A Guide to Healthcare for Expats with Chronic Illnesses
Chronic conditions include diseases, illnesses or injuries. They may be ongoing and have no known cure. They could recur or they could be permanent, or they could 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% of all deaths globally. Of this, 20% 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 because of heart disease, stroke or cancer.
Chronic illnesses are rising in Asian countries such as India and China. Every year, 8 million deaths due to chronic disease occur among those aged between 30 to 69 years of age. This brings into question the common belief 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, and smoking or drinking in excess.
Healthcare policies that offer coverage for chronic conditions are more expensive, with most insurance companies setting a limit for the type of chronic illness and the associated 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, so those individuals who fall into the low-risk category should delete this cover from their health insurance. However, there are cases where chronic disease can develop in otherwise healthy and young individuals. If this occurs then in the future it will be viewed as a pre-existing illness and so some insurance companies may be unwilling to offer 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 many insurance companies in the market, and a multitude of healthcare policies and options, each with their own definitions and limitations. So that you can make an informed decision, we have attempted to provide you with useful information that you may refer to when choosing health insurance.
When planning to buy the best health insurance for you and your family, it is essential to research the country that you are moving to. Find out if expats in that location choose public or private policies. Try to find out if you will qualify for subsidised healthcare in your host country. What exceptions are there, if any? 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 result in very high medical bills.
It is also useful to find out if your home country has a reciprocal healthcare agreement with the country you are moving to. You will need to ascertain exactly what the agreement provides for, as you may only be insured in the case of a medical emergency. Such reciprocal healthcare agreements are usually meant for tourists and those on short visits, rather than for expats who will be settling down in the host country for longer periods of time.
Employer health insurance
Nearly two thirds of expats receive medical coverage under their employer’s health insurance plan. Find out if you will be one of them. If you are, will you still need to buy extra health care coverage? Work out in advance what exactly is covered under your employer’s insurance policy. If you are a freelance worker, you will most likely have to provide your own health insurance cover. 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 travelling to another country, and not for those living in the country as an expat. Travel insurance cover is usually valid for the first six to eight weeks, and is only meant to provide cover for medical emergencies during this time. For those who have private insurance in their home country, this can in some cases provide you with cover for living abroad for up to one year. However, it is still important to check with your insurance provider before you depart to your new country of residence.
Expats are faced with a multitude of options when it comes to health insurance. For instance, should you buy public insurance in your host country? Will it be more suitable to purchase private health insurance from a local company? Or should you buy insurance from an international health insurance provider that specifically serves the expat market? The first point to consider 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 to the public healthcare system will be made through automatic deductions from your salary. In such cases, it is useful to find out if most expats also opt for additional private insurance so that you can then have access to better quality medical care and avoid 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 for by your employer. However, there may be no legal obligation on employers to pay unfixed sums if you personally have only purchased international health insurance, instead of national health insurance. Even if your employer is willing to pay a part of the contribution, the associated administrative and taxation costs that can be involved when dealing with an international insurer do need to be budgeted for.
Planning for the long term
Expats who plan to live overseas in the long term need to keep their long-term healthcare requirements in mind, 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 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 in their health cover provision. However, most will 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 may vary because of technological improvements that can influence medical costs.
Most international health insurers have the following exclusions:
• 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.)
• 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
Getting the best plan when you have a chronic illness
Choosing the right plan when you have a chronic illness may prove to be difficult as there are so many different specialists to select from, as well as working out how to choose your preferred physician. All of this must be considered when selecting health insurance. Choosing the wrong policy can cause you to spend a great deal of extra money, or you could find yourself unable to afford any healthcare.
Total cost analysis
When shopping for healthcare, the tendency is to opt for the lowest monthly payment, without paying sufficient attention to the deductibles one encounters, or the out-of-pocket costs for medication together with the cost for any doctor’s visits. There is also the coinsurance clause, which is currently common with many health insurance plans. The coinsurance percentage is based on the portion of the costs for health care after the agreed deductible has been paid or removed from the total. If the total of your medical bill is £2,000 and you have a £500 deductible, then the portion that the coinsurance will apply to is the remainder after the deductible.
So, the coinsurance will apply to the £1500 remaining. If you have a 20% coinsurance clause, you would first pay the £500 deductible, then 20% of the remaining £1500, which is £300, and you would expect the insurance company to pay the remaining £1200. Your out of pocket expenses would be the combined total of your part of the coinsurance clause portion and your deductible, which is £800. The insurance company would then pay the £1200.
Those with chronic diseases need to be wary of hidden costs. The need for regular prescription drugs along with the aid of specialist involvement and multiple visits to the doctor annually need to be included in any health insurance calculation. It would be a false economy to buy health insurance based only on a premium when you have a chronic disease as it can end up costing you more than if you had purchased a more expensive but fully comprehensive plan with a higher 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 fully comprehensive, as the deductibles and copays for treatments undertaken can work out to astronomical costs. Those with chronic illnesses need to consider what the total cost of medical care is going to be. An uncomplicated way of determining how much medical care is going to cost each year is to make a list of one’s 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 that you can use to do this calculation.
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 premiums tend to cost you the most, as the deductibles, copay and the cost of drugs tend to be higher.
Chronic illnesses in the family
It often happens that there can be more than one member of the family who is taking a maintenance drug, needs to visit a specialist on a regular basis, or generally needs more medical care than a healthier person. Many people who have a chronic condition can also have multiple issues. 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 your prescribed medications are on the insurer’s formulary (list of drugs covered). It may be challenging to find a plan that includes all the different doctors that need to be consulted and the medications required. 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 you and your family needs. 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 can limit your choices. Those insurers that offer plans with distinct levels will use the same network of doctors, so if your preferred doctors are not in a bronze plan, it is unlikely that they will be in the other plans, and thus you can move on to the next insurer.
If you’re planning a move abroad, take a look at our partners who offer various health insurance options.
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