Why do patients still make extra payments even with one hundred percent health insurance coverage?
It has been explained that rates like 95% and 100% on health insurance cards do not cover the entire bill, but only the relevant percentage of the costs included in the coverage.
It has been explained that rates such as 95% or 100% written on health insurance cards do not cover all hospital expenses, but only represent the relevant percentage of costs within the insurance coverage. Citizens can face large payments after treatment due to items left outside the coverage.
What is the real meaning of health insurance rates?
Many people believe that when they go to the hospital thinking their health insurance cards cover expenses at 80%, 95%, or 100%, the fund will pay the relevant percentage of the total amount.
However, the Health Insurance Fund does not cover the entire bill; instead, it calculates the cost based on the portion covered by the insurance and each individual's insurance level.
Amounts paid by patients despite high rates
Ms. Lan had to pay a significant amount out of her own pocket after hip replacement treatment at a hospital in Hanoi, even though she had an 80% health insurance coverage rate.
Experts note that a 100% coverage rate also does not mean all expenses incurred by the patient at the hospital, but only the entirety of costs within the coverage area.
Which expenses are covered by health insurance?
According to regulations, items included in the reimbursement scope cover medicines, technical services, medical supplies, hospital check-ups, and inpatient treatment fees.
According to Ministry of Health data, medicines and hospital beds make up the highest proportions of expenditures.
Medicines and medical supplies outside the scope of coverage
During treatment, doctors may prescribe medicines or medical supplies that fall outside the insurance coverage; in such cases, patients cover the costs in full.
Additionally, there are clear payment limits set for medical supplies such as coronary stents and knee replacements.
Exceptional cases where co-payments are not required
Patients receiving treatment at designated health facilities whose single-visit cost falls below a certain threshold are exempt from making extra payments.
Full coverage is also provided by the fund for insured individuals who undergo long-term treatment and whose annual co-payment exceeds a certain limit.