Can I use Medishield and Medisave together for cataract surgery?

Doctor's Answers (1)

In the context of private hospitals, the situation in Singapore is as follows:

Medisave can be used for surgeries/procedures performed for medical reasons and classified under the Ministry of Health's Table of Surgical Procedures. As such, Medisave can be used for cataract surgery.

Generally speaking, Medishield Life cannot be used for simple cataract surgery.

To understand why, we need to look at the reason behind Medishield Life and the mechanics of how it is implemented in order to achieve its purpose.

This is how the ministry of health describes Medishield Life:

'MediShield Life is a basic health insurance plan that protects all Singapore Citizens and Permanent Residents against large hospital bills for life, regardless of age or health condition.' (https://www.moh.gov.sg/medishield-life/what-is-medishield-life)

Note that it is supposed to be basic, and protection is against large hospital bills. Although large is relative, when you look at the mechanics below you will see that by large, the government is talking about bill sizes of tens or hundreds of thousands of dollars.

According to a business office personnel I spoke to, with regard to Medishield Life:

1. Of a total private hospital bill, only 30% is assessable for Medishield Life. Therefore, before we even begin, 70% of the hospital bill needs to be covered by funds other than Medishield Life.

2. Out of this 30%, there is a $3500 deductible. This means that regardless of how much the 30% is, an amount of $3500 needs to be paid by the patient. (Some of this can come from Medisave). 

3. The patient also has to pay 10% co-insurance. This means the patient has to pay 10% of the difference between the 30% of total hospital bill and the deductible of $3500.

Let's say a patient has a total hospital bill of 18000. The assessable portion is around 6000. Now, 6000-3500(deductible)=2500.

Out of this 2500, patient has to pay co-insurance of 2500x10%=250

Therefore, Medishield Life will pay 2500-250=2250 out of the total bill of 18000.

Now, my patients never pay 18000 for a cataract operation. In general, the bill size is around 6000-7000 (in total, including hospital charges and lens implant cost).

If we take a bill size of 6000, then the assessable portion is around 2000. This is already less than the deductible of 3500, so it does not make sense to try to claim from Medishield Life. In fact, 3500 is 30% of 11667. So if your total hospital bill size was 11667, the assessable portion just equals the deductible. The higher the bill size from 11667, the greater the amount and bill proportion that Medishield Life will help with.

So currently the amounts charged for cataract surgery are just too low for Medishield Life coverage to kick in, in private hospitals or A/B1 ward types at public/restructured hospitals.

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