new policy is likely to cover. You might find that eyes are not covered because many older people need retina and cataract work. Colonoscopies, problems with joints etc. may not be covered – and so on.
Beware of policies out there which do not guarantee lifetime cover. I know of one which only provides cover till age 75. Thereafter it is entirely up to the insurer to decide whether or not to offer a new policy thereafter. Not only is that taking an unacceptable risk, you have no clue how high the premiums might be!
4. As for how much you should budget, this depends so much on how old you are and what sort of cover you want - in patient alone or outpatient and in-patient, private rooms, semi-private rooms or ward accommodation in hospitals, worldwide, worldwide but not North America etc. I have one friend who pays a premium of around US$2,000 but I don't know what that covers. I pay nearer $3,000. Another friend who is covered from BUPA in the UK but who had several major procedures like open heart surgery before coming to Thailand pays quite a bit more. He now requires a lot of regular medication. He reduced his premium by giving up the medication reimbursement. He now gets those directly from pharmacies in India at a fraction of the price (although he uses an indirect route to get them in as customs have in the past refused to permit them into the country!) Again you have to do your own research.
Since you are a UK resident, I'll add one point which might be useful for you. After I decided I had to cancel my disastrous IMG policy (IMG is based in the USA), I did the research I should have done a few years earlier. I also spoke to an old friend here in Bangkok. He's English and retired here about 10 years ago. He has an excellent insurance policy from a company in Exeter with very reasonable premiums. I got in touch with that company. They were extremely pleasant but said they had decided not to offer policies to those already living overseas. They added that if the policy is offered to someone in the UK who after a few years decides to move overseas, the policy will be continued. So you might check with various UK insurance issuers.
1. As far as I am aware all new medical insurance policies for those living outside their home countries have a pre-existing condition clause. As I understand it, this covers any condition known at the time the policy is taken out AND any condition which arises within a certain time period after the policy is taken out. I believe that period can change but in my case it was two years in one case and three years in another. So, in your example, you need to double check before taking out a policy.
2. Insurance companies prefer to deal with company policies because with a largish group of people there will be a mix of younger and older, healthy and less healthy etc. So the risk of big payouts is spread. What I was told by International Medical Group as I was complaining about my absurd premium increases is that an individual taking out a policy is put into a batch of other individuals and premiums are dependant on the claims history of that group. Premiums do not depend on each individual case. So if you have a serious long term illness, your history is lumped in with that of the others. Against that you as one of the individuals have no idea who else is in that arbitrary group. It could be they are mostly older people and therefore more susceptible to serious illness. I was told it's the luck of the draw. In my case, I suspect that either the company was merely screwing me, as they had others, in the belief that I might not be able to get cover elsewhere - or take the risk of getting cover elsewhere because there would be a new pre-existing condition waiting period - or, being charitable, I was in a group that happened to have a dreadful claims record, even though I had claimed almost nothing. I suspect, but have no proof, that it was the former in my case, if only because the "agent" told me he had never before seen premium increases of the magnitude of those I faced.
Having said all that, as far as I am aware there is zero guarantee about future premiums or decreased cover. You are in the hands of the insurance companies. And that is as good a reason as any for getting a wide range of advice from existing policy holders and checking with each company on their record of past increases and their projections for future rises in the 5-year bands.
You have a few options to minimize the effect rising premiums. Increase the deductible – i.e. the first Bt xxx of total claims per year. Avoid policies with deductibles per illness. You can also make quite a saving by giving up out-patient treatment. As I mentioned in my earlier post, you can use some of the savings to start your own separate medical fund to pay for this. Outpatient costs can be quite inexpensive in Thailand.
3. It is a fact of life that you are more likely to be ill as you get towards the end of middle age and into older age. My understanding of the medical insurance market is that if you are in your 50s you are far better to lock in to one company and stick with it. Changing policies always means you are stuck with the 2 or 3 year existing condition exclusion. So if you get cancer, have a brain tumour or a long-term chronic illness, you might not be covered. Also the older you are, the less a new policy is likely to cover. You might find that eyes are not covered because many older people need retina and cataract work. Colonoscopies, problems with joints etc. may not be covered – and so on.
Beware of policies out there which do not guarantee lifetime cover. I know of one which only provides cover till age 75. Thereafter it is entirely up to the insurer to decide whether or not to offer a new policy thereafter. Not only is that taking an unacceptable risk, you have no clue how high the premiums might be!
4. As for how much you should budget, this depends so much on how old you are and what sort of cover you want - in patient alone or outpatient and in-patient, private rooms, semi-private rooms or ward accommodation in hospitals, worldwide, worldwide but not North America etc. I have one friend who pays a premium of around US$2,000 but I don't know what that covers. I pay nearer $3,000. Another friend who is covered from BUPA in the UK but who had several major procedures like open heart surgery before coming to Thailand pays quite a bit more. He now requires a lot of regular medication. He reduced his premium by giving up the medication reimbursement. He now gets those directly from pharmacies in India at a fraction of the price (although he uses an indirect route to get them in as customs have in the past refused to permit them into the country!) Again you have to do your own research.
Since you are a UK resident, I'll add one point which might be useful for you. After I decided I had to cancel my disastrous IMG policy (IMG is based in the USA), I did the research I should have done a few years earlier. I also spoke to an old friend here in Bangkok. He's English and retired here about 10 years ago. He has an excellent insurance policy from a company in Exeter with very reasonable premiums. I got in touch with that company. They were extremely pleasant but said they had decided not to offer policies to those already living overseas. They added that if the policy is offered to someone in the UK who after a few years decides to move overseas, the policy will be continued. So you might check with various UK insurance issuers.
Re: Expat Health Insurance
Excellent posts, fountainhall, thanks a lot for the heads up! Goes to show that it's a good idea to reevaluate your policy vs what's available every once in a while (and not too late in one's life).
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fountainhall
Re: Expat Health Insurance
There are two other points worth stressing.
As others have mentioned, some policies are offered with very large annual limits - e.g. US$1 million or $500,000. I reckon if you are to be spending most of your time in Thailand, it's unlikely you'll need even $500,000 annual cover. But then if you retire early, you have to factor in inflation over what might be a 30 year period and find out if the insurers will increase the annual limit from time to time or not. Other policies, usually issued after you get to 60 or so I believe, may have a maximum lifetime limit. Clearly the older you are the more likely it is that a lifetime limit will be fine. But you really need to work out what you are likely to be doing in retirement. If you are travelling overseas a lot, then medical costs will mostly be considerably higher than in Thailand. So either you need a higher annual limit/lifetime limit with better overall limits on nightly hospital rates etc., or you have a lesser annual policy but also take out an annual travel insurance policy. My travel policy gives me $1 million of cover worldwide for unlimited trips of up to 90 days for a premium of just over $450 per year.
Secondly, as a UK citizen your right to return to the UK for elective NHS treatment will disappear after a number of years overseas (I think it is 6 but am not absolutely sure). It doesn't matter that you will have paid your national insurance contributions for the full term (as I have done), that right is eventually stripped from you! If you retain a UK address and bank account and stay on a doctor's list, there is a chance you can get away with it after the cut off year. I have a Hong Kong Chinese friend with a UK passport who got NHS treatment when a student in London and somehow has been able to continue to get treatment on the NHS whenever he needs it - and he's lived in Hong Kong most of his life. He's now 62! But it's a risk which I would not be prepared to take.
As others have mentioned, some policies are offered with very large annual limits - e.g. US$1 million or $500,000. I reckon if you are to be spending most of your time in Thailand, it's unlikely you'll need even $500,000 annual cover. But then if you retire early, you have to factor in inflation over what might be a 30 year period and find out if the insurers will increase the annual limit from time to time or not. Other policies, usually issued after you get to 60 or so I believe, may have a maximum lifetime limit. Clearly the older you are the more likely it is that a lifetime limit will be fine. But you really need to work out what you are likely to be doing in retirement. If you are travelling overseas a lot, then medical costs will mostly be considerably higher than in Thailand. So either you need a higher annual limit/lifetime limit with better overall limits on nightly hospital rates etc., or you have a lesser annual policy but also take out an annual travel insurance policy. My travel policy gives me $1 million of cover worldwide for unlimited trips of up to 90 days for a premium of just over $450 per year.
Secondly, as a UK citizen your right to return to the UK for elective NHS treatment will disappear after a number of years overseas (I think it is 6 but am not absolutely sure). It doesn't matter that you will have paid your national insurance contributions for the full term (as I have done), that right is eventually stripped from you! If you retain a UK address and bank account and stay on a doctor's list, there is a chance you can get away with it after the cut off year. I have a Hong Kong Chinese friend with a UK passport who got NHS treatment when a student in London and somehow has been able to continue to get treatment on the NHS whenever he needs it - and he's lived in Hong Kong most of his life. He's now 62! But it's a risk which I would not be prepared to take.
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Jun
Re: Expat Health Insurance
Being unlikely to need over $500,000 cover is one matter, but if one had an accident or a major issue and needed several weeks in intensive care, it is better that the money doesn't run out. I don't even understand what it would cost to pay for such a scenario.....fountainhall wrote:There are two other points worth stressing.
As others have mentioned, some policies are offered with very large annual limits - e.g. US$1 million or $500,000. I reckon if you are to be spending most of your time in Thailand, it's unlikely you'll need even $500,000 annual cover.
Anyhow, thank you for your advice on premiums. Something like $2~3000 per year doesn't frighten me. However, how does this tend to go up with age and previous claim history ?
The following link shows how NHS costs rise with age. Those figures clearly climb significantly past 70 and 80. Whilst Thai medical care should cost less, I still suppose the percentage increase in costs v age might be similar.
https://www.theguardian.com/society/201 ... t-over-65s
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fountainhall
Re: Expat Health Insurance
I can't give any definite advice on future costs and premiums. About 3 years ago I was informed that a quadruple heart bypass would cost around Bt. 1.2 million all in. I do not know which hospital those figures came from - and costs do vary. That's around US$35,000. A few weeks in intensive care will be considerably more, I'd expect. But please, please don't take my advice or that of others here. Get from the internet a list of hospitals in Bangkok or Pattaya or wherever you plan to retire, email them and ask them for a list of all-inclusive costs for various procedures - to include room and board, nursing, medications etc. and not just surgeons' and anaesthetists' fees.
And when talking with medical insurers, ask them for their fact sheets on future premiums as of that date. This should give the 5-year band premiums until at least 75. In the first policy I discussed in an earlier post, premiums peaked at 75. What you should remember is that annual medical inflation tends to rise by several percent more than general inflation. So factor in at least 5% increase per annum in addition to what you are being shown for future 5-year band premiums.
I hope others will correct me if any of this is different from the policies they hold.
And when talking with medical insurers, ask them for their fact sheets on future premiums as of that date. This should give the 5-year band premiums until at least 75. In the first policy I discussed in an earlier post, premiums peaked at 75. What you should remember is that annual medical inflation tends to rise by several percent more than general inflation. So factor in at least 5% increase per annum in addition to what you are being shown for future 5-year band premiums.
I hope others will correct me if any of this is different from the policies they hold.
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Jun
Re: Expat Health Insurance
Thank you for the advice you have shared.fountainhall wrote:I can't give any definite advice on future costs and premiums.
I'm hoping some of the more mature board members might be willing to advise on how insurance premiums rise with age.
Also, do the insurers refuse to renew or hike premiums the year after someone is diagnosed with heart trouble, cancer etc?
Medical costs are a big unknown for me.
In a hypothetical world of zero medical costs, I would probably take early retirement right now.
In the real world, I would like to know more about potential costs, so I can figure out how long to work to build a bigger nest egg.
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fountainhall
Re: Expat Health Insurance
Respectfully, given the complexity of this issue and the very different experiences members here will have, may I strongly suggest again that you first do your own research about costs at various hospitals here. Then check with 3 or 4 companies in the UK who provide medical insurance and ask them all the detailed questions you are asking here. I do believe you are far more likely to get more detailed answers pertinent to your particular circumstances than from input from a chat room. Once you are closer to making a decision, that I believe is the time to run a double check here against the experience of members. Starting here is the wrong way to go about it in my view.
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Jun
Re: Expat Health Insurance
If I was about to actually take out an insurance policy, I would agree with you.fountainhall wrote:Starting here is the wrong way to go about it in my view.
Since I'm still working to accumulate capital & am not actually in the market for medical insurance now, getting an overview of other people's experience is good at present.
Re: Expat Health Insurance
My Australian dollar is around US 0.75 so that premium amounts to $AU4000 for me and probably more in 2017. I would need to have a high deductible to get that coverage rate from the online quotes that I have seen. At least you have made some claims and they have paid. You look to have made a good choice of health providor and Insurance broker. Not many others seem to be keen to provide their experiences with actual health insurance claims.Undaunted wrote:For those living in Thailand I would like to recommend April Asia Expat Ins. I have been with them for 5years.
60+You need a doctors exam..Real doctor of your choice I used my internal med. Doctor at Bangkok Pattaya hospital.
Coverage for a callander year is 1 million U.S. And drops to $500,000 U.S. at 65 and above, no deductible, no waiting period, direct payment to hospital.
Coverage valid in all Asian countries as well as short stays abroad.
My premium is approx. $3,000 U.S. Per yr. can be paid in 2 installments credit cards excepted. Out patient coverage is available at extra cost.
My research from the thaivisa forum shows that some expat retirees are considering changing to the more expensive April Asia type international policies. They believe that they will be provided with a more relaible cover and for lifetime if joining at a reasonable age, mostly before 60yo. Joining a Thai based insurance company at around 60yo or more seems to give them many excuses to not provide cover because of existing or possible pre-existing conditions, increase the price for coverage whenever they deem necessary and dump you if you have an expensive claim. It certainly pays to do some research and check the fine print before signing up for a policy.
A quote from a well researched thaivisa.com poster about finding a suitable health policy:
"I suggest you sift through all that, make a list of your requirements and then contact a broker. But do not make final purchase without yourself reading and understanding the policy documents.
For example, my personal requirements are:
- will newly enroll someone my age
-guarantee of lifetime renewal provided premiums paid and no fraud on my part
-premium hikes based only on age and inflation, not affected by claims history or "risk profile"
-inpatient cover only but including day care in hospital, inc. cancer treatment etc
-no exclusion for chronic diseases
-if second opinion required, choice of physician for that i.e. not required to use doctor selected by insurance company. Preferrably second opinion not required or required only for a few specific things.
-direct payment arrangement with Thai hospitals"
http://www.thaivisa.com/forum/topic/953 ... or/?page=3
I have gauranteed and reliable lifetime health cover in Australia for currently under $AU2000 yearly. Price rises in coverage are controlled by a government agency and not at the whims of any particular company when you get to a certain age or claims history. I would like to retire to Thailand but when considering health care it seems to be more sensible to stay in Australia and go for regular holidays to Asia. Since I stopped working, any time over a month spent here in Australia certainly makes me look forward to traveling again. Still, as we all know, there are many advantages in being closer to our friends in Thailand and other parts of Asia on a full time basis. Thank you for the valuable information you guys have provided.