Chronic conditions are diseases, illnesses or injuries that are either ongoing and have no known cure, are likely to re-occur, are permanent, or require long-term treatment. Some examples of chronic illnesses are cancer, respiratory disease, genetic disorders, heart disease, stroke, hearing impairment and oral disease. It is possible to prevent these conditions, and to manage them if they are detected early enough. Such conditions may also be managed through improved diet, exercise and treatment.According to data from the World Health Organization (WHO), chronic diseases account for 60 percent of all deaths globally. Of these, 20% are known to occur in high-income countries, while the remaining occur in middle and low-income countries. In Europe, chronic diseases account for 86% of deaths. In the United States, 7 out of 10 deaths take place every year due to chronic diseases. 50% of all deaths every year occur due to heart disease, stroke and cancer. Chronic illnesses are rising in Asian countries such as India and China. Every year, 8 million deaths that take place due to chronic disease are among those between 30 to 69 years of age. This puts into question the common view that chronic conditions occur only in older individuals. Research has found that 50% of deaths from chronic disease occur in individuals under 70 years of age, and 20% to those under 60. Some of the frequent causes of chronic ailments include poor diet, living a largely sedentary lifestyle, smoking and drinking to excess.
Healthcare policies that offer coverage for chronic conditions are more expensive, with most insurance companies setting a limit to the type of chronic illness and the cost of treatment. For instance, many insurers set a yearly or lifetime limit to claims relating to chronic disease. Some insurers do not cover chronic conditions at all, and individuals in the low risk category can delete this cover from their health insurance. However, there are rare cases where chronic disease develops in otherwise healthy individuals. If this takes place, it will be viewed as a pre-existing illness and so a number of insurers may be unwilling to cover it, or they may agree to cover it, but at exorbitant rates. Some international medical insurance providers agree to cover only the stabilization of acute flare-ups of a chronic illness, while others may also cover the routine maintenance of chronic conditions, such as through prescription drugs.
It can seem like an intimidating task to select the best suited and most affordable health insurance policy for you and your family. There are a large number of insurance companies in the market, and a multitude of healthcare policies and options, each with their own definitions and limitations. In order to help you make an informed decision, we will attempt to provide you with useful information that you may need when choosing health insurance.
Country-specific information
When planning to buy the best health insurance for yourself and your family, it is essential to research the particular country you are moving to. Find out if expats in that location choose public or private policies. Also, will you qualify for subsidised healthcare in your host country? Are there any exceptions? Will your healthcare plan come into effect as soon as you arrive in your host country? Or are you required to wait until you get your residence permit or health card?
It is essential to identify and cover any gaps in your health coverage as any accident or illness during these gaps can lead to very high medical bills. It is also a good idea to find out if your home country has a reciprocal healthcare agreement with the country you are moving to. You will need to figure out exactly what the agreement provides for, as you may only be insured in case of a medical emergency. Such reciprocal healthcare agreements are usually meant for tourists and those on short visits, rather than expats who will be settling down in the host country for longer durations.
Employer health insurance
Nearly two-thirds of expats receive medical coverage under their employer’s health insurance plan. Find out if you are one of them. If you are, will you still need to buy extra coverage, especially if you have a pre-existing or chronic condition? Figure out in advance what exactly is covered under your employer’s insurance policy. If you work as a freelancer, you will most likely have to provide your own health insurance. However, some expats may also be able to have an insurance clause added into their work contract.
Travel insurance – is it enough?
If you already have an affordable travel insurance policy, you may be wondering why you need to buy expensive international private insurance. Your travel insurance may be enough if you are only on a short-term international assignment and you do not have any chronic or pre-existing conditions. But travel insurance is specifically meant for traveling to another country, and not for living there as an expat. Besides which, the coverage of travel insurance is usually valid only for the first six to eight weeks, and is meant to provide cover for medical emergencies. For those who have private insurance in their home country, this can in some cases cover you for up to one year abroad. But it is still important to check with your insurance provider before you depart.
Local laws
Expats are faced with a multitude of options when it comes to expat health insurance. For instance, should they buy public insurance in their host country? Will it be more suitable to purchase private health insurance from a local company? Or should they buy insurance from an international health insurance provider that serves the expat market? The first point to figure out is whether it is mandatory to have health insurance in your host country. Some countries make it a legal requirement to buy public health insurance. In many cases, contributions are to be made to the public healthcare system through automatic salary deductions. In such cases, it is a good idea to find out if most expats also opt for additional private insurance so that they can have access to better-quality medical care and skip long waiting times.
National or international private insurance
There may be a language barrier when you take out private insurance from your host country. This may prevent you from understanding your policy and its documentation. The language barrier may also be in place when talking to customer services. In your host country, health insurance contributions could be paid by your employer. However, there may be no legal obligation for employers to pay unfixed sums because you only have international health insurance, instead of national health insurance. Even if your employer is willing to pay a part of the contribution, when dealing with an international insurer, administrative and taxation issues may crop up and need to be budgeted for.
Planning for the long term
Expats who plan to live overseas in the long termneed to keep in mind their long-term healthcare requirements, instead of just focusing on the immediate ones. International insurers tend to increase premiums steeply with age. National private insurers in your host country, on the other hand, charge higher premiums when you are younger, so that health insurance costs do not become prohibitively expensive as one progresses to retirement age.
Understand what is not included in your health insurance
Many insurers exclude pre-existing conditions and chronic illnesses. However, most cover costs for treatments that are necessary to stabilize the health condition of the insured. Based on how your policy is underwritten, some insurance companies may agree to cover pre-existing conditions. The exclusions vary from time to time as new technologies emerge, which influence medical costs. Most international health insurances involve the following exclusions:
– Addictions
– Mental disorders
– Allergies and allergic disorders
– Artificial life maintenance
– Birth control
– Conflict and disaster (this includes treatment that is required as a result of nuclear or chemical contamination, disasters, war, etc.)
– Obesity
– Cosmetic and plastic surgery (except for that which is administered immediately following a disease or accident, such as breast reconstruction after a mastectomy)
– Congenital conditions
Total cost analysis
When shopping for healthcare, the tendency is to opt for the lowest monthly payment, without paying much consideration to the deductibles one encounters, or the out-of-pocket costs for medication and the cost for doctors’ visits. There is also the coinsurance, which is common with many health insurance plans currently. This is a good idea for those who do not need to go to the doctor very often, are not on any maintenance medication, and are in good health.
But for those with chronic diseases such as diabetes where regular prescription drugs are necessary, along with the aid of specialists and multiple visits to the doctor annually, buying health insurance based only on premium can end up costing more than having a more expensive plan with a high monthly premium. For this reason, individuals with chronic illnesses need to do a total cost analysis before they begin searching for the right health plan.
Many people focus only on the premiums and later find that the coverage is not comprehensive, while the deductibles and copays work out to astronomical costs. Therefore those with chronic illnesses need to take into account what the total cost of medical care is going to be. One simple way of determining how much medical care is going to cost each year is to make a list of medications and note the frequency with which you or your family members visit the doctor. Once you have listed this information, you can use it to obtain an estimate of how much your healthcare will cost per year.
There are many websites that have online tools which will help you to do this. Equipped with this information, you can then begin shopping for a plan that meets your requirements. When the total cost is used to compare plans, it becomes evident that the plans with the lowest premium tend to cost you the most, as the deductibles, copay and cost of drugs tend to be high.
Chronic illnesses in the family
It often happens that more than one member of the family is taking a maintenance drug, or needs to visit a specialist on a regular basis, or needs more medical care than healthy people. Many with a chronic condition also have multiple issues. Therefore, when choosing health insurance, consumers need to make sure that they include their doctor’s advice on their choice of health plan. This also applies to prescription drugs. It is important to ensure that their prescribed medications are on the insurer’s formulary (list of drugs covered by the insurer). It may be challenging to find a plan that includes all the different doctors and medications. It is possible that the more expensive plans enable you to find most of what you need when it comes to doctors and medications. Those shopping for healthcare should also take into consideration the support services provided by an insurer for their specific disease.
Know what you qualify for
It can be time consuming to shop for health insurance when you have a chronic condition, as you need to find a policy that includes all your doctors and the medications that you and your family need. But there are ways to narrow down the choices. Those who qualify for premium assistance may also qualify for out-of-pocket assistance, but only if they have selected a silver plan. This brings the focus on silver plans as it limits your choices. Those insurers that offer different levels of plans use the same network of doctors, so if your preferred doctors are not in a bronze plan, it is likely that they will not be in the other plans, and thus you can move on to the next insurer.
Have you moved abroad with a chronic illness? Share your tips for other expats in the comments!