Six questions and answers about health insurance
1 Why will I pay more for my health insurance from January 1?
Next year we will pay an average of 9 euros more per month for health insurance. Healthcare costs are rising, partly due to increased wages in healthcare and especially the increasing demand for care. Healthcare costs have also risen in recent years, but insurers used savings to soften the blow. As a result, the premium rose less rapidly than the actual cost increase of healthcare. However, they cannot continue to do this indefinitely, says Marco Varkevisser, professor of Market Regulation in Healthcare at the Erasmus School of Health Policy & Management. NRC. “Health insurers must have a minimum buffer to prevent them from going bankrupt in the event of unforeseen circumstances.” This year, fewer insurers are using (part of) their savings to cover costs. Menzis, VGZ and ENO even top up the savings account slightly, which increases their premium even more.
2 Why do the premiums for cheap policies increase the most?
Policies that are cheapest this year generally increase in price the fastest next year. In recent years, many insurers offered twin policies. Two policies that hardly differ from each other, but one is much more expensive than the other. Insurers attracted healthy policyholders with the cheap version of the twin policy. Also because extensive supplementary insurance – popular among insured people who use a lot of care – can only be taken out in combination with the expensive version of the twin policy.
The House of Representatives called twin policies the ax to the root of the solidarity healthcare system. Favoring healthy policyholders, which means that sick policyholders have to pay more for the same policy. It is a mortal sin, CZ already acknowledged last year. Like other health insurers, CZ says it has no choice due to an error in the health care system.
Instead of banning twin policies, the minister came up with a different solution. From 2024 onwards, healthy policyholders will no longer generate predictable profits for health insurers on average. And unhealthy policyholders no longer cost money. “That is breaking news,” says Wynand van de Ven, emeritus professor of Health Insurance at Erasmus University Rotterdam. “The most drastic change in twenty, thirty years.” Professor Marco Varkevisser speaks of a “major step forward”.
The perverse incentive has disappeared by adjusting the risk adjustment. For this purpose, it is estimated how much the healthcare costs for basic insurance will amount to. With equalization, the costs expected for the coming year are distributed fairly among insurers. After years of discussion, the distribution key used to distribute costs is now fairer.
According to Minister Kuipers, unhealthy policyholders have become more attractive from the perspective of insurers. It no longer makes sense for insurers to focus on attracting healthy policyholders, says Wynand van de Ven. “It is embarrassing that health insurers have had a financial incentive for twenty years to keep out chronically ill people.”
3 Should we go back to the health insurance fund?
The current healthcare system was introduced in 2006 and replaced the health insurance fund. Because health insurers can compete with each other, they must keep healthcare providers competitive and enforce lower prices. The SP has been fighting against market forces in healthcare for years, a position shared by BBB, GroenLinks-PvdA, Party for the Animals and NSC.
Health insurers can indeed make a profit, but they have no shareholders to pay out money to. Most health insurers are associations or cooperatives and do not have a profit motive.
According to experts, the image of the health insurance fund is romanticized. With its disappearance, the inequality between low incomes (health insurance fund) and high incomes (private health insurance) also came to an end. If the health insurance fund had not disappeared, healthcare would not have been cheaper today. According to various studies, the current healthcare system is one of the best in the world. The Netherlands is mainly praised because insurers work so efficiently.
Also read: Less – or no – market forces in healthcare, what then?
4 Can an insurer refuse me?
Health insurers may not refuse basic insurance to anyone. You can also switch if you are chronically ill or pregnant and even during ongoing treatment. Refusal is permitted for additional insurance, which in practice usually concerns dental insurance.
Of the 99 dental insurance policies offered by Poliswijzer.nl at the request of NRC looked at, fifteen ask for a declaration of health. If an insurer expects costs for a new insured person, this could mean a rejection. Insurers say they do this to protect existing policyholders. Because a new insured person who will incur costs will lead to a higher premium. Another weapon in the fight against calculated healthcare use by insured people: waiting time. You do pay a premium in the first year, but costs for orthodontics, crowns or bridges can only be claimed from the second year of insurance.
5 Are children insured for free?
For basic insurance, children up to the age of eighteen are co-insured with their parents free of charge. Insurers can charge premiums for additional insurance for children. According to Poliswijzer.nl, Menzis, ONVZ, VvAA and Zekur involve amounts between a few euros and tens of euros per month.
6 Should I be concerned if there is no contract yet between my health insurer and healthcare provider?
Healthcare providers and health insurers make agreements about care and its costs. Insurers should have informed their policyholders about this by November 12 at the latest. As in previous years, negotiations are taking longer. More and more often, contracts are only concluded in the new year. “It is possible that an insured discovers in February 2024 that a practitioner is no longer contracted,” says Koen Mous of Dirkzwager Advocaten. “If the treatment has not already started in 2023, the insured may have to pay part of it himself and it is no longer possible to choose another insurer.” It is not without reason that the Consumers’ Association says: Insurers actually ask consumers to sign blindly.
Six tips: This way you save on your health insurance
1 Check whether a policy that is cheap this year will still be cheap next year
Do you now have cheap health insurance? Then it is wise to check whether you will still get a good deal in 2024. Budget policies, select policies, online in-kind policies and twin policies will increase in price the most, according to Professor Wynand van de Ven. Insured people with a ZEKUR policy from the VGZ group will receive the largest premium increase of more than 24 euros per month: 20 percent. According to a spokesperson, this basic insurance is no longer a budget policy, but it does offer a wider range of hospitals than a in-kind policy.
2 Save on free choice of doctor
In recent years, one refund policy after another has disappeared and that trend continues. Now there are only seven, from next year only three. The reimbursement policy is the counterpart of the in-kind policy and offers policyholders complete freedom of choice.
With reimbursement insurance, a healthcare provider who charges much more than fellow healthcare providers will also be paid. To keep control of costs, insurers want to exclude expensive practitioners. This means that policyholders no longer have completely free choice of care and a policy can no longer be called a refund. The type of care to which the restriction applies has become in-kind. Such a policy is then a combination policy. One combination policy is not the same as the other; Some policies have restrictions on certain types of care. The more types of care that have a limitation, the more dominant the in-kind character.
A refund policy comes with a hefty price tag; ASR’s is the most expensive at 170.96 euros per month. “We think it is important to continue to offer customers a completely free choice,” says a spokesperson.
Three health insurers are canceling the reimbursement policy thus restricting the free choice of doctors
3 Be careful with budget policies
Comparing health insurance is difficult, according to research by the Netherlands Authority for Consumers and Markets (ACM). Last year, one in three switchers used a comparison website, such as Poliswijzer.nl, Independent, ZorgKiezer or the Healthcare Comparator of the Consumers’ Association. Money Wise (an initiative of the Ministry of Finance) recommends using several comparison websites. According to the ACM, price is the most important reason for consumers to switch. However, Money Wise advises to look further than just the price. After all, cheap can easily become expensive. For example, there are budget policies where insured people cannot or cannot go to more hospitals. Without a contract, the part that insured people have to pay themselves can be up to thirty percent. If you go to a care provider without a contract, the part you pay yourself can be up to thirty percent. According to the Patient Federation, this can involve hefty amounts. For example, does a treatment cost 8,000 euros and do you have to pay 20 percent yourself? Then it concerns 1,600 euros.
Also read this piece about budget policies from 2018: The torn knee ligaments suddenly cost 1,500 euros
4 Voluntarily increasing the deductible is much less attractive
Insured people will also pay the first 385 euros in healthcare costs themselves in 2024, except for GP and maternity care. “Healthcare expenditure is increasing,” says Professor Varkevisser. “That is why freezing the deductible will cause the health insurance premium to rise additionally.”
Insured persons can receive a discount on their premium by voluntarily increasing the mandatory deductible to a maximum of 885 euros. “In 2023, the highest discount was still 300 euros,” says Jorn Alders, health insurance specialist at Poliswijzer.nl. “Next year that benefit will only be 270 euros.” Anyone who saved money by voluntarily increasing their deductible would be wise to redo that calculation and compare it with other policies. It is unwise to increase in any case for those who do not have 885 euros on hand.
5 Review your supplementary insurance policies
In 2006, 93 percent of Dutch people had supplementary insurance, this year that is only 82.5 percent. The decrease is not illogical if you consider that insurance is actually intended for situations that are unlikely to occur, but which, if they do occur, will have a major impact. Dental insurance is the opposite: many people know that they are going to the dentist and the costs are manageable. If you have additional insurance, calculate how much you paid for the insurance and what reimbursement you received. Most pay more than they get back.
The additional coverage is becoming less and less additional: health insurers no longer accept everyone
6 Check whether you are double insured
Basic insurance covers emergency care abroad, but not always in full. Many supplementary insurance policies therefore offer foreign cover. But travel insurance also often contains a medical module. Anyone who has both pays double. The easiest option is to cancel the medical module of the travel insurance. You can change travel insurance throughout the year (not health insurance).