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.
When you use the refine and click the help buttons (?) – they are all really helpful. If, of course, you find ‘undefined’ helpful.
I never said it was perfect! It is just better than anything else I know of. Will you email HIA.ie with the problem, and let us know what they say in response?
excellent commentary – i have learned and understood more from these 2200 words than many 30 minute sessions listening to Aviva and VHI explaining above – thank you
Awesome article, really helped me although now I have to go through the compare process..
Thanks – moving back to Ireland shortly and this has been very helpful.
Many thanks Antoin. Premium due on 1st April (Fool’s Day anyone…) and this article has somewhat separated the chaff from the wheat!
Hi ,Am i mad at 50 yrs to start trawling through healthcare products especially when i have a med card at the minute and my wife has a few ongoing medical problems which they probably wont cover ( diabetes,ibs,and needs a hip replacement) i know unlucky or what?
Thank you. I find this whole territory quite overwhelming. You have offered clear suggestions that do not covet commission! Thanks a million!
I’ve just spent an hour trawling through the different options from different insurers, I wish I’d read this first! Great article, very helpful, thanks!
Thanks Antoin, very helpful.
Thank you very much. A big help.
Thanks a million for the great article. Immensely helpful for a dunderhead like me!
The author is right regarding GP cover, usually the excess (amount you pay) is very high – so it is difficult to ever get much back on a claim.
if you look carefully (hia.ie comparison site) you can get some schemes where the excess for day to day is 1€ per family. If you have young family this can work out well if you make many gp visits.
This is an exceptionally useful article. Many thanks!
Great Article, I can see sense with everything you say.
You never mentioned anything about Cancer Care Costs.
Just wondering what are your recommendations when choosing a policy?
Thanks for breakdown, v.help full
I used to sell insurance with city bank as a add on to mortgages and know it’s supposed to be ethical, as in selling loss of job insurance to someone who is self employed!
I thought selling maternity insurance to a man not ethical or relevant?
Any chance you could explain the limits of the statement “per claim”. What are the boundaries of “per claim”? Say you are in a car accident and need 3 operations on the same injury. Does this involve 3 claims or one claim? Would you have to pay your excess 3 times for the same injury?
If the three operations were in one hospital visit it would be one claim. Any excess in this case (or indeed the entire amount) would ultimately be recovered from insurers.
Unfortunately a health insurer has no choice but to offer you maternity cover regardless of who or what you are! That is the regulation. This makes sense because it is a community-rated insurance.
Make sure to get a policy with cover for semi-private hospitals, especially making sure it covers the ones that you are most likely to visit. Don’t worry too much about excesses, especially if you are young and healthy. Put some money aside to cover any excess when it occurs. Don’t bother with stuff like dental cover or physio cover. It is better to put money in a savings fund.
Excellent article – very helpful!
What was the plan for an older couple which included semi private room,cardiac care, orthopaedic cover in private hospital,which you mentioned in 2nd. last paragraph of your article .Irish Times. It was an alternative to the Teachers Plan.
Really good article, thanks,
Thank you so much for this! I found it really helpful. I found an interesting option today from Glo/Irish Life Health – ‘Kick-Off’ – a policy that costs less than many €561 – gives access to consultants, scans and public hospital beds, but if you get struck down with something serious, you can upgrade to include private hospital beds ‘Kick-Off Upgrade’ €950 (minus the amount you’ve already paid on the basic cover). It’s still all very expensive, but an interesting idea…
I am not mad about this plan concept. Here is why. Once you go down this road, you are not in a strong position to switch to another insurer who will not offer this structure of plan. If you do switch, you may have to serve a ‘waiting period’ before you can avail of the cover. I also don’t see details of the upgrade mechanism clearly explained on the website or in the documentation. If you have clear written information about this, fair enough. An alternative to consider is Control 600 Connect from Laya. This is a more straightforward structure, although it does require you to have 600 euros handy (or available on your credit card) to pay a significant excess. Still, if you are relatively young, it’s a good way to go. I have always thought that the GloHealth upgrade structure is very unwieldy (although they never asked me for my opinion).
Good question. Those move around all the time. It is one of the PMI numbered plans. There is no longer a plan without excesses available to mirror the old Teachers’ Plan. At the last renewal, we picked a plan which had an excess but which otherwise offered similar cover. Again, we picked a PMI plan. There is pretty good value there if you poke around for it. The main thing is to make sure you have cover for the private hospitals, and that there is cover for the hospitals you are likely to use (the ones nearest you, the ones you’ve been in before and the ones which your specialists are associated with).
Thanks for the article, Antoin.
Just found your very helpful website.
I’m 58 years old & have a medical card as my husband is over 75 & we qualify as a couple.
I’m also in Laya’s Moneysmart 40 Individual. Truth is I don’t know what exactly this entitles me to. My husband has full coverage with Laya for public/private. He’s 81 & has many health issues.
My queries are:
1) While I still have a medical card do I need any health insurance
2) If I opt out now, will I have huge problems getting coverage when I get older?
3) If my husband dies, I’ll lose my medical card, due to Single Allowance qualification
4) I will then have nothing don’t know what to do?
Thanks for your help & time.
I also live on an Island – Sherkin – off the coast of west cork. Many of us have only mobile phones as landlines were broken frequently during winter months.
Mobile phone packages, do not allow call to 1800 or 1850 numbers. Therefore its quite difficult to speak with some of these companies.
All the best,
1. In my view, you should retain your health insurance now.
2. Yes, you will have huge problems in that situation.
3. I am not sure about this.
4. You would not have nothing. You could still go through public system.
5. Moneysmart is a cash benefit scheme. It is not health insurance. I do not think there is much point in you having this, especially since you have a medical card. You would be better to put the money towards health insurance. (This is my view with limited knowledge of your circumstances, and i am not an FSA, but in general, these packages give more peace of mind than they give value.
In hospital plans look out for excess payments. Some are per admission some are per night. If you are in hospital for say two weeks the difference is huge.
Thanks Antoin;great info.What is best value childrens plan for 2018?
Regards And thanks,Caitriona.
thanks for this. You should write a book about the Irish health care system. Badly needed.
The long-term costs (after 30 days) are 153.25 euros per week in a public hospital. Do private policies cover this on the same terms as their cover for private hospitals (e.g. my present Vhi policy covers six months in private hospitals). Would they only cover the equivalent time-wise or would they cover the total cost for a year provided it were less than the cost of 6 months’ equivalent in a private hospital? A year in a psychiatric unit in a public hospital would cost 7969 euros(153.25X52). This is a lot less than the cost of St Patrick’s, about 650 per day!!!!!, which VHI cover for max. six months per year.
Many thanks for that clear, informative and very useful commentary.
My big question is that as I’m 74 and have a medical card, do I need private health insurance at all?
My present cover is reasonably cheap at €65 per month but I hate all hospitals equally, have no hang-ups about going public and in the past I’ve used my card rather han pay excess on my insurance. I could surely do with that €65 in my pocket towards the end of most months.
Joe: this is the time in life when you will get value out of health insurance. Other members are actually subsidising you. I would advise not giving it up. It could help you get an operation you need faster at some stage. If you live until you are 90, this will cost you about 12,000 euros. It seems worth it for the peace of mind. You are getting a subsidy of about 1950 euros per year on this policy that you never see. Now, this assumes you have a good enough policy to be worthwhile, i.e., one that will cover you in a semi-private room in a hospital that suits you.
maria: as far as I know the insurers will cover this. It is called ‘public hospital statutory levies’ in the blurb. Will they cover beyond the 100 (or whatever days) – I don’t really know.
I would say that in general, you should not be too worried about health insurance not covering every single bit of the cover. What you are trying to do is be comfortable is that you can get the cover you need without running up big debts (by which i mean debts of over 5000 euros). The reason I say this is because if you are stuck, most people who can afford private health insurance can somehow cover 5000 euros. And even if you can’t, the hospital will probably give you some credit, as long as they know bulk of the cost is covered by the insurer.
Thanks – a very well constructed piece,
I’m new to the Irish health business, oh sorry, health system….
oh heck lets split the difference and call it a healthy business.
I’m an ex pat back in Dublin from living in the EU for the last 30years.
So can some one tell me – If I decide to pay my own health bills, can I get anything back on my tax?
Im retired with an over seas pension so I will be doing a self assessment tax return at year end.
Hi Percy, I’m glad it helped. Yes. You can claim back 20 percent of expenses (assuming you have a tax liability). The rules are here. https://www.revenue.ie/en/personal-tax-credits-reliefs-and-exemptions/health-and-age/health-expenses/index.aspx