Health Insurance

Sick in bedI’m following the current debate on US health care reform with interest.  Having grown up in the UK with it’s NHS system and then emigrated to Canada where there is something similar, I only encountered paying for visits to the doctor when I first became an expat.  I’ve been fortunate to have had excellent health insurance, but it’s still been a shock to see how it all adds up.  The year I had a back problem the cost of specialist visits, scans, physiotherapy, etc was truly alarming even though my injury wasn’t anything major.

Medical expenses can literally take you out financially.  Even though she was insured, a good friend found that the 20% co-pay for a life threatening illness she suffered while overseas was more than the value of her house back home.  She and her husband had to delay retirement as a result.

It’s therefore surprising how many expats don’t seem to take health insurance all that seriously, shopping for it primarily on the basis of cost, rather than coverage or relying on holiday travel insurance policies from home when they’re resident abroad.  Even if you’re from a country like the UK where health care is “free” in the event of an accident or serious illness you may not be fit to fly home for days or even weeks, and when you do, you may not be immediately eligible for coverage. 

So what’ s important when shopping for health insurance?

  1. What’s covered, what’s not.   Hospital care usually is, but what about normal visits to the doctor, tests the doctor may order and prescription drugs?  What about physiotherapy, eye care, dental and annual checkups, mammograms, vaccinations, etc?
  2. Medi-vac (medical evacuation).  This is important if you’re living in a country where medical facilities are not that great.  I once knew someone who had to be flown out to have a broken leg set, as local x-ray facilities were not considered safe.
  3. Pre-existing conditions and other exemptions.  This can be a real killer.  Most policies for individuals will not cover pre-existing conditions although some may do after a year or two, providing they haven’t re-occurred.  If you suffer from a chronic condition like diabetes it can have major implications.  I just read a story about American expats who are stranded overseas because of they can’t get coverage back home for conditions they’ve developed as expats.  Usually the only way around it is a company or group policy, as they generally do cover pre-existing conditions immediately.
  4. Is the coverage 100%?  Many plans require a co-pay, in other words covering less than 100% of the cost.  This may or may not have an annual limit, after which everything is 100% covered.  Accepting a co-pay may be a good way to reduce the premium if you’re paying for the plan yourself, but it may turn round and bite you on the bum as it did to the friend I mentioned earlier.

Finally remember that although some plans will pay the health care facility directly, generally you will have to pay and claim it back later.  This can often take a few weeks, so remember to keep some funds or a credit line available to cover such unforeseen expenses.

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