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A fan recently consulted us and asked if the Million Dollar Medical Insurance is no longer worth buying.
She originally wanted to configure a million-dollar medical insurance for herself, her husband and her children, but she saw many people on the Internet saying that after the reform of medical insurance DRG, medical insurance is becoming more and more difficult to claim.
She was also worried that she wouldn't be able to get a claim after buying a million-dollar medical insurance, so she asked us to see if the above statement was true.
01. Why is it harder to get a claim?
Based on our observations, although there is some truth to the above statement, it is a bit exaggerated.
The coverage of the Million Medical Insurance is mainly for the medical expenses incurred during hospitalization, and the extent of coverage for outpatient services is very limited, let alone out-of-hospital.
For example, general products have the responsibility of outpatient and emergency treatment before and after hospitalization, but outpatient treatment during hospitalization is not covered by insurance, which often caused claims disputes in the past.
In order to avoid overspending and losses, many hospitals usually set restrictions on the use of drugs and equipment in ordinary wards, and some expensive drugs and imported equipment can only be prescribed by the special needs, international or VIP departments.
If some hospitals simply do not have drugs and equipment, the patient's family even has to go outside the hospital to buy them, which involves the liability of millions of medical insurance for out-of-hospital drugs.
Not to mention that most million medical insurance does not carry out-of-hospital drug liability, and even if it does, there are many restrictions.
For example, the responsibility of out-of-hospital drugs for most products is now focused on anti-cancer drugs, and there are restrictions on cooperative pharmacies and drug periods, and the actual help is not as good as advertised.
Therefore, under the baton of DRG fee control, the above various medical chaos has indeed raised the claim threshold of ordinary medical insurance in disguise.
02. Is mid-to-high-end medical insurance feasible?
That being said, it cannot be said that the million-dollar medical insurance is completely useless.
If you want to bypass the restrictions of DRG, you can also buy it at the rate of "no social security", and you will not go through medical insurance when you are admitted to the hospital, and you will pay completely out of pocket, giving doctors a higher degree of freedom in medication.
However, the price of buying in this way is 1 to 2 times more expensive than the rate of "social security", and it is still impossible to break through the limitations of ordinary wards.
Some Million Medical Insurance plans also offer medical plans in non-ordinary wards, which of course are more expensive.
On this basis, some products also provide better outpatient and out-of-hospital drug liability, gradually expand the scope of protection, and evolve into the so-called mid-to-high-end medical insurance.
The products are getting better and better, but the price is getting more and more expensive, and they are no longer as close to the people as millions of medical insurance, and some are even beyond the affordability of ordinary families.
This is because after breaking through the traditional scope of liability, the insurance company has no idea whether it will lose money according to the current pricing.
Therefore, mid-to-high-end medical insurance is guaranteed to be renewed for up to 6 years, unlike millions of medical insurance, which can be renewed for up to 20 years.
Therefore, for most ordinary families, buying mid-to-high-end medical insurance to cope with DRG reform is not a very effective strategy.
03. It is more reasonable to combine it with critical illness insurance
Medical insurance wants to continuously expand the range of treatments it covers, but also does not limit the scope of diseases, so it is impossible to bring down the price.
In order to reduce the price to a range that ordinary people can afford, some products even raise the deductible to 30,000 yuan, which will inevitably affect the user experience.
In fact, if we think about it from another angle, we will find that critical illness insurance is actually a better solution to deal with the DGR reform.
If you are hospitalized due to a critical illness, we can use the medical insurance to reimburse you with conventional treatment.
Treatments that are beyond the coverage of the million-dollar medical insurance, such as out-of-hospital examinations, out-of-hospital medications, or treatments that are broken down into outpatient treatments, can be paid for with the benefits of critical illness insurance.
There are also some non-treatment expenses, such as food and lodging, transportation expenses, nutritional products, etc., which cannot be reimbursed by medical insurance at all.
For 28 high-incidence critical diseases, such as cancer and cardiovascular and cerebrovascular diseases, the state has also unified the definition of diseases, and the product terms of each insurance company are the same, which minimizes the risk of claims disputes.
In terms of price, critical illness insurance is not much more expensive than million-dollar medical insurance, and even cheaper than mid-range medical insurance.
Because critical illness insurance only needs to be paid for about 20 years, it can be insured for decades or even for life, so it is generally necessary to pay thousands of yuan per year, which is bitter first and then sweet.
Although the price of medical insurance is only a few hundred yuan at the beginning, it will increase every few years, and it will cost thousands of yuan a year when you are old, and the cost of conversion is actually similar to that of critical illness insurance.
Therefore, in order to make up for the shortage of medical insurance of one million after the DRG reform, it is a more reasonable solution to match critical illness insurance from the perspective of protection function and cost.
04. Conclusion
With the topic of DRG reform, we talked in detail about the relationship between medical care and critical illness insurance, which is also a common topic.
Without medical insurance, many diseases and critical illness insurance cannot be covered.
In the absence of critical illness insurance, some expenses cannot be reimbursed by medical insurance.
Therefore, if you want a 100% health protection plan, medical and critical illness insurance are indispensable.
Well, that's all for today.
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