Health Insurance At what age does health insurance make little sense?

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SGWidow

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My dad is in a nursing home and my mam is at home - both just about on the right side of 90.

They have been paying their medical insurance premiums since forever and I'm wondering is there much point in continuing to do so.

My understanding is that the main purpose of private cover is to get you some combination of nicer accommodation, better treatment or earlier access. They are not particularly bothered by the nicer accommodation bit. So my question is - in what ways might they get better treatment and/or earlier access?
 
A very good question.

Maybe ask the nursing home if it's necessary for your dad?

The main advantage of health insurance is jumping the queue. I would suspect that for people of around 90, most medical requirements e.g. after a fall, would be urgent, so the A&E would deal with them quickly. And there is a good chance that they will go into a public ward anyway.

Brendan
 
My father died aged 93. He had VHI Insurance since the company opened. Never claimed on it until he was in his late 80's when he had to stay in hospital for over a month. He was put in a public ward after a fall. This ward was reserved for elderly people. Despite being in the VHI, he never got a ward either private or semi private but his VHI was billed by the hospital at full cost.

Because of the fall he needed a bed quickly. However a planned visit might result in getting a private or semi private room.
 
One of the usual reasons given is for quicker consultant appointments, scan referrals, elective surgeries.
However, at 90 even if an issue were to be found, major surgery may not be a practicable resolution.

Someone thing springs to mind e.g. for cataract surgery there may be long waiting lists on the public system.
Hip replacement surgery also potentially.

For their current plan, pay attention to what shortfalls there are on opthalmic or orthpaedic procedures.
Laya Connect Simplicity has good cover for both at approx €1300 per person, so if you are paying more than that you could consider switching.
Make sure if switching provider that you don't have to serve any waiting periods, shouldn't be an issue if you are downgrading cover but best to confirm.
 
My dad had private health insurance until he passed away aged 100. He lived at home and he did avail of private hospital accommodation when ill. It wasn’t great, he was very bothered by others when in a public hospital so the private room and the extra space was great but I found the care sub par (especially over the weekend).

In his final year he had a few spells in a public hospital, due to infections so he was in a private room because of the infections not the laya. He did need a special type of chair which my sister tried to get through laya, they pay up to €6K for “appliances”. Initially they said what?, then they said yes, so the manufacturer started to make it. But then they said no, they would only pay for a different cheaper version, which the HSE would supply but had already deemed not suitable for my dad. He had very long limbs apparently or something.

So it may be beneficial to have insurance but some private hospitals do not have skills to care for very elderly patients. And admissions at that age are usually through A&E which means you are in the public system anyway.

He did get cataracts done in his early 90’s privately which worked very well.
 
There is no way any hospital should put an elderly, vulnerable person in a private room. They should be on the ward where staff can monitor them, at all times.
Private Health Insurance is only useful for jumping the queue for healthcare when you are reasonably well and for conditions which are chronic, rather than acute or life threatening. It's a disgraceful system, in my opinion, but that's a discussion for another day.
 
Allpartied said:
There is no way any hospital should put an elderly, vulnerable person in a private room.
Click to expand...

So true, my father had health ins for private room but in his later years when he was admitted to private hospital we always requested he be put in a semi private room and as happened of course he needed help but was unable to call for it himself, luckily his room mate was in a position to do so.
 
We cancelled my dads health insurance when he was in a nursing home following advise from his doctor in the nursing home. However it did worry me afterwards on many counts but especially that if he required a stay in hospital and if medical card eligibility changed he would have to pay the 80 euro cost per day for a certain amount of days. . So My tuppence worth would be if you can afford it keep it on.
 
The max annual charge though is 800 euro for hospital stays without medical card so even if he paid max on that it would hardly make paying for health insurance worth it, there would want to be some other benefit as well. I think it all depends on the health of the person in the nursing home, there comes a stage when they are unlikely to be transferred to hospital and if a doctor advised it then I would be inclined to go with that advice.
 
Went through this discussion for another older relative recently.

As they have a condition which requires a regular procedure 4 -5 times a year the best choice for them was to keep the VHI.
 
Hi all,

OP here. I asked this question a few months ago and have just kept paying the premium on a monthly basis to give me time to consider. I put in on the side burner longer than intended but now wish to make a decision either way.

One thing that was suggested to me was that health insurance might be very useful if my dad ever needed IV antibiotics in the nursing home. Does anyone know whether all insurers cover this benefit (current plan is LAYA Simplicity) and how much it would cost if we went the self-insured route?

Also, the one treatment that my dad does get is physio. The Simplicity benefit here is pretty good (50% of cost for up to 25 visits). Is that as good as it gets in terms of dad-to-day physio benefits?

Before ever I joined AAM, I sometimes used to read healthcare posts and there was a poster who was a whizz at this sort of thing. I don't recall seeing him in recently? He was great.
 
SGWidow said:
Hi all,

OP here. I asked this question a few months ago and have just kept paying the premium on a monthly basis to give me time to consider. I put in on the side burner longer than intended but now wish to make a decision either way.

One thing that was suggested to me was that health insurance might be very useful if my dad ever needed IV antibiotics in the nursing home. Does anyone know whether all insurers cover this benefit (current plan is LAYA Simplicity) and how much it would cost if we went the self-insured route?

Also, the one treatment that my dad does get is physio. The Simplicity benefit here is pretty good (50% of cost for up to 25 visits). Is that as good as it gets in terms of dad-to-day physio benefits?

Before ever I joined AAM, I sometimes used to read healthcare posts and there was a poster who was a whizz at this sort of thing. I don't recall seeing him in recently? He was great.
Click to expand...
The poster was snowyb I think? He was the one who put Simplicity on our radar here I think. Hasn't posted for a long period now.

Simplicity has an excess of €100 for everyday medical expenses, so you'd need more than 3 physio sessions before you'd start getting money back from Laya. But then other policies such as Connect Simplicity have no excess but have a cap of €1000 on outpatient refunds.
Simply Connect Plus has no limit on number of physio sessions that can be claimed but has the cap of €1000.

I don't have any knowledge on the nursing home cover.
 
Thanks odyssey06,

That's the lad...……..[someday there'll be mention about a very helpful fella who kept us all informed about Covid!]

We pay approx €2,600 a year on physios - i.e. €50 once a week.

So just to be sure to be sure, are we saying
- Current refund is (25 x €50 x 50%) less €100 = €525
- Simply Connect Plus refund = €1,000

If I've got this right - that's a great tip, odyssey06 - especially given that the premium for Simply Connect Plus is lower. THANKS.

Another question is how far can I go back??? My administration has been somewhat inefficient! The renewal date is 1 November. Can I go back to 1 Nov 2019? Can I go back even further?
 
SGWidow said:
Thanks odyssey06,

That's the lad...……..[someday there'll be mention about a very helpful fella who kept us all informed about Covid!]

We pay approx €2,600 a year on physios - i.e. €50 once a week.

So just to be sure to be sure, are we saying
- Current refund is (25 x €50 x 50%) less €100 = €525
- Simply Connect Plus refund = €1,000

If I've got this right - that's a great tip, odyssey06 - especially given that the premium for Simply Connect Plus is lower. THANKS.

Another question is how far can I go back??? My administration has been somewhat inefficient! The renewal date is 1 November. Can I go back to 1 Nov 2019? Can I go back even further?
Click to expand...

Simply Connect refund is capped at €1000 so you would get €625 back.
If you had weekly physio sessions say 50 x €50 x 50% you would get €1000 back with Simply Connect.

I think further you can claim for the remainder of the phsyio under the MED1 scheme - you could pay it and claim the 20% credits if your father wont get any benefit.

I think for day to day benefits you are meant to claim within 12 months of the receipt date of the treatment.
 
Thanks again odyssey06,

odyssey06 said:
Simply Connect refund is capped at €1000 so you would get €625 back.
If you had weekly physio sessions say 50 x €50 x 50% you would get €1000 back with Simply Connect.
Click to expand...

Sorry for being slow on the draw but I don't quite get this?

Does the first line refer to Simplicity?
And is the approach something like:
- First 2 physio sessions ignored to cover the excess
- Next 25 are allowed
 
SGWidow said:
Thanks again odyssey06,



Sorry for being slow on the draw but I don't quite get this?

Does the first line refer to Simplicity?
And is the approach something like:
- First 2 physio sessions ignored to cover the excess
- Next 25 are allowed
Click to expand...
If you had simply connect and did 25 x €50 x 50% you would €625 back versus Simplicity would give €525 because of the €100 excess.
So with Simplicity it would actually be the first 4 sessions ignored to cover the excess - the excess is based on your refund (€25) not your claim amount (€50).
With Simply Connect Plus if you had a lot more than 25 sessions a year, somewhere in the 40 session mark LAYA would stop giving refunds as you'd have hit your €1000 cap.

Hope that makes sense.
 
Ok thanks again odyssey06 - very much appreciated.

So my remaining / updated queries are:

1. Anyone know anything about the cost of IV antibiotics in nursing homes and which health insurers cover this; and

2. Is there an even better policy for physio cover than Simply Connect Plus
 
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