Health insurance - to have or not to have???

[Jennifer13]

Can I add to the original question? I have never ever had PHI and neither had hubby, nor did our parents when we were kids. I know that not having it means you get put in waiting lists when you need something, but generally everything is covered by medicare? But when you have PHI you may get treatment straight away but you have to pay for loads of things like blood tests, ultrasounds etc. Is that right? And if so, is the only benefit to PHI not going on waiting lists?

There are many medications and health services that are not covered under Medicare (or they may be, but they are in such short supply that it's not only the waiting list but being able to access those services that is the issue). Dentists are one example, yes, there are public dentists (mostly through hospitals) but good luck getting an appointment for an annual check up!

Physios, chiros, most other 'alternative' therapies are not covered by Medicare. You can go to a dr or pharmacy and get drugs if you are in pain, but ongoing pain management through anything I mentioned you'd have to pay out of pocket without PHI. Also, a lot of health aids might not be covered (or if they are you are very restricted in what you can get, glasses come to mind here, as do braces). My orthodontic expenses all up cost over $12,000 (braces, dental work, oral surgery, implant). I got about two thirds of that back from PHI. The point is not just that I would have been more out of pocket, but in all likelihood, because it was 'cosmetic' (let's ignore the fact I was grinding my teeth down to nothing, had one missing completely and would have needed significant work and probably dentures in future when it got acute) it would not have happened at all in the public system.

Psychologists and psychiatrists are another one - there are some that are publicly funded, but unless you have an acute condition and can get to where they are based, then you certainly won't get treatment in the timeframe you might like.

That's just off the top of my head. So if it's a specialist that you can find in a public hospital, yes, Medicare will cover that and technically you would be more 'out of pocket' if you went to someone privately. But because there are so few, you might not be able to get all the treatments you would like.

I actually have used the public hospitals when I needed to (not as an in-patient) and for acute issues, like an injury, I found them to be good. But when I had a sore back this week, I was very grateful to be able to book in to see a chiro immediately and only pay a very small fee by comparison to what the actual fee was, thanks to PHI. And with two more visits needed this month, then my PHI has paid for itself for the month. And that's before I factor in the physio-led antenatal aqua classes I take every week that PHI also contributes the majority of the cost towards.

At heart, I'm actually more of a socialist and I have a strong belief that publicly funding PHI (though the PHI rebate) is not the best use of public health money and taxes. I would like all people to have access to the health services I mentioned above, without preference going to those who can afford it and not those who need it most. But that's a debate for another day! I work with the system I find myself in.

[misty]

We don't have PHI. (my parents have never had it either).

We have looked into it a number of times, but financially it really just does not make sense for us. We have access to most of the services we use for free with medicare, whereas if we had PHI, we would have to pay for those same services, and be out of pocket even with the rebates. Generally we have been very happy with the public system and have no reason to change (being in very good health).

With my Gallstones, it did take me 3 months waitng for my operation, which wasn't the nicest - but I felt comfortable with the knowledge that if it had of been 'life-threatening' (or some such) I would have received emergency treatment ASAP. Which is kind of the veiw I have with aany unforeseen 'emergency'. Also, I have the comfort of knowing that although we are not exactly 'flush' with money, if something arose and we didn't want to wait on the public waiting lists for whatever reason, we have the ability and resources to draw upon to fund most things ourselves. Of course it wouldn't be ideal financially to do so, but the odds are with us that we will never need too.

We have looked at PHI specifically for the 'extra's', but again it doesn't make sense for us. For example, Dental generall has a cap on how much they will rebate you and what for - we far exceed most of these caps, or the premiums don't make it worth it for us.

Many people have told me that I should at least have ambulance cover - but I have never in my entire life needed an ambulance, and if the need actually arose where one was required, I have the funds (or access to funds) to pay the debt - and I would still be better off financially to pay when and if I used one: unless I suddenly planned on using an ambulance at least once a year.

So there is no "one answer fits all" for the question of whether PHI is worth it. It very much depends on your personal financial situation and where you live.

[Miss E]

Many people have told me that I should at least have ambulance cover - but I have never in my entire life needed an ambulance, and if the need actually arose where one was required, I have the funds (or access to funds) to pay the debt - and I would still be better off financially to pay when and if I used one: unless I suddenly planned on using an ambulance at least once a year.

Ok, each to their own. But seriously, if you or one of your family members had to be airlifted by helicopter or whatever, you wouldn't be looking at $800. Probably more like $15,000 or $20,000. And the average trip in a road ambulance is something like $5,000. For $100 a year or whatever the ambulance cover is, I can't see how you would be financially better off even if you or your family only used it once in your life time.

Personally, I like having the security of knowing that I can call an ambulance at the drop of a hat - if something happens I won't be trying to weigh up if it is serious enough or not to require, I will just call.

JMO

[misty]

Ok, each to their own. But seriously, if you or one of your family members had to be airlifted by helicopter or whatever, you wouldn't be looking at $800. Probably more like $15,000 or $20,000. And the average trip in a road ambulance is something like $5,000. For $100 a year or whatever the ambulance cover is, I can't see how you would be financially better off even if you or your family only used it once in your life time.

Personally, I like having the security of knowing that I can call an ambulance at the drop of a hat - if something happens I won't be trying to weigh up if it is serious enough or not to require, I will just call.

JMO

Well, as with any insurance, it depends on your "sleep at night factor" (ie, feeling secure).

For me there are two parts to this.
1) the actual likelihood of me or my family actually needing ambulance services - which in itself is pretty small. And statistically even less likely to need air ambulance services. Of course there is a possibility, but given our personal circumstances (healthy, young, live in a Capital city with good medical facilities,etc), it is not very likely. Most people will go their entire lives without ever taking an ambulance ride.

2) Although $20k is not a small amount, IF the statistically unlikely were to happen, we are in a position where we could (and would) access the funds to pay it. Afterall, our lives are worth so much more then money.

I can sleep at night knowing this. It may seem like a gamble to you, but to me it is just risk analysis; just like I don't have pet insurance for my dogs and cats, and yet (given there is no animal medicare) they are much more likely to incurr medical costs which I cann't afford, then sny of my family members.

[Jennifer13]

I'm young, healthy, etc too and I've been in an ambulance three times and attended an ambulance station one more time for treatment. Most of those happened while I was a teenager (head injury that required stitching, broken and dislocated fingers, serious abdominal pain, sun stroke), so not just something that applies to adults. All were acute and couldn't have been predicted. My DD has once required the ambulance when she got a bad cut to the head as a six week old which was bleeding heavily.

One time when the ambulance was called for me, I wasn't in a state to object. For that trip I received the bill (which I then passed on to my PHI, I was too out of it to give it to them at the time), it was about $400 from memory, and that was for 15 mins drive with no medical procedures at all. Literally being wheeled on and off the trolley and driven to the closest hospital. Another time after a car accident I refused ambulance attendance and got a friend to take me to the hospital to get checked (I had concussion). Really, i would have been far better off not freaking out about the ambulance cost because I had forgotten to renew my subscription and getting medical attention much more quickly. I had rolled the car down an embankment and didn't even realise I was that banged up until well afterwards.

[Jellyfish]

We have looked into it a number of times, but financially it really just does not make sense for us. We have access to most of the services we use for free with medicare, whereas if we had PHI, we would have to pay for those same services, and be out of pocket even with the rebates. Generally we have been very happy with the public system and have no reason to change (being in very good health).

I'm curious because a few people have said things along these lines but how does having PHI diminish your ability to access Medicare related rebates/bulk billing etc? They have no impact on eachother as far as I've experienced or am aware of; isn't PHI essentially in addition to, not instead of? I do understand the premiums not being balanced by usage for different people and different circumstances but was just wondering about this side of things.

[Miss E]

As a young, healthy person with a family that also lives in a major capital city, I also don't expect to need an ambulance for an illness related issue.

But DH and I drive a car almost every day, cross the road several times a day, have a toddler who loves to climb, who despite all my child proofing efforts could possibly get his hands on something poisonous (at home or at someone elses home), who falls over all the time, who doesn't look where he is going, who plays on playground equipment at the park, my house probably has spiders that I haven't seen... You get the idea.

Every day, just going about our daily lives we are at risk of seriously injuring ourselves. Yes the odds are low, but they're real. I've been in 6 car accidents in my life, none of them have been serious enough to require an ambulance, but gee everyday there are many, many others who aren't so lucky. What's to say, me or DH or DS won't be one of them one day. Whose to say that won't happen out in the country where an air ambulance is needed?

But like you said, you're willing to take the risk and could pay the bill if you needed to. I get it. We could also pay the bill if we had to, but I'd rather pay $100 a year and support the ambulance service (whether I need it or not) and know that if I think I might need it, I'll use it rather than take my chances and drive us to hospital.

Again JMO

[JLeigh29]

Having PHI does not mean you can't access Medicare benefits. PHI covers things Medicare does not. If Medicare covers it, PHI won't (simplistically put).

As someone who spent three years worth of savings (our first house deposit) on a private hospital stay and treatment for endo because we didn't have PHI, I wouldn't be without it now. We have hospital and extras and it's more than paid for itself.

We make sure we get the best value we can out of it so that means, among other things, dentist check ups every 6 months (we've just had our last lot and for three of us we'd have been out of pocket over $450 but 100% covered by PHI! And that was just a check up, no treatment needed), chiro (covers $1200/year), optical (though an eye test every two years is covered by Medicare) etc.

As Cherished said, there are lots of other things that would have to go before we'd consider giving up our PHI. $150/month sounds expensive, but I know someone who smokes/drinks moderately and they spend $150/week on that habit. Then there's their pay TV, lunches and snacks for work 5 days a week, the DVD's they 'have' to buy every week, the Friday night take away etc etc - oooh, if only I had their budget to cut back on, we'd be rich, lol!

I know finances are tight for you, but I'd be looking at other ways to cut back before losing your PHI. Shop around, you can get a better deal than what you have and maybe you can also select the type of extras that would most benefit you and your family.

[*EJ*]

Some interesting converstions while i was away.

I have now signed up to Comprehensive Extras that is costing me $73 a month. This i feel we will be able to make better use of for the money we are paying, i intend on using quite a few of them. So i know we are taking a risk in some way by not having hospital cover but for the time being this is what we are able to afford. I have just under 3 years to sign back up to hospital cover before we will be changed an extra levy for being over 32 (i think that was the age??). Once i am back at work again i will change our cover to hospital and extras.

As for ambulance the other night i was talking through various extras cover with DH and one of them included ambulance but in emergency only. It would cover only if the reason was specificly listed as being an emergency. Before i had even read what has been posted in here my thoughts on that were i would still pay ambulance for the security of knowing that no matter what the circumstance we would be covered.

For me i have always been a member and encouraged DH to become a member when he was younger and would go on motorbike riding weekends. Thankfully he has never needed an ambulance but his friends have after coming off their bikes in the bush.

Also a close friend of mines DP has twice been caught out needing an ambulance without actually having any cover. I'm not too sure about the details of the first time but i know the second time involved an ambulance ride and then being airlifed. One was for a car accident and the other was for a freak accident while away on a boys weeeknd. So twice he has been left with very large bills.

You really do never know when you might need it. Earlier this year i called an ambulance for DD which was the first time ever for me. She woke up with croup and was gasping for breath, i knew i needed to get her to the hospital but putting her in the car and drving her myself (so DH could stay home with the boys at 11pm) was not an option (i knew she would not handle it well as she was a bugger in the car and her breathing was worse when upset). So my thoughts were i know she needs treatment tonight, i pay my membership this is a time when i need to use it. It's the best $75 a year i could spend for my family in my opinion and we definately would not have access to such funds if we needed them without membership.

All it is is $75 a year and for all the years we've been a member now i still don't know if the total cost i've paid would cover what our one and only trip would have cost us. It's supporting the organisation also, i want them to be there for me like this for as long as i and my family are alive.

[Taurean]

Just wanted to give some recent ambo 'costs'.

My parents have been on my brother's case since his late teens (he's almost 29) to get ambulance cover. He is a mad keen bmx rider and has broken so many bones over the years and has so many trips to hospital that we've lost count. They assumed he'd sorted it out until last week when he told them he has an outstanding ambulance bill after an accident at a skate park in Melbourne earlier this year. It's for $2500 for a quick trip from the skate park to the closest hospital. He was unconscious and bleeding from the head badly so his mates didn't even think twice before calling 000, an ambo was necessary. It turned out to be one hell of an expensive joy ride at the skate park that night though.

Food for thought.