Health Insurance Questions (newbie)

con1982

I'm new to understanding health insurance and medical costs. I was on a family plan for a number of years and now I'm considering the cost v benefit of continuing with a policy.

I've been comparing the lower end policies, in and around 500-700e.

Policies cover 3 main areas, in-patient, maternity and out-patient. As I am a guy I'm gonna ignore maternity.

I understand the advantage of semi-private/private from a comfort perspective. Is there any other difference compared to a public patient? Do you get better doctors? Do you see the doctors more often? Do you skip the line ahead of public in-patients?

Out-patient cover doesn't seem all that great on the policies I look at. There is an excess and you get 40-60e per visit to consultants. If I was public (no private health insurance), could i not just pay the fee myself to see a private consultant. Someone on a basic policy is only getting 40-60e towards the visit. Is there also some additional entitlement to jump the queue versus people paying cash?

Is the whole point of private health insurance to cover you incase of serious long term illness? as opposed to providing meaningful beneifit for less serious issues?

If I had kids I would take out a policy for myself and them because you don't want to take any risks with your kids. For a childless 30 yr old non smoker? I just don't know yet.

Further question. With the cost of policies rapidly increasing, is it only a matter of a couple of years before they are too expensive for the average worker? If yes, does it make sense to enter a system if there is a reasonable possibilty you will have to leave in the near future?

coylemj

con1982 wrote: »

I understand the advantage of semi-private/private from a comfort perspective. Is there any other difference compared to a public patient? Do you get better doctors? Do you see the doctors more often? Do you skip the line ahead of public in-patients?

For elective surgery, you will get access to a consultant faster and you or your GP can decide who. The consultant will perform the procedure probably in a private hospital and you will be able to ask for a semi-private bed. You did say that you are looking at the 'lower end policies' so you probably wouldn't be covered for a private room.

I don't think there is a quality issue, almost all the best consultants work in public hospitals, some of them do private on the side.

For emergency treatment such as an appendix or accident, you will be treated in a public hospital and the medical insurance will make no difference to bed selection. Except that when the hospital discovers that you have insurance, they will magically upgrade you to private patient status and your (public ward) bed will be redisignated semi-private! This happened me on the day I was being discharged after an appendix operation, a hospital administrator with a clipboard appeared out of nowhere and asked me for my VHI number even though I was in a public ward in a public hospital and I had come in via A&E.

Your follow-up consultations with the consultant who treated you will be held in his/her private rooms rather than you have to queue up for to meet any old consultant as happens with public patients.

con1982 wrote: »

Out-patient cover doesn't seem all that great on the policies I look at. There is an excess and you get 40-60e per visit to consultants. If I was public (no private health insurance), could i not just pay the fee myself to see a private consultant. Someone on a basic policy is only getting 40-60e towards the visit. Is there also some additional entitlement to jump the queue versus people paying cash?

No, you will have to pay the consultant cash (or credit card) per visit anyway, the medical insurance reimburses you afterwards. The actual procedure and usually one follow-up visit are covered by the insurance who pay direct so the hospital or clinic won't ask you for your credit card when you're on the trolley going into theatre! Otherwise every time you see the consultant, you pay up and keep the receipt. In the case of the VHI, you submit a claim with receipts within the three months following your next renewal date.

con1982 wrote: »

Is the whole point of private health insurance to cover you incase of serious long term illness? as opposed to providing meaningful beneifit for less serious issues?

Not really, medical insurance don't cover long-term care in a nursing or convalescent home, just specific treatment and up to a certain number of days convalescence but it eventually stops. You need different insurance to cover long-term care.

con1982 wrote: »

Further question. With the cost of policies rapidly increasing, is it only a matter of a couple of years before they are too expensive for the average worker? If yes, does it make sense to enter a system if there is a reasonable possibilty you will have to leave in the near future?

With a lot of people dropping out because of the recession, it's possible that the waiting time for cover will be extended to stop people jumping back on the bandwagon to the detriment of people who have paid all the way through.

con1982

Thanks for the well thought out and lengthy reply.

I'm still on the fence with my decision. I also spoke with the Health Insurance Authority hotline. Very helpful.

I'm leaning into the no camp, based on my age and cost of basic policies. Over a five year period I could easily spend 4k.