I’ve been avoiding this topic because it’s like trying to catch a fish with your bare hands, no better way to describe it. Insurance in general is a tricky subject, but health care in recent years has evolved into a complex algorithm, even more so for those of retirement age living overseas.

Pre-conditions, policy inclusions, exclusions, personal medical history, desired treatment locations, facility needs and wants, service level options, premiums, payment plans, pre-payments, co-payments, deductibles, policy limits, age, hereditary conditions, and other parameters conspire so that practically no two people have the same insurance needs and limitations.

I wrote an article recently detailing the cost of living for a typical foreign retiree residing in Vietnam.

The budget in the article includes 'medication and doctor' and 'health insurance.' I explained that the medication and doctors’ visits I need are inexpensive (for now) so I pay out of pocket, but best to insure as prices will no doubt increase.

I also mentioned that I have inpatient hospital care insurance from Bao Viet that costs just over VND5 million (about US$220) per year, very inexpensive.

There is a long list of excluded ailments, plus others where a one-year waiting period is imposed before treatment can be paid, then whatever doesn’t slip through that sieve is subject to a 30-percent co-pay. 

I keep the policy to avail of the accident coverage since the health portion doesn’t provide a lot of protection.

Big elephant in the room

Bao Viet will not renew this policy as of my 65th birthday - no complaint, they had informed me when I signed on but I didn’t move quickly to find other coverage. Many insurers don’t accept new policyholders after 60, so you may have to hunt around if you’re already older. 

Potential snakes in the grass

While researching this topic, I uncovered several risk areas for all to be wary of.

1. In many cases, testimonials, ratings, and reviews from policyholders are available to assess a company’s reputation. If you can’t find that information online, ask the insurer to provide you with recent references.
2. Billing is critical, especially when you’re in an emergency situation. Many insurers claim hospitals will bill them directly so you don’t need to pay cash up front, but check that it’s clearly stated in your policy, then confirm with the hospital you’ll most likely want to use.
3. A couple of companies analyzed below promise coverage until age 70 or 71. One pledges lifetime coverage on their website, another also guaranteed lifetime renewal during our live chat, then in the next breath stated coverage may be denied if many substantial claims are made. Unrestricted lifetime coverage is a big commitment, so if the insurer offers it, it will be clearly spelled out in the policy, not just in a sales brochure.
4. Some insurers provide worldwide coverage except the U.S. and expensive countries such as Singapore. Vietnam may offer the medical services you need, but both Malaysia and Thailand have well-established reputations as health tourism hubs, so you may want a plan with worldwide coverage.
5. The government in Vietnam is working on proposals to improve service to attract overseas health tourists. Improving private hospital rooms is one idea, but will increase cost by 37 percent to $172 per day according to one proposal. Health tourism in Vietnam has been up 50 percent during the last five years with over 300,000 foreigners visiting last year for health treatment. In the future, we can expect higher quality services and escalating costs to go along with them.

With all that in mind, I went fishing on the Internet using the search term 'health insurance Vietnam,' analyzed the findings, then chose the 11 providers below arbitrarily after eliminating some dubious results.

The list of 11 insurers are only samples. You may uncover better insurers and options with your own analysis. 

I didn’t include Bao Viet because it was difficult to find the appropriate website in English on Google, but you’ll see below it is a partner to others listed here.

I don’t know any employees of any of the providers listed here except a representative from my current insurer that I met once several years ago, nor do I recommend any of these companies in particular.

When the provider’s website processes your online quotes, you may not get the same results as I did due to differences in nationality, residence, and age.

Note also that all amounts quoted here are in U.S. dollars. 

We cannot publish any external Internet website links as per Tuoi Tre policy. To assist you in finding each provider, Google search keywords are included beside the name. 

Be sure to enter the words in quotations below beside the insurer’s name in the Google search bar, e.g. 'expat.acs-ami' to find ACS. Check that you land on the official company website which should be at or near the top of the search results. 

1. ACS - 'expat.acs-ami'

To get an online quote, hit the blue 'Online Quote' button upper left, choose a country from the pull-down menu, then enter the required information.

Compare the Packaged and Customized plans that appear in Step 3, select one, then choose a module on the next page and your quote will be displayed.

ACS specifically states that new policyholders must be under 60, but goes on to explain they will enjoy 'full coverage for life,' the only broker I found to offer such a guarantee in writing.

The policies are administered by Allianz Insurance and consist of Bronze, Silver, and Gold coverage, representing incremental coverage for inpatient, outpatient, and dental coverage. Their online brochure details all the benefits.

Customized policies including inpatient care are offered with no co-pay starting at $2,100 per year ($175 monthly) with many more comprehensive options listed on their quote page.

ACS details their refund procedures, so apparently they do not have direct billing from their company to service providers, definitely a downside.

2. AETNA - 'Vietnam health guide AETNA'

AETNA has an interesting cover page for its health care section comprising detailed instructions and precautions for those coming to Vietnam. I tried to get an online quote and the website instructed me to contact Bao Viet via email, so it seems there is an arrangement between the two covering Vietnam.

3. Allianz - 'allianz care health'

Allianz has a disclaimer stating policies are intended for those temporarily living abroad without mentioning a time limitation, but they have an online quote available, so it’s worth a look.

There are various options for coverage and deductibles with the Classic Plan costing just under $420 per month when an $850 deductible is applied. Prices are quoted in euros, which implies an exposure to rate fluctuations for those using other currencies.

4. CCW Global - 'ccw-global.com'

No online quote is offered but their website is comprehensive with individual and family options listed.

5. Cigna - 'cignaglobal.com'

This provider offers insurance worldwide except the USA. Cigna offers three levels of coverage with annual benefits ranging from $1 million to unlimited and premiums from $300 to $500 per month based on a $750 deductible.

There is mention of 'cost share' and 'OOP max' which are both a mystery to me so just leave the default values on the quote page and carry on.

6. Health Care International - HCI - 'healthcareinternational.com'

Country of residence is not mentioned during their online quote process, so perhaps policies provide worldwide coverage outside the USA. Just enter age and a few other parameters and a quote will be displayed.

They offer five plans with no co-pay ranging from Emergency to Executive with premiums ranging from $1,735 to $6,360 per year ($145 to $530 monthly) and maximum coverage from $500,000 to $4 million.

One of the elements of the quote is 'Excess,' which is similar to co-pay, but expressed as an amount. The website also asks if co-pay is desired, so I guess choosing both means 'Excess' comes right off the top of any charge after which a co-pay percentage is applied.

7. HSBC - 'hsbc medical care insurance'

Offers five levels of coverage in Vietnam plus two levels available throughout Asia or worldwide with benefits listed on their website.

Mysteriously, Bao Viet is referred to in the red footnotes instead of HSBC, no idea why. The most comprehensive plan called 'Privileged' offers a policy limit of VND3 billion or $130,000 but does not specify a time limit. 

The cost per policyholder aged 61 through 65 is about $500 but no frequency is specified, so I conclude it must be per month.

8. Luma - 'Luma Vietnam'

Luma requires those interested to fill out a form for callbacks by one of their representatives. I include them here only because their website states that they do not accept applicants over age 71, which implies coverage continues until at least that age. Those extra years can make all the difference, so Luma is worth contacting.

9. MyHealth - 'myhealth Vietnam'

MyHealth is underwritten by the Saigon Post and Telecom Insurance company and administered by April International. 

No online quote is available but there is an application form on their website. I include this one because with a Post and Telecom company behind it, the offerings may be different from the standard brokers.

10. Pacific Cross - 'Pacific Cross Vietnam'

Interesting to note that their benefits chart goes to age 75.

Pacific Cross offers two levels of coverage: Foundation and Master. Benefits and premiums of both levels are detailed on their website but you need to complete a form in order to get a quote.

11. Tenzing - 'Ten-Pac.com'

Tenzing offers four coverage levels ranging from Bronze to Platinum with maximums between $400,000 and $1 million per year.

The Platinum plan in my age group costs $3,346 per year or about $280 per month. A disclaimer states premiums “…do not factor in pre-existing conditions, high BMI (Body Mass Index), or occupational hazards." The Silver to Platinum plans “most likely” include pre-existing conditions while the Bronze plan does not cover any.

Note that coverage continues through age 69 according to the chart.

Break-even point

Let’s take a scenario where a policy seeker soon to be 63 years old with a pre-existing condition finds a company offering coverage for seven years until age 70.

The policy costs $4,800 per year until age 65, then $7,200 per year until age 70. Therefore the cost of that policy is $9,600 for the first two years and $36,000 for the next five years, for a grand total of $45,600.

Policy seekers with pre-conditions need to get an opinion (or two!) on the risks of hospitalization including which surgery could be needed, how much it would cost, and how soon it could be required. Of course, doctors are typically hesitant to stick their necks out, but even vague estimates help.

With a feeling in hand on the probability of needing hospitalization during the seven years of the policy, you can get rough cost estimates and decide if it’s worth insuring.

Options to consider

(a) Buy a policy that guarantees lifetime renewal if you can meet the conditions, e.g. decent health, under the insurer’s enrollment age limit, without major pre-conditions, and able to afford the premiums.

(b) If your home country offers government-sponsored health care, take a policy here in Asia, then assess your health before that policy expires. This is an option for U.S. citizens because upon reaching age 65 you are eligible for Medicare but must reside in the U.S. or its territories to be eligible. You may wish to return to your home country permanently or split time between places (while adhering to Medicare residency requirements in your home country). Remember there will be lead time to apply, so be careful to avoid a lapse in coverage.

(c) Don’t buy insurance and be prepared to pay cash if/when you need extensive medical attention. This option assumes a cash reserve is in hand for such emergencies and you have the above 'break-even' calculation in hand. 

My preferred option is (c) above because I don’t believe my pre-condition is serious enough to warrant surgery in the foreseeable future, nor do I want to diminish my cash reserve paying high premiums. That approach has risks too because insurance companies have special discounts with hospitals that uninsured individuals can’t get, so if I need hospital care I may pay more over the counter than through a provider.

Ambiguity in the wording of many policies leaves a lot of latitude in assessing the health issue and the best remedy irrespective of cost, so I feel it’s best to have the situation in my own control instead of the insurers’.

The devil is in the details, so investigate your options thoroughly and go through every policy in detail before committing.