Older patients face hefty health bills as insurers alter cover

OLDER people could face medical bills running to many thousands of euro – even if they pay for pricey health cover.

This is because more and more policies are failing to fully cover the most important procedures for the elderly such as eye procedures and hip and knee replacements.

Yet at the same time insurers are trying to woo younger customers with an ever-wider range of extra coverage aimed at the under-70s such as fitbits, gym membership, fertility treatment and sex change operations.

Insurers are keen to attract younger customers who don’t make many claims, yet under Irish law must pay the same fees as older people who do.

Meanwhile, vital elements of basic cover for ageing customers such as knee and hip replacements and eye procedures are being downgraded, leaving many older people with bills for thousands that they can’t afford to pay.

Laya was the latest company on the market to make such a play ‘which is reducing the benefits on some plans for major orthopedic and ophthalmic procedures when carried out in private hospitals, which is similar to [what] VHI and Irish Life Health have already done’, said Dermot Goode of health insurance comparison website Totalhealthcover.ie

‘They are introducing a 20% shortfall in cover on 13 listed procedures, which means that members could now face [paying] anything from €600 to €3,000 depending on the procedure.’

‘Laya are really following in the footsteps of the other insurers who have already introduced these copayments over the previous years,’ he said.

However, the regulatory body Health Insurance Authority said that Laya – unlike other insurers – still has dozens of plans costing from around €1,000 upwards that offer full cover for eye, cardiac and orthopaedic care in private hospitals.

Mr Goode said: ‘The good news is that they are only bringing this in at present on a relatively small number of plans, which means there are plenty of other options for Laya members where they can still retain this full cover and potentially do so at a similar renewal premium compared to their current plan.’

Laya’s popular Simply Connect and Simply Connect Plus corporate schemes still include full cover for these major orthopaedic and ophthalmic procedures in private hospitals though this is subject to review at each renewal, which means customers should not automatically renew their cover.

However, there are fears that Laya will continue the trend by reducing cover for joint and eye procedures on mid-range policies costing around €1,300. And this would leave older people with a choice of paying more than €1,800 a year for more extensive – or forking out thousands to cover the full cost of a hip replacement.

‘It is a balancing act for the health insurers,’ said Mr Goode.

‘The good news for consumers is that there are alternatives available from each of the insurers where those who would prefer to pay a higher premium to retain this full cover can still do so.’

Many of Laya’s mid- and even lower-mid-range plans – from around €1,000 – still provide full cover in these areas for policies.

However, the better mid-range plans – recommended by Mr Goode – from both VHI and Irish Life don’t offer full cover in important areas despite costing upwards of €1,300, although they may have better cover in other ways.

The VHI’s PMI 5310 and 3613 only provide 80% cover in a private hospitals while Irish Life’s 4D Health 2 requires a patient contribution of €2,000.

‘All plans are increasing in price across the market and if you let your cover “auto-renew” without doing some investigating, you will simply pay more for possibly less cover,’ warned Mr Goode.

But he poured cold water on the claim that health insurance companies are undermining community rating by increasing benefits for younger members while reducing them for older people.

‘On the face of it, it looks like that but I don’t think it is that. Insurers are under serious pressure to reduce costs and bring in younger members. The community-rating model needs them. And remember €450 on every plan goes on a levy, not to the insurer,’ Mr Goode said.

He also said hospitals are often prepared to waive shortfalls if the vast majority of cost is covered by insurance.

‘I haven’t had a client yet who had to pay a shortfall,’ he said.

A spokesman for Laya said it had no plans to reduce eye and joint cover on mid-range plans.

‘Laya is the only health insurance company in Ireland to offer full cover on specific orthopaedic procedures on the majority of our schemes, with no shortfalls or excesses in a wide range of private hospitals,’ the insurer said.

‘If full cover for orthopaedic procedures is a priority for members they can choose from approximately 85 schemes where these shortfalls do not apply. For many members, it comes down to having a choice.’

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