Private Health Insurance - save instead

[Sheryn]

Really hard decision to choose whether to go in a medical fund or not IMHO...especially when young.

There are lots of times where you should select 'public patient' and a few times where you should select 'private patient'.

Even if you choose 'private' in a 'public' hospital you are not guaranteed a private room and vice versa - you could be in a private hospital and end up in a 2 or 4 bed room.

If you are young and healthy and have the ability to save and earn less than the wage that you have to pay additional medicare charges than go without it.

After all you are in Australia.


If you go overseas = you would be risking a lot if you did not take out travelling medical insurance. IMHO

Now let us get down to the 'nitty gritty' - you have a non-life threatening condition requiring a surgical operation

In a public hospital, you will wait months if not years and it may be cancelled the night before operation DUE to lack of public beds.

You most likely have taken holidays and organised family to help with house and kids whilst recoverign for operation.

Private - Surgeon can book you in on his/her Operating Theatre surgical list and it is not generally cancelled unless the Surgeon has overbook in other words Surgeon is in control - in a private hospital.

Medical condition - public hospital you have to be admitted via Emergency Department - Your Doctor sends you up to be assessed by Registars/resident Doctors.

EMERGENCY DEPARTMENT DOCTORS are the 'gate keepers' as to whether you get a bed in a public hospital or not.

Private Hospital - Your Doctor rings up Supervisor and says I would like to admit Mr or Mrs XX with XX and Supervisor says OK we have a bed (or they may say we will admit patient in Surgical and transfer to Medical tomorrow) - Bottom line you get a bed.

IMAGINE - you are really sick feel like death and in pain and they say there is no bed and you can go home - ring your family up to come and get you.

CONTROL - you are really sick and in pain and when ED says you are to go home - you say to ED Doctor - Get me a bed in a private hospital I am too sick to go home.

Risk management - you take out car insurance (green slip is compulsory - comprehensive insurance is your choice), house insurance, contents insurance, landlords insurance etc are all your choice.

I could do with orthodontic surgery to replace a tooth that had to be removed cost is about 10 -15K as far as I am concerned 10 -15 K buys me a good second hand car. The lack of a tooth does not cause me any pain it is cosmetic.

If on the other hand I required hip surgery cost 15K + / + stint in rehab unit and I am 60 years of age and in poor health - I may be way down the Operating Theatre priority list due to my lifestyle (especially if a smoker and a drinker - IMHO).

I would need to be in a private health fund so I could say to my Doctor - I am a private patient - can I have a written quote as to your charges, who is the Anaestist, as I need to obtain a written quote off them as well. I will contact my private insurance and see if I have 'gap cover' for the hospital.

RISK MANAGEMENT + knowledge = choice otherwise you react to fear.


Regards
Sheryn

 

[Mamaof3]

no matter what 'preferences' or 'essentials' you tick on that iselect website as being most important for you, you're pretty well gauranteed to get the same recommendations popping up because they only deal with a select few.

i did my own research and went to every single private health insurers website i could find and compared each one to find the one that suits us best.

here's a govt. website which has a list of the majority of them...

http://www.privatehealth.gov.au/dynamic/searchbyinsurer.aspx

 

[Jazza]

I agree with csc - it's bollocks.

I mountain bike and snowboard and asked for appropriate cover when I turned 31 suitable for limbs breaking from speed related falls in the bush.

Shattered knee cap doing something else and they didn't want to know me, 'sorry you aren't/weren't in hospital'. Even had to pay and get my own crutches.


Anyone ever canceled their private health insurance? Medibank Private treat you really aggressively then, they send 'doom and gloom' letters warnings that you really should reconsider, phone you up (for an ear full ;-) ) - real dodgy practice.



And what's with this 'cover' garbage?

How is $70 for glasses ONCE every 4 years 'cover'?
How is a free pair of running shoes 'cover'? I don't run!?!?!?
How is $x for chiropractor and/or physio ONCE per year 'cover'?

This is well short of real world costs and totally impractical.

My solution; pour money into property, if ever needed later in life (and I will) I'll redraw it if public treatment won't work/pay. (i.e. Rainy Day Fund/Emergency Buffer)

That way I get 100% cover without the deception and false security.

 

[emu]

I find it simple................. if you don't have access to at least 40k at a moments notice , you need private health insurance.
That's assuming your in your 40's like me and i have 2 kids and no history of family genitic problems.

I guess it's a gamble but i'm saving 2.5k this year......so over the last 21 yrs i have been married it adds up.

Last yr i paid over 6k in orthadontics and this yr 4.5k............and in 2yrs time another 6k, but heath insurance would have given me a maximum of $800 claimable for orthadontics if i waited 4yrs before i claimed..........10k for a $800 claim..b$###t

Health insurance has it's merits, but don't compare it to car or house or landlords insurance because if your not insured heath wise they still try and keep you alive whether you like it or not

Cheers

 

[Jazza]

Health insurance has it's merits, but don't compare it to car or house or landlords insurance because if your not insured heath wise they still try and keep you alive whether you like it or not

Cheers

They sure do, my grandfather copped a pace maker at 90-something years old.

They only did it to access his private health insurance.

Result: they got paid, he had a heart that now worked like new, the rest of his body couldn't handle it.

 

[wylie]

And what's with this 'cover' garbage?

How is $70 for glasses ONCE every 4 years 'cover'?
How is a free pair of running shoes 'cover'? I don't run!?!?!?
How is $x for chiropractor and/or physio ONCE per year 'cover'?

This is well short of real world costs and totally impractical.

That cover is just not "real" surely. We are a family of five and we each can get two pairs of glasses for no cost to us at all, each year. Hubby and I get one reading and one sunglasses.

We all (except Hubby) have chiro about once every six weeks and it costs us a few dollars out of pocket.

We have had need of physio on occasion and your "once per year" is just not right. If that is the cover you have taken, then you have only yourself to blame .

Our boys braces cost us about $800 of our own funds instead of $5K (a few years ago). With one more son who may need braces, we will keep this cover.

Your figures must be from the worst company you could find. My health fund is one of the best ones with least running costs and very high cover, but there are plenty of other good ones.

 

[Perp]

They sure do, my grandfather copped a pace maker at 90-something years old.

They only did it to access his private health insurance.

Result: they got paid, he had a heart that now worked like new, the rest of his body couldn't handle it.

Hmmm.... wonder if this is why my 89yo grandmother is considering getting her hip replacement (15 years ago) replaced again!

That cover is just not "real" surely.

I'm glad to hear there is much better coverage out there, wylie, but the examples given by Jazza and emu sound much more typical than yours. My experience is that the coverage for extras is exceedingly limited, and yes, you only get back a tiny portion of the total bill, and there are huge limits on how often you can claim etc.

 

[wylie]

And what's with this 'cover' garbage?

How is $70 for glasses ONCE every 4 years 'cover'?
How is a free pair of running shoes 'cover'? I don't run!?!?!?
How is $x for chiropractor and/or physio ONCE per year 'cover'?

Well now my interest is really piqued. I have friends with top cover who have similar cover to mine, so my fund is not way above several others.

I would be really curious to know who else has cover that only covers things like in the quote box above? We have never run out of chiro cover. I have been covered by acupuncture a few years ago and had say up to 20 visits before my fund advised that I was approaching the limit and would have to wait a month or so for the year to click over and start the next year's cover.

Like I said, friends have similar cover with different funds. One friend gets more back on some things than me, so I am really surprised if many funds have such low levels of cover. Perhaps the premiums are also low.

 

[Perp]

I would be really curious to know who else has cover that only covers things like in the quote box above?

We had our fund's very top level of cover, and our experience was very much consistent with what Jazza and emu have outlined.

One example: went to dentist with top cover, bill $320, get $60 back. They told me the cost without private health insurance is $275. ($15 more out of pocket.)

These examples - and I can assure you they're abundant - are why so many people don't bother with extras.

I'm more surprised to hear of your example, than Jazza's and emu's! If I knew who provided such a great level of cover then I'd consider changing... (depending on cost etc)

 

[Peter Parker]

To me this comes down to three options:

1. Public only

2. Private health insurance

3. Self-insurance (pay for things as private patient through your own savings plan, as per the topic here)


Since 1. acts as a 'safety net', the decision as to whether to also aim for 2 or 3 depends largely on quality of life and is not as critical as in countries like the US with no 'catch-all' health insurance.

Financially speaking, 3 is interest, considering that as a general rule:
(a) People get wealthier as they get older (with some drop off at the end)
(b) Average annual health costs rise with age http://govinfo.library.unt.edu/chc/healthreport/images/figure3.jpg

There are several problems with self-insurance, or effectively your own saving/investment plan.

The first is that it's open ended and there seems to be no ceiling on expenses. But in your favour you can go back to the state system as a last resort. Secondly you might have a big health expense when young and your 'self-insurance' fund is low. Thirdly you lose the 'pooling of risk' that private insurance provides.

And if you're a dud investor you might lose the lot if self-insuring, whereas you'd hope that a health fund was safer, and it represents a way of 'quarantining' risks, or putting them in water tight compartments rather than a big bucket.

But provided you can get through the young years without a claim and you have a large balance that's well invested, the amount you accumulate should provide self-insurance in old age due to compounding interest. I think health costs also have their expontential phase, particulary where high care is required above about age 80 or 85, but your money will have had about 50 years of exponential growth before that hopefully to pay it.

Also while self-insurance doesn't have pooling risk with other people, you are still averaging over your life. And when you spend less than you make the balance rises in those years. So although health costs rise (on average) per year of age, in more and more cases your 'balance' rises faster and soon outstrips the fomer until very late in life.

It's not all smooth though - eg there will be costs with childbirth and looking after the children. Having dependents might shift things towards private cover. And there's the X factor of people's health - some people just get sick more than others - even if they're 15 years younger than you.

Private health cover, at least in Australia, appears to have an emotional or 'peace of mind' appeal not dissimilar from owning your own home, so the decision will often be swayed by non-financial considerations.

Not owning your own home or not having private health probably makes you wealthier if you're able to invest the saving wisely. But it's a very big 'if', and it's also true that most wealthy people own their own home (plus many other assets) and have private health (ie those agressively on the 'journey' might do different things than those who have 'arrived').

Ask many people this: would they rather moderate wealth and private health cover or slightly more wealth and no private health cover? Most would go for the conservative first option as they percieve it limits their financial liabilities and pays for private stuff during the time they most need it (ie when ill).

Although wealth is associated with security, people will often put 'security' ahead of maximising wealth accumulation. Which is why more have private heath and more own their own home than the financial merits of either bear out.

In the long run though, as JM Keynes said, we are all dead with that risk increasing with age. Good health care can't buy immortality but it can make the journey a bit nicer.

http://chestofbooks.com/finance/eco...tality-Rate-Americal-Experience-Age-35-65.jpg

 

[steveadl]

Jazza, that sounds like you had some shocking cover!

We're with Mutual Community, and whilst I don't use it much myself - it does cover almost all of my dental bills when I have something done. eg. $300 bill from memory I paid about $60. Would have covered most of my root canal a few years back as well, but unfortunately I wasn't in it long enough.

On the other hand, my fiancee has had a fair few health issues over the years, so she has much more experience in using it.

She says the cover is great, with the exception of Xray costs. It covers anethetist (quite hefty bills!), most of dental/ortho, majority of her intensive chiro for a period of almost 2yrs, glasses once every 2yrs at least (possibly more I dunno), and most importantly she doesn't have to wait in queues for the 'elective' surgeries she's had to have (how it's considered elective when you can barely walk I'll never know!). And on that point it also covers unexpected things like the extra cost of her stay in ICU and HDU after her last surgery when unexpected complications arose.

Here are her thoughts on the subject:

had i not had private health care i would be in constant pain due to my back being still mucked, dislocating my knees and having issues with my jaw and still waiting on some stupid wait list that would have been extended since due to the outbreak of swine flu as a preventive measure they've cancelled elective surgeries

 

[JIT]

I haven't read the thread entirely, but my 2c is that private health insurance is worth it. Mainly if you need an operation, particularly semi-urgent or non-urgent/ elective ones. Or for semi-urgent/non-urgent specialist appointments. Even if it's 'urgent' though, you could still be waiting days in the public system for a bed/theatre time etc... Even if you're young I would say so too, eg. for knee injuries etc... Saving the $80/mth or whatever it is I think is a false economy. You won't really know the upfront and ongoing costs involved till ''x'' happens to you, so how do you budget for it? The only exception I think is if you have close contacts/connections within the public hospital system... ie. people working as doctors could get around the system.