医保到底值不值？报销金额远超个人支付？你还在犹豫是否参保吗？

Core Viewpoint - The article discusses the importance of medical insurance (医保) in people's lives, highlighting the benefits and complexities of reimbursement processes, and argues that despite some concerns, it is worthwhile to maintain insurance coverage [1][8]. Group 1: Hospitalization Reimbursement - For employees under the employee medical insurance scheme, hospitalization in a tertiary hospital can have a reimbursement rate of 70%, meaning for a 100,000 yuan expense, the individual pays 30,000 yuan while the insurance covers 70,000 yuan [3]. - The reimbursement rate increases to 80% for secondary hospitals and can reach 90% for individuals over 70 years old, indicating that older patients and those using lower-tier hospitals benefit more from the insurance [3]. - The maximum reimbursement for serious illnesses can range from 200,000 to 500,000 yuan, providing significant financial relief for families dealing with severe health issues [3]. Group 2: Outpatient Reimbursement Changes - Prior to April 2020, outpatient expenses were primarily out-of-pocket, but recent reforms have allowed outpatient costs to be included in the insurance reimbursement system [3]. - In community hospitals, outpatient expenses can be reimbursed at 50%-60%, significantly reducing the personal payment burden [3]. - For chronic diseases like hypertension and diabetes, the reimbursement rate has been raised to over 65%, with no minimum payment threshold [3]. Group 3: Benefits for Urban and Rural Residents - Urban and rural residents pay approximately 400 yuan annually for insurance, which covers about 50% of outpatient costs, allowing them to "break even" after just two visits [5]. - Hospitalization benefits are also substantial, with reimbursement rates of 70% in tertiary hospitals and up to 85% in community health centers [5]. - The insurance system encourages patients to seek treatment in community settings for minor ailments while reserving hospitals for more serious conditions [5]. Group 4: Reasons for Perceived Low Reimbursement - Not all medical expenses are covered; expenses for drugs not listed in the insurance directory must be paid out-of-pocket, with over 14,000 types of drugs excluded [6]. - High deductibles for certain hospitals can deter patients from seeking reimbursement for minor ailments, as they may not meet the minimum threshold for claims [6]. - The reimbursement rates vary by hospital tier, with community hospitals generally offering higher reimbursement rates compared to tertiary hospitals [6]. Group 5: Overall Value of Medical Insurance - Despite concerns about reimbursement amounts, the overall value of medical insurance remains high, with employee insurance covering 2-3 times the amount paid by individuals, and resident insurance covering 50%-60% of medical expenses [8]. - The article emphasizes the importance of maintaining insurance coverage, as the premiums paid today can provide substantial financial protection in the future [8].