Health insurance - how much should I buy

[chang]

I'm coming up to renewal of our global expat medical insurance. It's a worldwide (ex-US), comprehensive plan with a high $8m annual limit, and even with a high deductible ($3,200) it's very expensive. My expiring premium (for both of us) is around $16,500, and the renewal premium is $19,000.

I'm considering stepping down to a $3.2m annual limit, to reduce the annual premium to $14,600. Besides the annual limit, the other big difference is the cap on out-patient [non-surgical] treatment. The top plan covers all out-patient treatment within the annual limit, while the next plan down limits out-patient treatment to $9,200 a year. (This means consultations, diagnostic tests, x-rays, physiotherapy, etc. but does not include surgery or MRI scans.)

One more difference - Prescription drugs. Top plan: no limit. Next plan down: $1,200 limit.

There are a bunch of other minor differences (e.g., private vs. semiprivate rooms for in-patient care, routine eye exams and dental work covered in the top plan, etc.), but the biggest differences are the ones noted above.

The question really is: how much insurance does one (ideally) need? It's very hard to find a recommendation on the internet. I found a Forbes article that suggest a good insurance plan provides an annual limit of $6-7 million. That's actually a pretty big number.

As far as the outpatient treatment goes, I like the idea of not worrying about hitting a cap.

On the other hand, it boils down to the insurance premiums, which seem sky-high to me given the healthy deductibles we are keeping.

I would much appreciate thoughts on this. I need to go back to the insurance agent tomorrow. TIA.

[yogibearbull]

An interesting topic about global or expat health insurance.

My experience is limited to foreign travel insurance - for one-time travel. Even that isn't cheap, but I may pay up to 10-15% of trip booking cost for peace of mind. For many years, we didn't use travel insurance, but then we heard some horror stories about trip cancellations/rescheduling or people getting sick in some foreign countries - the US insurance won't cover those, and in many foreign countries, upfront cash/credit payments are required even to access healthcare, although the costs may be much lower than in the US.

I found some sites for global and/or expat health insurance. These aren't cheap. These may be familiar to chang .

General www.investopedia.com/health-insurance-for-expats-7113406
Online Broker www.internationalinsurance.com/about/

[chang]

Thanks steelpony10. To focus specifically, do you think a $3.2m annual limit is too low for comfort?

[FD1000]

How much insurance do I need?
The more money you have, it makes sense to buy more insurance to protect yourself with common sense. Imagine you need HC in US for 4-6 weeks. How much is it? gazillions.
When you rent a car, how much insurance you take to avoid headache.
Why I switch from Original to Managed Medicare? because I would save at least $5K per year + the max out of pocket is close to $9K if I have a terrible illness. In most cases up to $2K.

Do I take international trip insurance?
I only started it about 2 years ago because we got older, but I get it much cheaper than the norm...how?
Most vacations are running at $6-8K for both of us. I only insure $1000 per each...why?
Because I plan all the trips at about 30% of the cost + we see more. The only thing I can't cancel is the flights. If you have a reservation for organized tour, you need to insure all if. It's about 6-7%. 
In about 1.5 weeks we go to NZ. The tickets were $1129 per person, I insure only $1000 PP because I get everything I needed. I don't need to insure up to the max.

[chang]

Nobody seems to want to go out on a limb and say that $3.2m is enough insurance (per person/per year), or that $8m is significantly safer? Or if $9,200 and $1,200 are adequate limits for out-patient treatments and prescription drugs?

I'd like the higher limits, but the $19,000 premium just sticks in my craw. I am thinking I'll save $4,400 and go with the next plan down. 

(By the way, one other difference I didn't mention is that the top plan gives some short-term coverage (30 days?) while traveling in the USA, while the next plan down doesn't. The plans are worldwide-ex-USA.)

[keppelbay]

I didn't intially want to weigh in on this - your comfort level is a personal decision.
(Folks in the US may have a different view on the potential cost of healthcare vs europe.)

A bit of back of the envelope arithmetic:

The premium saving of 4400 exposes you to:
(1) potential outpatient costs over 9200 (after the 3400 deductible). It seems highly unlikely that you could run up an outpatient bill this high = more than 1K/month. In the UK, I've yet to hit more than 600 for a self funded private doctor visit with tests (excluding MRI), and I don't do this monthly.
(2) it would take a major catastrophe to run up in patient costs of over 3 million. Typical surgical costs for routine stuff like hip replacement in the UK are in the 12-15K range. Obviousy there is more expensive stuff out there... 3.2M is a lot of coverage. The additional costs of private vs semi private rooms are affordable in light of the 4400/yr savings...

otoh - you can afford the luxury coverage, if it gives you peace of mind. The additional cost roughly equates to dinner for 2 at a nice french restarant once a month.

fwiw

[chang]

keppelbay That's what I'm thinking - $3m is actually quite a large number. I just googled a kidney transplant for fun (maybe I should put a comma in there - I just googled a kidney transplant, for fun) and it says £17,000 in the UK and $442,00 in the US. (Quite a difference.) So, $3m would buy me dozens of kidneys.

Likewise, as you say, the outpatient limit is high. I'm not sure how they're calculating the premiums. Maybe an excessive number of very ill people are buying the platinum level, triggering a large number of claims.

[yogibearbull]

In buying insurance, there are 2 considerations,

1. Don't over insure,
2. Buy the best coverage you can afford.

So, you have top of the line coverage now for both you and your wife for $16,500. New premium is an increase of $2,500 to $19,000. So, $16,400 is a false bogey with much reduced coverage.

BTW, travel insurance for short visits may be a couple of hundred bucks per trip. But it isn't for general or optional healthcare.

[FD1000]

Stepping down to save money is OK globally, except in the US. The main question is what happens when you visit the US.

[chang]

Feb 27, 2024 11:08:50 GMT yogibearbull said:

In buying insurance, there are 2 considerations,

1. Don't over insure,
2. Buy the best coverage you can afford.

So, you have top of the line coverage now for both you and your wife for $16,500. New premium is an increase of $2,500 to $19,000. So, $16,400 is a false bogey with much reduced coverage.

BTW, travel insurance for short visits may be a couple of hundred bucks per trip. But it isn't for general or optional healthcare.

That's exactly the question - is the top plan too much insurance? I used to think you can't have too much insurance .... until the premiums became ridiculous.

[chang]

Feb 27, 2024 11:54:23 GMT FD1000 said:

Stepping down to save money is OK globally, except in the US. The main question is what happens when you visit the US.

We'd probably have to look at a travel insurance option.

[fishingrod]

Not that this applies to you but I figured I would insert here.

www.hhs.gov/healthcare/about-the-aca/benefit-limits/index.html

If you had chronic health problems I would say opt for the higher coverage. But you are healthy I think.

But, Heart surgeries can easily cost millions of dollars.

[bigseal]

Maybe I’m in a significantly different financial position, but I wouldn’t let a $2,500 price increase prevent me from getting the insurance I wanted. But if you can’t afford it, you can’t afford it. Reducing your health insurance as you get older doesn’t seem to be a good idea, but I know nothing about you and your circumstances. If it were me, I’d pay the additional amount and move on.