Finding Health Insurance for My Adult Disabled Sister. Any Advice, Experience, Bargains?

• 

  orangetrain on 24/08/2021 - 11:58

  +3

  Why do you want private health insurance instead of medicare? The costs will eat her pension.

  • 

    mini2 on 24/08/2021 - 12:30

    +1

    Medicare doesn't quite cover dental and OP is expecting some dental expenses soon-ish.

    On the other hand, where's NDIA in the grand scheme of things?

    • 

      dylan345 on 24/08/2021 - 13:09

      She has NDIS funding however I believe they wont cover medical expenses such as dental.

      While Medicare is great my sister deserves to be taken care of correctly in the event of unexpected medical needs and paying a premium for insurance may be worth it to us. We are undecided.

      @orangetrain are you saying health insurance is only for the well off? Disability pensioners need not worry because Medicare is good enough?

      • 

        thatonethere on 24/08/2021 - 13:32

        +3

        Don't expect private health insurance to cover 100% dental - but if you play it right you can use the providers dental outlet to cover cleaning 2 times a year (which will stave off fillings and thus save on costs. eg AHM use Pacific Smiles for clean and fluoride 2 times a year no gap).

        However stuff like crowns and root canal - you will have gap payments with private insurance.

        May want to look into a Health Care Card too for dental treatment if elligble

      • 

        Quantumcat on 24/08/2021 - 13:38

        +2

        are you saying health insurance is only for the well off?

        It kind of is, as it reduces an extra tax when you're over 31. Only barely worth it then. Not going to be worth it for someone who wouldn't have to pay that extra tax anyway.

        • 

          Pry on 24/08/2021 - 13:49

          @Quantumcat: Not entirely correct. You're not taxed anything more when you're over 31, but you do have to pay an additional fee if you don't hold private hospital cover, and decide to take it out after the age of 31. If you never take out hospital cover, you'd never know this additional fee exists.

          • 

            Amaris on 24/08/2021 - 13:59

            @Pry:

            but you do have to pay an additional fee

            I was under the impression till very recently that this extra fee was government imposed. Was surprised to find out that the health funds have the option of charging someone extra if they didn't have insurance by 31.

            • 

              Pry on 24/08/2021 - 14:05

              @Amaris: It is a government initiative, you can view more information about it here

              • 

                Amaris on 24/08/2021 - 14:10

                @Pry: Yes, government has allowed them to charge more. They have the option not to if they want of course.

                • 

                  Pry on 24/08/2021 - 14:20

                  +1

                  @Amaris: From my understanding I don't think this is accurate, but I can't say with 100% certainty. I've worked in the industry for 5 years and haven't heard of it being possible for a fund to choose not to charge the LHC, and haven't seen examples of it happen.

      • 

        mini2 on 25/08/2021 - 13:49

        +1

        NDIS money covers all kinds of wonderful things. Today I've learned that one of my tenants is on NDIS and part of her funding pays for someone to come and maintain my property every single month. If they can fund such a frivolous task, why wouldn't they look after your sister's dental issues?

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  freefall101 on 24/08/2021 - 13:26

  +5

  Former Bupa employee here. While I had zero to do with writing/selling policies, I did talk to a lot of people while there about what is the best thing to get. However, this is very, very generalist advice, you really need to think specifically about what care your sister needs or talk to a financial planner.

  Hospital cover: The only reason for most people under 60 to get hospital cover are those who expect to have elective surgery or want options on who their doctor is for giving birth. Care is provided already under our public health system for anything life threatening/emergency. Private hospitals almost always have extra out of pocket costs as well, the only benefit is you get a room to yourself and it lets you jump the queue on anything with a wait time. But if you have a life threatening problem, the public system is great.

  Example of jumping the queue - need a hip replacement? So do many others. It can also hurts like a bitch but isn't life threatening, so there is a wait time where you have to just deal with it. Look at what potential health issues your sister may have to deal with and whether they would qualify her under existing programs/NDIS/medicare and whether there's long wait times for those at public hospitals. Also make sure there's no loopholes from the insurer for preexisting conditions (I'm pretty sure that isn't allowed in Australia but worth checking).

  Reason for over 60s is things start hurting and those things almost always need specialists. Health care companies make money on those who get cover for tax reasons/are scared of hospital bills, lose money on the oldies who are still active but things start going wrong with their bodies.

  Extras: For nearly everyone you are better off paying out of pocket over a long period of time. And dental usually has a pretty low cap, the defence health extras plan you mentioned has a cap of $1,100 a year on major dental. The cost? $1,100 a year. Funny that. Unless she's going to be needing that every single year, over a long period of time it may not be worth it, unless it's going to cover other out of pocket costs she has. There's also a 12 month waiting period on major dental, so if she needs it now it's probably already too late.

  Side note: Get ambulance coverage for her. Everyone should get ambulance coverage. (edit: Just saw you're in Queensland so I think it's free there already)

  • 

    dylan345 on 26/08/2021 - 12:01

    thank you for explaining these considerations. It was very helpful.

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  Quantumcat on 24/08/2021 - 13:35

  Don't get private health insurance, will cut into her income hugely and if she has the mind of a child like you say, how could she even use it properly? She'll probably end up paying out of pocket and not know how to claim, or go to the wrong practice where that insurance doesn't give good benefits, and not be able to get rid of it if it isn't working for her anymore, so will eat away at her income forever. Dentists can do payment plans if she needs something expensive done, and if she has a support worker they should help her be able to claim any dental benefits she may be eligible for as she is under ndis.

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  Pry on 24/08/2021 - 14:45

  +1

  I think health insurance is a great idea, but you have to make sure you find the right policy. Personally I wouldn't go for that Defence policy unless she would use a lot of different extras services regularly, or if she will need braces. You want to make sure that she's claiming more back each year on the extras than what the extras policy costs, like what freefall101 was alluding to.

  For hospital cover it's a bit more like other types of insurance where you hope you don't have to use it, but you're glad it's there if you do need it. Emergency situations are handled by the public system, but once you've been treated, if you require any further treatment that can wait then you'll go on the public waiting list. This could just be a wait of a few hours, days, months, or years. Make sure you've looked over what clinical categories are included/excluded/restricted on the hospital policy and ensure that nothing in the excluded/restricted list are things that you'd want her to be covered for.

  Also make sure you take into account her Lifetime Health Cover (LHC) loading, as this is going to increase the cost of the policy.

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  screensaver on 24/08/2021 - 16:19

  +1

  She will have to pay a small loading for 10 years as over 31/ Defence is part of a group of health partners. Queensland Country Health has very good premiums, cheaper than Defence, HCF is good too

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  Seraphin7 on 24/08/2021 - 16:26

  +2

  All insurance is a waste of money … until you want to make a claim!

  As with all insurance, you need to weigh up the cost against the benefits and the risk.

  Spoiler alert, on the average, people pay more in premiums than they receive in claims … the reverse situation would see every insurer go out of business!

  As has been pointed out about, PHI provides "greater" benefits under certain circumstances that may or may not be valuable or used by the insured. This is both a personal choice and the luck of the draw.

  If you want/need to have some form of elective surgery and want to be attended to quicker than the public system allows for and/or just prefer what the private system offers, then PHI will defray these costs if/when this situation arises.

  If you only have call for "emergency situations" and/or don't mind waiting in order to avoid the cost, then the public system will service the need.

  The choice to get/not to get PHI is ultimately a personal choice … but don't get it and then complain about the costs, and equally don't complain when someone who has PHI gets something that others don't.