There was an interesting article in the Irish Times today about health insurance in Ireland by Fiona Reddan. It was interesting, in that it addressed some questions and queries about health insurance, but not that helpful in that it didn’t provide any answer to the question of how to get the best value for your health expenditure. It also stepped around the obvious conclusion: private health insurance is good value, if you can afford it. So, here is my short guide to buying health insurance.
[Note. There are a lot of odd things about health insurance. If I explained all the odd things, this would go on forever. If you are really puzzled, ask a question in the comments and I will try to help if I can.]
The first thing is to understand is the benefit of having private health insurance. In Ireland, we have a public health system, which is very good in an emergency and to support may types of illness and to pay for more expensive drug treatments. But resource constraints mean that it is not always a good option, and this is where private health insurance comes in. The basic benefit of having health insurance is that it helps you get non-urgent but important medical procedures done quickly, by going to a private hospital. This allows you to skip the queue for the public facilities.
(The above quite likely collides with your socialist and republican ideals as an Irish person. I am very sorry about that. Please do not feel bad about that. I am going to tell you how to get the best hospital care for your partner and your children that you can afford nonetheless.)
First off, don’t expect too much from health insurance. For many private health and medical costs, you are better off paying your own way and not bothering with insurance. For me, this would include dental, physic, GP visits, consultants’ visits and anything alternative. You can get insurance for a wide range of events, sure, but you would probably be better off putting the money in a special bank account or fund to cover these things. Do your sums carefully, and bear in mind, insurance will not cover an existing ailment if you have not been insured for it previously. (There is an exception to this, but chances are it is not relevant to you.)
So you need private health insurance. But there are so many types of plan (also called ‘schemes’). How do you find the one that suits your needs? Some of the insurers have sites where you can do meaningful comparisons too and that might suit you better as a starting point. Also, you could talk to a broker who, if she is good will give you some guidance and help you navigate the maze (although you should be aware that many brokers will steer you to the company which gives them the best deal on commissions).
I suggest you carry out your search for health insurance on the HIA website comparisons section. It has all the information, although it is not particularly digestible. You should certainly pay a visit to this site at some stage during your search, no matter how little time (or patience) you have for what can be a laborious process.
On the HIA website comparison tool, go to the option ‘I do not know what plans I would like to compare’. (I never said this tool was intuitive.) Now, pick the accommodation type to search for plans that have ‘Semi Private Room in a Private Hospital’. What this bizarre piece of jargon refers to is cover to be in a private hospital, but in a room that is shared with other patients. This is the balance between cost and quality that will suit the vast majority of private health insurance customers.
Your search will give you back well over 100 plans. Now, use the refine button to pick a narrower range of plans, by setting your maximum budget. This will narrow the range somewhat. Now, you have to sort through the possibilities by selecting some plans and using the ‘compare’ button.
The difference between these plans is the range of hospitals they give you access to, and the excesses they carry. Now, there is a matter of compromise. You need to decide which mix suit you. If you go to hospital a lot this will be pretty easy. You know which hospitals you regularly attend. If you have a relative or friend who goes to hospitals, you probably have some views too, although those may be quite narrowly informed and based on limited information. If you are like most people, you have no real idea. A lot will depend on where you are located too. I live in southeast Dublin city, and for me, a policy without St Vincent’s Private Hospital in it would not feel right, for example. You will have your own ideas, depending where in the country you are.
In terms of excesses, I suggest you think about whether you could afford the excess for a long stay. So flat excesses might be ok, but nightly excesses might be unmanageable.
As you can see as you page through the plans available, there is room for discretion and opinion. The above is really my view. Someone else will think different, and in the end you have to take responsibility for your own choices. There are a few other thoughts below.
A note about orthopaedic care: some plans only cover 60-80 percent or have an excess for orthopaedic procedures. These policies are oriented at younger people.The purpose of these exceptions is to deter older customers from taking the plans, because orthopaedic procedures (basically replacement hips or knees) are mostly relevant for older people. This may or may not be a good deal for you. In general, I think it is a good balance.
A note about the ‘über-hospitals’ (Beacon, Blackrock Clinic and Mater Private. One thing I would not be too worried about would be full cover for the Beacon, Blackrock Clinic or Mater Private. These hospitals are ‘special’. Why they are special is not that easy to explain, and not that important for our purposes. However, it is worth having cover for at least one of the Blackrock Clinic or the Mater Private (the one that is nearer your home, I’d suggest) for cardiac procedures. I don’t know the situation outside Dublin and you might think there are better alternatives there.
‘Day case’ may be important too. Lots of stuff these days is done within a day in private hospital environments, and it is important to have cover for this.
Another thing that might matter is outpatient radiology. Scans can be expensive. It may be a worthwhile benefit if your insurance covers it.
Psychiatric care – a good thing to have if things go wrong in your life. Mental illness and addiction are real problems and real illnesses in our society. These policies will help if you have to go into an in-patient setting.
Snob value – some people may well see health insurance as giving them a chance to be ‘segregated’ in the health system. If this is your view, I would advise you to disabuse yourself of it for your own health and sanity. Hospitals, public or private, are not social amenities. If you are ill, you want to be in the hospital with the most appropriate facilities, based on the advice of your doctor and medical team. Sometimes this will be a private hospital, other times it will be a public one. Sometimes it will be nice and shiny, other times it will be old and grey.
Stuff that wouldn’t bother me too much is as follows. For starters, there’s maternity. Maternity is a big fuss for insurers, because having a baby is the traditional start of a family’s private insurance ‘journey’. This is the point in young people’s lives when they usually decide to get private insurance, so it’s important for insurers to wax lyrical about childbirth. Now, I’ve never been pregnant, nor is there much prospect of it so I am on dodgy territory here, but I’m not seeing a lot of difference, in real terms, between public and private. The closure of Mount Carmel seems to me to have more or less banjaxed the value of private maternity. In general, Ireland has good enough public maternity hospitals, and having a baby isn’t ‘elective’ in the sense that having gallstones removed or cateracts done is. So the treatment is ok. Besides the marketing advantage, it is a regulatory requirement that all private health insurance have some sort of maternity cover (whether the punter is likely to get pregnant or not).
Cover for herbalists, acupuncturists, physios and all that stuff are basically not a lot of use. The idea is that you can send receipts in at the end of the year and claim something back. with most insurers, you never actually get the money. It is just applied as a discount from next year’s insurance. And you are very unlikely to ever recoup the cost of these extra features.
Many plans will allow you cover for stuff like consultants and physios, if you reach beyond a certain threshold. But unless you are really ill, you won’t reach that threshold. Still, it’s a good facility to have in reserve, in case you get really bad.
Private room, private hospital, and all the other ‘extras’ you can get – to be honest, I wouldn’t be too bothered. As stated above, room allocation, whether in a private or public hospital is a murky business carried out by shadowy characters whom you will never meet called ‘bed managers’. Just because you have the insurance doesn’t mean you’ll get the private room. Unless you are Bono, and even if you are, do not complain about being in a shared room, because they will laugh at you once you are out of earshot. And my opinion, although I am not a clinician, is that because of the way our hospitals generally work, you are better in a shared room. It is just less boring, you have better access to hospital staff and to other patients for help and support if you need it. Others will no doubt disagree with me, and I look forward to seeing their evidence for the superiority of outcome for private rooms.
Travel insurance. If you travel a lot, it’s worth seeing if your health insurance can cover your requirement for travel insurance. This isn’t an area I’ve investigated a lot, but I can see there might be some benefit in looking into it further for some people.
The question of price
So that’s the broad strokes of finding the right plan for you. As you go, you will no doubt be keeping one eye on the price for the plan for one adult. However there are a few other things to think of when you are working out the cost.
Instalments. Traditionally, health insurance is paid for in monthly instalments. One insurer charges you extra for this convenience. Unless you are a cattle farmer, a professional Christmas performer or a ski professional who earns all their year’s money in a short period, you will probably want this feature, so this is a slightly hidden extra you will need.
Discounts. In general, health insurance must be sold for the price quoted on the HIA website. No back-room deals are allowed and any policy must be available to any customer. But the insurer can give you a discount of 10 percent at its discretion. Will you get this discount? I really don’t know. It depends. For instance, Laya say they give the 10 percent discount for buying a ‘wide selection of schemes’, whatever that means. When you see what plan you like, it is worth ringing up and asking if there is any way to get a discount and see what the insurer has to say for themselves. Sometimes there are discounts for vocational groups (like teachers or nurses) who purchase a particular plan. These are sometimes referred to as ‘group schemes’ . It may be worth asking about this in your workplace.
Children and students. Different companies have different deals for children and students and this may make a big difference to your overall price. (One tip about kids is that even if you decide to go on a fancy expensive plan, it might not be worth putting your kids on the same plan, because there is only a narrow range of private hospital services available to children. It’s all basically done through the public system.) Generally, there are discounts and deals for newborns. That’s because a happy event is often the point at which a couple will first consider getting health insurance.
So that’s the beginner’s guide to health insurance in 2200 words. I hope it helps, but I would be happy to read any comments or suggestions. By the way, if you are commenting and work for an insurance company or a broker, it is a rule that you must state that clearly, whether you are posting ‘officially’ or not. For my own part, I have been engaged by an insurer to work on product development in the past, but not currently working with any of the players.