Do I really need health insurance? We have a free public health system and it’s not like health insurance will see me jump any A&E queue, will it?
That’s a legitimate question and as good a place as anywhere to start. It is absolutely correct to say that, if a person has a heart attack or stroke, is involved in a car crash or has to be rushed into an emergency department suffering from some other serious ailment – or even a not so serious one – then health insurance makes no appreciable difference.
Why is that?
Because in most emergency circumstances people are brought to the nearest public hospital and treated in the public system at no – or at least at very little – cost to them. And most people who are diagnosed with serious, life-threatening conditions will most likely be treated in the public system fairly expeditiously whether they have health insurance or not.
And that public system works right?
For all its flaws – and they have been widely documented for a long, long time – our healthcare system can be good. That is thanks mainly to the medical professionals who are central to it.
Tell that to anyone who has been left waiting in an A&E for hours on end
That is not the fault of the doctors, nurses or teams of healthcare professionals. The reality is that even the most gilt-edged of health insurance policies won’t protect people from the hell that is a hospital trolley.
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So back to the first question, what is the point of health insurance?
Quite simply, people with health insurance get access to consultants more quickly – even consultants working out of public hospitals. They get private and semi-private rooms in public hospitals if they are available. They can also access private hospital and private emergency departments and clinics which dramatically reduces waiting times for many procedures – both elective and otherwise. And they have access to a much broader range of out-patient services and can more often than not be treated much faster for elective and non-urgent issues much, much faster than people relying on the public system.
How much faster?
As anyone who has had to navigate the maze of Ireland’s public health system will tell you, people can be left waiting months and sometimes years, before seeing consultants. The sad reality is that people have died because of these delays or they have been left living in often unnecessary pain for far too long. At the end of last year there were more than 66,000 people on the outpatient orthopaedics waiting list with close to 12,000 of them facing an estimated wait time of more than 12 months. And that is just orthopaedics.
That is terrible
It is and it goes some way to explaining why just over 2.5 million people have health insurance despite multiple price hikes in recent years and why, according to a recent report from the Health Insurance Authority (HIA), “consumers view health insurance as a necessity and not a luxury”.
But it is an expensive necessity right?
It is certainly not cheap and it is getting more and more expensive with the cost climbing by an average of 11 per cent so far this year. The average policy premium is now €1,712. Increases are running at more than five times the current rate of general inflation.
Why is that?
The insurance companies point to sustained increases in the cost of delivering healthcare and the increased use of more expensive, high-cost drugs among other things.
So just how much can a family expect to pay?
Even if we allow for the fact that children’s policies typically cost a good deal less than adult ones, a family made up of two adults and two children paying for a fairly middling level of health cover won’t have much change out of €4,000 a year – and that is an after-tax figure, which means they will have to earn close to 10 grand to cover the cost.
Yikes. Could I not just pay for access to private healthcare as I go?
You could. But the chances are you will have to rely fully on the public health system if you get seriously ill as the costs really ramp up if you, or a family member, gets sick. It might not cost that much to see a consultant privately on a one-off basis, but ongoing visits or treatment costs will quickly bleed a patient dry. Getting a colonoscopy private, for example, will set you back well over €1,000 and if it turns up something that needs treatment and you have to pay for it privately, it will cost a whole lot more again with the cost of overnight stays in hospitals, procedures and courses of medication sometimes costing many thousands of euro.
I am young and healthy, could I save myself a few bob by waiting until I am older to take out cover?
You could, but you will you will pay a premium for that. Lifetime Community Rating is designed to target those who wait to take out private health cover until they are older and more likely to need more medical care. Anyone taking out insurance for the first time aged 35 and older will be charged an extra 2 per cent of their policy for every year they are over 34 without health insurance. The maximum loading is 70 per cent. It applies for 10 years, after which a person reverts to the standard policy price.
So who offers health insurance in Ireland?
Maybe a history lesson might help answer that question. In the beginning, there was the VHI, a State-owned operator that offered a handful of private plans running from Plan A to Plan E. It was a simpler time and it had the playing field all to itself. Then, in the 1990s, Bupa arrived, but it quickly turned into Quinn Healthcare, which then became Laya Healthcare, which is now owned by Axa. We then had Vivas, which was acquired by Aviva. But Aviva left the market in 2016 and sold the business to Irish Life, which also took complete control of GloHealth and merged the two into Irish Life Health. Then a couple of months ago, Aviva came back into the market under the brand name Level Health.
That is confusing
It is, but the confusion doesn’t end there. There are about 350 health insurance plans on the market and, according to the HIA, that has left consumers feeling “overwhelmed” by the number of options available. It recently said the complexity works against people’s best interests and sees many paying over the odds for cover.
But does all cover at the same level not cost pretty much the same?
Absolutely not, there are huge price discrepancies between plans and canny consumers who shop around when renewal time comes can make big savings amounting to hundreds of euro each year – and sometimes even more than that.
So everyone shops around all the time, right?
Wrong. According to the HIA, a total of 71 per cent of the market have never switched provider, while half of those who have switched have only done so once.
What? Why?
Well we mentioned the complexity of the market, right? Many people believe that it is difficult to switch and while it is certainly harder to change health insurer than it is to change energy provider – or at least there are many more variables to consider – it is not as hard as people might think and there are far fewer risks than many probably believe.
But it is complicated, right?
Well, while the sector is undoubtedly complicated, much of the complexity is easy to sidestep. There are strict rules in place that give consumers protection irrespective of their age or their health issues.
What do you mean by that?
A person who has a long-standing policy with Company A will have served the waiting periods expected of them so can switch to Company B and get all the existing cover they had with Company A immediately.
To put that more simply, you do not lose the cover you already have by moving from one company to another. If the plan on the table from Company B offers enhanced cover, you will most likely have to wait for that to kick in, but whatever you had, you keep.
But I have a pre-existing condition so I am stuck?
No. Unlike with other forms of insurance – and we can’t stress this enough – you cannot be penalised financially because of a pre-existing condition or because of your age. The law requires health insurance companies to treat everyone equally.
But if I am taking it out for the first time?
Anyone buying health insurance for the first time or after a break in cover of more than 13 weeks will have to serve waiting periods before having full access to all of their benefits. The waiting period for inpatient care for pre-existing conditions can be a maximum of five years.
So where do I start if I want to switch?
You start with the facts. Call your existing provider to see if they have a lower-cost equivalent plan to the one you are currently on. Make it clear you’re happy to take on some excesses or minor reductions in cover, depending on the savings.
Why do I start with them?
Because it is the easiest thing to do. Your existing insurer has a complete record of all previous claims you have made and the simplest question to ask is if any new and cheaper plans would have covered all the claims that have been paid out over the last two years and to the same level. If the answer is yes, then your choice is pretty simple. You switch.
But what about the other providers – they won’t have the record of my previous claims?
And that is why it is important that when you are talking to them you are upfront. You will not be penalised – financially or otherwise – for honesty. Detail all the important elements of your existing policy, and outline any underlying conditions and procedures carried out. Have them confirm that any new and cheaper plan will cover everything you have had covered in the past.
And I can do this online?
Probably, but it is better to do it over the phone. Providers like it when we shop online, but by doing so we become responsible for all the decisions, be they good or bad. By talking to a company representative and asking the right questions, and insisting on having everything explained to you puts the onus on them to make everything clear. Do not be afraid to ask questions and make sure everything is clear in your mind before making any final decision.
What about my children?
The key thing here is they do not need the same level of cover as an adult because there are no private children’s hospitals in the State and GP visits for under-eights are free.
But health insurance still has value for them. Children can obviously be seen by private consultants at a cost and treated in paediatric wards in private hospitals as well. Then there are assessments for neurodevelopmental conditions. The healthcare support often relies on diagnoses, and wait times for autism and ADHD assessments and other conditions in the public system can be insanely long. They are expensive in the private system if people pay upfront.
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