Health insurance: What will you get for €500, €950 or €1,600?

With nearly a million people on public health waiting lists, having another option in the event of illness, injury or poor health is becoming increasingly important.

The public health system isn’t entirely free, either; if you end up in hospital you will pay €80 a night, up to a maximum of €800 in a year, if you don’t have a medical card (Covid-19 patients are exempt from this). This charge applies even to children older than six weeks.

Of course, opting for the private route won’t necessarily obviate the waiting times entirely – dermatologists operating in the private sector across the State for example, have extensive waiting lists. But it should, at least, offer you a faster route and some alternative options.

But, while you might think that having appropriate cover is important, you will also want to ensure that you don’t overpay for your cover either – particularly given all the cost of living pressures at the moment.

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Remember also, if you’re on a cheaper policy, you might want to upgrade it as you get older because of the waiting periods that apply for new illnesses.

As Dermot Goode of totalhealthcover.ie notes, "the time to take out health cover is when you are healthy, which means your cover kicks in immediately for accidents and after six months for new medical conditions, whereas if you wait until you have an existing medical problem, then you may find that this condition will be excluded for up to five years on all policies".

So here we take a look at options for private health insurance cover based on the budget you might have, whether you’re a first-time customer or looking to upgrade your cover.

Entry level (€500-€600)

Given price increases in recent years, a so-called budget health insurance option will now cost you at least €500 a year. But what do you get?

According to John Haigney, health insurance adviser with Lyons Financial Services, these entry-level plans primarily focus on public hospitals.

They typically offer a private or semi-private room in a public hospital (unlikely that you would get one, but still), and certain day-case procedures in private hospitals, as well as some money back on a host of day-to-day expenses.

So, while you might get cover for an MRI in an approved treatment centre, such as VHI’s Swiftcare, for example, you will have difficulty accessing other services in private hospitals.

And you can forget about cover for pricier “high-tech” hospitals.

“You won’t be going near Blackrock or the Beacon,” says Goode.

If your budget is in this bracket, you could consider the VHI’s Public Plus Care policy, which has the distinction of being the cheapest policy on the market. It costs €504 per adult/€140 per child per year.

Alternatively, you could upgrade to the Public Plus Care Day-to-Day policy, which, for an extra €31 a year, will give you better outpatient benefits, such as €20 back for each of up to three GP visits and a similar benefit for a physio.

Laya has a similar plan, Assure Protect, for €518 per adult/€158 per child, but watch out for the small print. The family excess on the policy for accessing outpatient benefits is a hefty €450 a year. This means that you’ll only start benefiting from money back on day-to-day medical expenses once you go over this limit.

Policies do have variations, however, so it’s worth paying close attention.

Irish Life’s Kick Off Plan, for example, is a bit more expensive, at €627, but does offer 65 per cent cover on a semi-private room in a private hospital. It also comes with free travel insurance.

You can also consider a so-called “cash plan”, such as HSF’s One Scheme. Unlike the previously mentioned policies, this doesn’t offer you cover for hospital stays but offers cash back towards a host of medical expenses.

Its “3” scheme costs €565 a year, and will give you €300 a year back on the cost of GP visits, €450 for dental and optical costs, €370 towards consultant visits and €75 a night for the cost of hospital, for up to 40 nights.

Such a policy can be useful for everyday costs. But, while it offers money back on consultant costs, it won’t give you access to the private care route in public hospitals.

In short, as Haigney notes, the cheaper the premium, the more excesses, exclusions and shortfalls you’ll experience.

“I would always recommend that people do have a certain level of access to private hospitals; having access to private hospitals is how you get seen a lot quicker,” he says.

Upgrade (about €950-€1,400)

The key difference between policies at this price level and the €500-€600 level is that they cover both public and private hospitals – although you might find a shortfall on certain hospitals or treatments.

Goode explains the difference between these policies and the entry-level ones, by analogy to comprehensive and third-party car insurance, respectively.

VHI’s First Care 250 day-to-day policy (€899), for example, offers up to 75 per cent back in certain private hospitals, but no cover in the Blackrock, Mater Private or Beacon, while Laya’s Signify offers cover with a €300 shortfall in certain private hospitals. It offers cover for the Mater Private and Blackrock, but not the Beacon.

As Haigney notes, the problem with having selective hospital cover is if you are referred to a consultant, a specialist in your area of need, and they only work out of certain hospitals.

Irish Life Health has a similar plan – Benefit Access 300 (€907) – which offers cover for private hospitals but has a €2,000 co-payment on listed cardiac and orthopaedic procedures.

If you can spend more, about €1,350, you’ll come into the realm of corporate plans, which offer a more comprehensive offering.

First off, you can expect a lower excess on your policy – if there is one at all – for outpatient expenses, while you are also likely to get more money back each time. Laya’s Inspire Plus (€1,345) policy has an excess of just €1, and offers 50 per cent back on outpatient benefits up to €1,000 a year.

Secondly, you can expect cardio cover in high-tech hospitals.

“All those [corporate] plans cover major heart surgeries, valve repair etc in Blackrock, Beacon/Mater Private,” says Goode.

Aged 50+ (about €1,600)

As you get older, your priorities might change; where, once, decent outpatient cover was important, now you might be looking for better cover in private hospitals.

As Goode notes, too many people look backwards. When it comes to health insurance, you need to be looking ahead at all the “what-if” scenarios that could arise in the future to make sure you are adequately protected. Moreover, while you might be happy with a semi-private room in your thirties, “your appetite for risk will change as you get older, so you need to ensure your cover matches these requirements”, he advises.

According to Goode, you should expect to pay about €1,600 a year if you’re looking for private room cover plus extra outpatient cover for those day-to-day expenses.

Each of the insurers has a plan around this price bracket; VHI’s PMI 48 10, for example, which costs €1,657 per adult; Laya’s Optimum Premium (€1,670) and Irish Life’s 4D Health 4 (€1,680).

But again, you can expect shortfalls and exclusions, although Haigney notes that “people are now more willing to accept there will be an excess”.

These policies will give you a private room in both a public and private hospital (the latter might be subject to an excess, such as €75 with VHI, as well as a shortfall of €50 per night).

You’ll also get cover (but maybe not in a private room) for the Beacon, Mater Private and Blackrock hospitals and, again, there might be an excess. With Laya, for example, you’ll have a €175 shortfall per night in Blackrock Clinic and the Mater Private.

Be aware, however, that these policies won’t always give full cover for certain orthopaedic procedures. With Irish Life, for example, you’ll have to make a €2,000 co-payment.

If you want to ensure better cover for orthopaedics, you might have to upgrade to a policy costing about €1,800. But not always. Laya’s Simplicity plan (€1,535) has no excess or shortfall on five orthopaedic procedures, including hip and knee replacement.

Outpatient cover tends to be decent at this price level, and you could expect about 75 per cent back on GP and consultant visits. Beyond that, however, it can make less sense to pay much more, unless you have particular needs.

“If you’re spending more than €1,800 per adult, you need a good reason to be doing that,” says Goode.

If you are looking for full cover across the hospital system, Haigney notes that you’ll be looking at a plan such as VHI’s Company Plan Executive (€3,474). However, even with such a plan you’ll face a shortfall, of 20 per cent, on a private room in the high-tech hospitals.

For full cover for a private room in such hospitals you’ll need to consider a policy such as Laya’s CompanyCare Advanced (€4,083).