Why is there no general outpatient coverage in Medicare Plus?

September 23, 2021

Recently, some of you have asked if there is any medical insurance with general outpatient coverage that is highly recommended. I myself do not strongly recommend purchasing medical insurance products with general outpatient coverage. The reasons are as follows.

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I. General outpatient coverage

1. How to get outpatient coverage

There are two situations, one is to buy a medical insurance with extra outpatient coverage, and the other is to buy outpatient insurance right away.

2. Why is there no general outpatient coverage in Medicare Advantage?

If the medical insurance policy provides general outpatient coverage, it will lower the claim threshold and increase the risk for the car insurance company. Although each claim is likely to be a few hundred dollars, the volume of claims is quite large and can be a significant expense. Therefore, for car insurance companies, in order to better control the risk, control costs, to ensure that the price of insurance costs are reduced, to improve the competitiveness of the market, the general outpatient clinic is not covered.

II. Application of general outpatient coverage

Is it necessary to purchase an outpatient insurance policy? For most groups, it is not necessary.

1. In the case of similar insurance costs, the amount of coverage for medical insurance is several million dollars, while outpatient insurance only covers outpatient treatment for 5,000 yuan and inpatient treatment for 20,000 yuan.

2. Expense reimbursement content.

Expense reimbursement scope: Most of the outpatient insurance has this limitation, for the use of drugs outside the medical insurance is not to be reimbursed.

Commercial insurance credit: Although the annual insurance amount is 5000, the most expense reimbursement is 500 per day.

Deductibles: Those with deductibles are to be counted by frequency! But there are some outpatient insurance, each time all counted separately, even if it is constantly medical treatment, yesterday deducted deductible, today again deducted. The original outpatient medical treatment spent not much money, that gouge out, the amount of credit that can be reported is actually very relatively limited.

3. Claims processing is complicated

When filing a claim for expense reimbursement, even though the claim credit is not large, it is necessary to prepare adequate and sufficient documents. For outpatient insurance, because the claim credit is small, you only have to take a picture and send it by mail, so you don't have to send the documents back and forth. However, it will continue to waste some time.

4. jeopardize the purchase of other health insurance

It is the key point in this! It is the outpatient insurance claims that may interfere with the purchase of other health insurance. This includes accident insurance. In the case of health insurance, including accident insurance, critical illness insurance and life insurance, many of the products are informed about "whether or not you have filed a life safety claim" during the health notification. Especially for online insurance purchases, even if you have only claimed a few hundred dollars or even a few tens of dollars with your outpatient insurance, it is still classified as a claim.

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III. Which groups can buy outpatient insurance

1. The body's physical condition is not compatible with most health insurance

For example, children, just after birth, often sick, has long been incompatible with the majority of health insurance health notice, you can buy an outpatient insurance to properly reduce the pressure of social and economic development work.

2. Already bought a sound health insurance protection

There are some basin friends other health insurance has already bought a relatively sound, 500,000 insurance amount of several compensation lifetime critical illness insurance + a million insurance amount of accident insurance + a million insurance amount of life insurance + million medical insurance. In addition, even if the outpatient insurance claim is settled, it will not cause the trouble of not being able to buy other health insurance.

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