Health Insurance for Senior Citizens

Health Insurance for Senior Citizens  Health Insurance is available for those 66 years old and above, so let's discuss the mechanics - and the price.
"The only choice for senior citizen's."

If you've tried looking for health insurance for your parents, or anyone older than 65 for that matter, then you've probably come to the same conclusion. The only medical insurance currently available is Blue Cross' Premier plan.

But technically speaking, that isn't true. Another more basic (and affordable) insurance is still available - PhilHealth.

Of course, in practice, PhilHealth is usually not enough. And so, if you're looking for medical insurance for senior citizen's you're pretty much stuck with Blue Cross Premier.

However, that's almost beside the point. Insurance is available, so it's more practical to discuss the mechanics - and the price.

So how do you go about insuring someone who is over 66 and up?

Well, first you get them PhilHealth - the "right" kind. What the heck do I mean? There's only one PhilHealth right?

Yes, but when you're a senior citizen, it's FREE. Their premium, instead of being paid by themselves or their children, is paid for by the Sin Tax Law.

And since you've probably already guessed that insuring a senior citizen will be costly, you're going to want to save what you can so you can better cope with the premiums.

To qualify, all you need to do is to enroll via the Office of the Senior Citizen (OSCA). Once you register with OSCA (there's an office in each city/municipality), your name gets included in the list submitted to PhilHealth, which then entitles you to free PhilHealth.

If you somehow are unable to do so, you can go to the nearest PhilHealth office and register yourself. You'll need:
  • 1x1 picture (taken within the last 6 months)
  • Filled up PhilHealth Member Registration Form
  • Valid government ID or senior citizen ID (from the local OSCA)
(For more details, you can refer to PhilHealth's official website: http://www.philhealth.gov.ph/members/senior/)

So now that you have PhilHealth, what about Blue Cross? Well, let's go straight to the most common question - how much?

Well, it depends on the room classification you want to have when you get confined.



Private
Semi-private
Ward
Annual
69,299.00
41,245.00
25,487.00
Semi-Annual
37,421.46
22,272.30
13,762.98

(Premiums as of Aug. 2015. For current rates, refer to Blue Cross's official online quotes.)

Yikes. I wanted to get my parents a private room, but I'm gonna have to do some serious budget gymnastics if I want to make that happen.

But now that we know how much it costs, what exactly do we get in return?
  • 1.5 million pesos maximum coverage limit.
  • No restrictions on your choice of hospital, doctor, or specialist
  • Emergency overseas coverage (for travel)
  • 24/7 customer assistance
  • And a promise of quick reimbursement
  
Health Insurance for Senior Citizens  Health Insurance is available for those 66 years old and above, so let's discuss the mechanics - and the price.
Sounds great? Sure; considering it's the only deal available it's not really a bad one. However there are some stuff we need to realize.

It's medical insurance, not HMO. You'll have to pay out of pocket and reimburse it. That's why there are no restrictions in terms of doctor or hospital.

That's also why the promise of quick reimbursement is crucial. You're probably getting insurance because you're worried the hospital bill will be too big. But with this medical insurance, you're possibly going to have to pony up the cash anyway. You could probably pay in chunks and reimburse as you go, to cycle the money and keep afloat of the bills.

That Php1.5M sounds great. And it's at least adequate. A relatively "affordable" heart operation (like an angioplasty) can easily cost 500k. The more expensive ones (like a double bypass) would probably reach millions.

Emergency coverage is great, but with a Php1.5M cap, it might not last much if you're traveling to a first-world country (and getting treated there).

But perhaps the greatest caveat here is that this is for in-patient services only. You get to utilize it if you get confined. You don't get annual check-ups, free consultations, medicine reimbursements, or any sort of preventive care.

With all those concerns, should you still get medical insurance? Yes, if you can afford it.

Even when paying ~75K per year (Private, semi-annual), you still come out ahead when an illness strikes. Let's face it, when you get confined, the bill can get really astronomical really fast.

However, like all financial matters, it's not a total no-brainer. Insurance might be a great tool, but if you stretch your finances too much with it and a different sort of emergency strikes... Well, that's not so great either.

For those looking for a cheaper alternative, there is one other possibility: You could invest in a hospital directly. As in you have to negotiate that with the hospital owners/admin.

To be completely honest, I have not done that and have heard only second-hand reports. But I have heard enough to know it is possible. (But obviously this is highly unlikely for bigger hospitals like St. Lukes or Medical City)

For a certain amount, you can invest in a hospital and be a sort of part-owner. You most likely won't get any monetary returns (though in one instance I read that was at least a remote possibility). But by doing so you do get some medical benefits - to the point that it was as if you still had an HMO. But only with that specific hospital.

You would be severely restricted in terms of choices, but the cost (reportedly) would also be minimal compared to the equivalent medical insurance.

In the end, there is no perfect solution. There isn't even a lot of choices. But at least there are options, and now we're a slightly more informed and can ask deeper questions.


Update: see my other post comparing different medical insurance for senior citizens: Blue Cross Premier and Kaiser Senior Care

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photo credit: Education Health Insurance via photopin (license)
photo credit: Alex E. Proimos via photopin cc

5 comments:

  1. It is nice to know Blue Cross extend their coverage to our elders. This is the time of our life we need more medical attention thus require a bit of expense.
    Kaiser International Health Group also offers a Senior Care product intended for 65 and up.

    ReplyDelete
    Replies
    1. Thanks for mentioning an addtional option Bill! I'll update teh article to include it.

      On inspection though, the Senior Care product seems more expensive and... well, difficult. My peso will only "buy" 16.xx pesos of coverage with Senior care, while Blue cross will give me 21.xx pesos in return (potentially, of course). Senior Care will also require pateitns to shoulder the first 10,000, as well as foot 10% of the total bill. Will investigate Blue Cross, but based on their website it appears that isn't the case.

      But I'm sure in some cases, some may prefer Kaiser Senior Care over Blue Cross Premier. And it never hurts to have options.

      Delete
  2. What about pre-existing medical conditions of the patient? Is it covered?

    ReplyDelete
    Replies
    1. By default it is not, though it can be covered subject to evaluation by their medical director.

      Delete
  3. I'm also looking for HMO or Medical Insurance for my mom (52yrs old) then google show me this very helpful article of yours.

    And I just realized if medical insurance will just reimburse your medical bills, is it more convenient or practical if I just start a mutual fund for my mom/family health fund?

    Hope you can share your thoughts.

    ReplyDelete