🧮 便宜一定好嗎？Visitor Insurance 固定給付 vs 綜合型：爸媽來美醫療保險大解析

在上一篇 Visitor Insurance 入門裡，我們先講了什麼是「來美旅遊醫療保險（Visitor Medical）」、為什麼不能只靠台灣旅平險。

接下來，很多人會遇到下一個關卡：

「為什麼有些 Visitor 計畫很便宜，有些貴很多？」
「保額看起來都寫 10 萬、20 萬美金，差別在哪裡？」
「什麼是固定給付？什麼是綜合型？看不懂英文的表怎麼辦？」

這一篇，就是要把兩個關鍵字講清楚：

固定給付型（Fixed-Benefit / Scheduled Benefit Plan）
綜合型（Comprehensive Plan）

它們的差別，不只是「價格不同」，而是：

同樣一張 10 萬或 20 萬美金的保單，實際能不能幫你擋住幾千、幾萬美金的帳單，差很大。

🧩 一、兩種 Visitor Medical 的基本概念：Fixed vs Comprehensive

1️⃣ 固定給付型（Fixed-Benefit / Scheduled Benefit）是什麼？

可以把它想像成「價目表式」保險：

保單背後有一張很長的表
上面寫：看門診一次最多賠多少、住院一天最多賠多少、開刀最多賠多少、X 光、救護車、ICU 各自有上限
每一項都「有天花板」

例如（純舉例，非真實商品）：

門診看診：每次最多賠 US$60
急診：每次最多賠 US$250
住院：每天最多賠 US$1,000
ICU：每天最多賠 US$1,500

而醫院實際收費可能是：

門診一次 US$180
急診一次 US$3,000
住院一天 US$6,000
ICU 一天 US$12,000

差額怎麼辦？

超過那個「表上的上限」的部分，就是由你或家人自付。

也就是說：

固定給付型保單：「保險公司最多給你多少」先寫好，剩下的由你自己承擔。

2️⃣ 綜合型（Comprehensive Plan）是什麼？

綜合型就比較接近大家熟悉的「醫療險」概念：

先有一個總額，例如 US$100,000 / US$250,000 / US$500,000
你先付免賠額（Deductible），例如 US$0、100、250
超過免賠額之後，由保險公司依條款支付一定比例（例如 80% 或 100%）
保到整體醫療費用累積超過總額為止

例如：

總保額：US$100,000
免賠額：US$100
醫療費用：住院三天＋急診＋檢查，總共 US$15,000

在許多綜合型計畫裡：

你先付 US$100（免賠額）
剩下 US$14,900，由保險公司依條款比例支付

差別在哪裡？

固定給付：每一項目有各自小天花板，你要自己扛超過那部分。
綜合型：看總額＋免賠額＋比例，只要在額度內，保險公司可以幫你扛比較大的帳單。

💸 二、為什麼固定給付型這麼便宜？貴在什麼地方？

多數人第一次查 Visitor Insurance，看到的畫面很像：

Plan A：保費便宜一半，名稱聽起來也很專業
Plan B：保費貴很多，看起來差不多都是「醫療保險」

通常，Plan A 很大機率是「固定給付型」，Plan B 則是「綜合型」。

固定給付型之所以便宜，是因為：

保險公司已經把「最多會賠多少」寫得非常死，風險相對可控。
超過那個上限的部分，全部由你自己負責，所以保費可以壓得很低。
對保險公司來說，這比較像「給你一點補貼」而不是「真的替你扛大部分醫療費用」。

換句話說：

固定給付型便宜，是因為「風險主要還是在你身上」。

綜合型貴，是因為：

保險公司可能要替你扛下幾千、幾萬、甚至十幾萬美金的住院費
風險不只是「一次門診」，而是「整個醫療過程」

所以，便宜不代表不好，但一定要先知道：

固定給付型比較像「紅包」，綜合型比較像「真正幫你扛醫療帳單」。

📊 三、簡單比較表：固定給付 vs 綜合型

項目	固定給付型（Fixed / Scheduled）	綜合型（Comprehensive）
保費	通常較便宜	通常較貴
理賠方式	每項目有固定上限（門診、住院、手術、檢查各自限額）	依總額度＋免賠額＋比例（例如 80% 或 100%）支付
醫療帳單風險	超過表格上限的部分全部自己負擔	在保額內，多數費用可由保險公司承擔較大比例
適合對象	短期、風險接受度高、只是希望「有一點補貼」的人	希望把重大醫療風險轉移出去的家庭，尤其是高齡或有慢性病史
容易誤會的地方	看到「總額 10 萬美金」以為所有費用都可以賠到 10 萬，其實每項目有小天花板	以為「有保險就完全不用自付」，忽略免賠額與共同負擔比例

🧪 四、用一個簡化例子，看兩種計畫的差別

假設：

爸媽來美期間，不幸因肺炎住院 3 天，醫療費用總共 US$15,000。
我們只看「粗略結果」，不管每一個小條款。

情境 A：固定給付型保單（舉例）

住院每天上限：US$1,000
急診上限：US$250
醫師看診、檢查、藥物各自有小上限

結果可能變成：

保險公司總共給付：例如 US$3,000（各項目加總）
剩下 US$12,000 → 由家人自付

情境 B：綜合型保單（舉例）

總保額：US$100,000
免賠額：US$100
共付比例：80% up to US$5,000，之後 100%

結果可能變成：

你先付 US$100 免賠額
剩餘 US$14,900，由保險公司依比例與規則支付大部分

細節各家商品都不一樣，但這個例子是要說：

同樣都是「有買 Visitor Medical」，出事時感受到的差距可以是幾千、幾萬美金。

👵 五、爸媽年紀大、或有慢性病時，怎麼思考這兩種方案？

如果爸媽：

年紀已經 60、70、80 歲以上
有高血壓、糖尿病、心臟病、腎臟病等慢性病

你可以先問自己幾個問題：

「如果真的要住院幾天，我們有能力自付幾千、幾萬美金嗎？」
「這次旅程是『一定要現在來』，還是可以延後到健康狀況穩定一點的時候？」
「這次買保險，是想要『有一點補貼』，還是希望『真的把重大風險轉出去』？」

很現實，但也很誠實：

如果家庭財務可以承擔大額醫療帳單，固定給付型可以當補貼。
如果一筆 US$10,000～20,000 的帳單會讓全家壓力很大，綜合型會比較有意義。

當然，每個家庭的預算不同，不是每一次都「一定要選最貴」。
重點是，在預算範圍內，知道自己選的是哪一種風險結構。

🧠 六、什麼情況可以考慮固定給付？什麼情況比較適合綜合型？

✅ 比較可以接受固定給付型的情境（例子，不是建議）

來美時間很短（例如 1～2 週），活動行程很保守
爸媽身體狀況相對穩定，沒有近期住院紀錄
家庭對「萬一真的發生大事」心理上有準備，財務上也有一定能力應對
只是希望「有一點醫療補貼」，而不是把所有風險轉出去

✅ 比較適合考慮綜合型的情境

來美時間較長（數週到數月）
年紀較大（例如 65＋、70＋、80＋）
有慢性病史，即使不一定全保，但希望其他醫療事件有較大保障
家庭對大額醫療帳單的承受度不高，希望風險盡量轉移到保險公司

這裡沒有「唯一正確答案」，只有：

搞清楚你買的是哪一種結構，然後在預算內做出最不後悔的選擇。

📋 七、選擇 Visitor Insurance 前，可以先做的小檢查清單

不管最後你選的是固定給付還是綜合型，買之前可以先檢查：

🔎 這個計畫是 Fixed 還是 Comprehensive？（官網說明通常會寫）
💰 總保額多少？（50,000 / 100,000 / 250,000 / 500,000…）
💳 免賠額多少？（0 / 100 / 250 / 500…）
📉 共付比例是多少？（80% up to 某金額、之後 100% 等）
📑 既往病史怎麼處理？（完全排除？有沒有 acute onset 條款？年齡限制？）

如果看條款有壓力，可以：

請懂英文的家人幫忙一起看
請熟悉美國醫療與保險的人一起拆解
把重要條款一條一條寫下來，用自己的話轉述一次（確認自己真的懂）

這不一定需要花錢，只是一種「對自己負責」的準備方式。

🔗 八、這篇在整個 Visitor Insurance 系列裡的位置

這篇是「來美探親醫療保險」系列的第二站：

第 1 篇：什麼是 Visitor Insurance？爸媽來美為什麼不能只靠旅平險？
第 2 篇（本篇）：固定給付 vs 綜合型：便宜方案的限制與差異
下一步會有：70＋／80＋高齡父母來美怎麼選？
還有：慢性病父母來美 × Visitor Insurance 應該怎麼評估？

當這幾篇都串起來之後，你就不用再靠「聽說」、「朋友說」來選保險，而是可以用：

爸媽的年紀
健康狀況
停留時間
家庭可以承受的大額支出

一步一步，做出對全家都最踏實的安排。

保險不會讓風險消失，但可以讓「萬一」那一天，少一點恐慌、多一點選擇。

🧮 Fixed-Benefit vs Comprehensive Visitor Insurance: What Families Should Know Before Parents Visit the U.S.

In our previous article, we introduced the basics of visitor insurance and why parents visiting the U.S. often need more than just home-country trip insurance.

The next big question many families run into is:

“Why are some visitor plans so cheap while others are much more expensive?”
“If both plans show a US$100,000 or US$250,000 limit, what’s the difference?”
“What exactly are fixed-benefit and comprehensive visitor medical plans?”

This article focuses on two key concepts:

Fixed-benefit (scheduled benefit) visitor plans
Comprehensive visitor medical plans

The difference is not just about price. It’s really about this:

When a serious medical event happens, will the plan help with a few hundred dollars, or with several thousand or tens of thousands of dollars?

🧩 1. Two Types of Visitor Medical Plans: Fixed-Benefit vs Comprehensive

1️⃣ What Is a Fixed-Benefit (Scheduled Benefit) Plan?

You can think of a fixed-benefit plan as a policy built around a detailed “price list” of maximum payouts.

The policy includes a long schedule of benefits
Each type of service has a specific maximum: doctor visit, ER, hospital per day, ICU, surgery, X-ray, ambulance, etc.
Each category has its own cap, regardless of what the hospital actually charges

For example (illustrative only):

Doctor visit: up to US$60 per visit
ER visit: up to US$250 per visit
Hospital room: up to US$1,000 per day
ICU: up to US$1,500 per day

Actual U.S. charges might look like:

Doctor visit: US$180
ER visit: US$3,000
Hospital room: US$6,000 per day
ICU: US$12,000 per day

What happens to the difference?

Anything above the fixed schedule limit is paid by the patient or family.

In other words:

Fixed-benefit plans set a hard cap on how much the insurer will pay for each type of service. You are responsible for the rest.

2️⃣ What Is a Comprehensive Visitor Medical Plan?

A comprehensive plan works more like typical major medical coverage:

There is an overall coverage limit, such as US$100,000 / US$250,000 / US$500,000
You pay a deductible first (e.g., US$0, US$100, US$250)
Above the deductible, the insurer pays a percentage of covered expenses (e.g., 80% or 100%)
Coverage continues until the overall policy limit is reached

Example:

Policy limit: US$100,000
Deductible: US$100
Total medical bill: US$15,000 for ER + three days in hospital

In many comprehensive plans:

You pay the first US$100 as the deductible
The insurer pays the remainder (subject to the policy’s co-insurance rules) up to the limit

The practical difference:

Fixed-benefit: each service has a small built-in cap; anything above that is your responsibility.
Comprehensive: coverage is based on an overall limit, deductible, and co-insurance, allowing the insurer to pay a much larger share of big medical bills.

💸 2. Why Are Fixed-Benefit Plans So Much Cheaper?

When families first shop for visitor insurance, the comparison page often looks like this:

Plan A: very low premium, impressive-sounding name
Plan B: much higher premium, also called something like “visitor medical”

Typically, Plan A is a fixed-benefit plan, and Plan B is a comprehensive plan.

Fixed-benefit plans are cheaper because:

The insurer’s maximum payout for each type of service is tightly controlled and clearly limited.
Anything beyond those limits is paid by the patient, so the insurer’s risk is lower.
In practice, many fixed-benefit plans act more like partial “stipends” than full medical coverage.

In short:

Fixed-benefit plans are inexpensive because most of the financial risk remains with the traveler.

Comprehensive plans are more expensive because:

The insurer may end up paying for substantial hospital bills: thousands or even tens of thousands of dollars
The risk is tied to the entire course of treatment, not just a single flat amount per service

So price alone doesn’t tell the full story. A helpful analogy:

A fixed-benefit plan is like a small red envelope (a limited stipend).
A comprehensive plan is closer to real medical insurance that may absorb large bills.

📊 3. Side-by-Side Comparison: Fixed-Benefit vs Comprehensive

Feature	Fixed-Benefit (Scheduled)	Comprehensive
Premium	Usually lower	Usually higher
How claims are paid	Each service has a fixed dollar cap (doctor, ER, hospital per day, etc.)	Based on overall policy limit, deductible, and co-insurance percentage
Exposure to large bills	Anything above the schedule amounts is paid by the traveler	Insurer can cover a large share of big bills, up to the policy limit
Best fit for	Short trips, higher risk tolerance, families who mainly want partial help	Families who want to transfer more serious medical risk to the insurer
Common misunderstanding	Seeing “US$100,000 limit” and assuming all bills can be paid up to that number (ignoring per-service caps)	Assuming “insurance means zero out-of-pocket,” overlooking deductible and co-insurance

🧪 4. A Simple Example to Show the Difference

Imagine this scenario:

During a visit to the U.S., a parent is hospitalized for pneumonia for three days
The total medical bill is US$15,000 (ER + hospital + tests + doctor fees)

Scenario A: Fixed-Benefit Plan (Illustrative)

Hospital room: up to US$1,000 per day
ER: up to US$250 per visit
Various caps for tests, doctors, and medications

The outcome might look like:

Insurer pays around US$3,000 total (all capped amounts combined)
The remaining US$12,000 is the family’s responsibility

Scenario B: Comprehensive Plan (Illustrative)

Overall limit: US$100,000
Deductible: US$100
Co-insurance: e.g., 80% up to a certain amount, then 100%

A possible outcome:

You pay the first US$100 (deductible)
The insurer pays most of the remaining US$14,900, subject to the plan’s rules

Exact numbers will vary by policy, but the goal of this example is to show:

Two travelers both “have visitor insurance,” but the practical financial impact can be dramatically different.

👵 5. What If Parents Are Older or Have Chronic Conditions?

If your parents are:

Older (60s, 70s, 80s+)
Living with chronic conditions (diabetes, hypertension, heart disease, kidney issues, etc.)

You might quietly be asking:

“If something serious happens, how much could we realistically afford out-of-pocket?”
“Is this trip truly necessary right now, or could we schedule it for a more stable time?”
“Are we buying insurance just for a small subsidy, or do we want real protection against big hospital bills?”

Honestly:

If your family can handle a US$10,000–$20,000 medical bill without major stress, a fixed-benefit plan might function as a partial subsidy.
If that kind of bill would be devastating, a comprehensive plan is generally more meaningful.

Not every family needs the most expensive option. The goal is:

Understand the structure you’re choosing and make the best decision you can within your budget.

🧠 6. When Might a Fixed-Benefit Plan Be Acceptable? When Is Comprehensive Strongly Preferred?

Situations Where a Fixed-Benefit Plan Might Be Acceptable (Examples, Not Recommendations)

Very short trips (e.g., 1–2 weeks) with low-risk activities
Relatively stable health, no recent hospitalizations
Family understands the limitations and has savings to handle larger bills if needed
The goal is to have some help, not full protection

Situations Where a Comprehensive Plan Is Often Worth Serious Consideration

Longer visits (several weeks to months)
Older parents (65+, 70+, 80+)
Chronic conditions are present and you want better protection for other illnesses or injuries
Family has limited ability to absorb large, unexpected medical costs

There is no one-size-fits-all answer. There is only:

Clarity about the trade-offs and a conscious decision that fits your family’s situation and values.

📋 7. A Small Checklist Before Choosing a Visitor Plan

Before you click “buy,” it can help to check:

🔎 Is this a fixed-benefit or comprehensive plan?
💰 What is the overall medical limit? (US$50,000 / 100,000 / 250,000 / 500,000…)
💳 What is the deductible? (US$0 / 100 / 250 / 500…)
📉 What co-insurance or cost-sharing applies? (e.g., 80% up to a certain amount, then 100%)
📑 How are pre-existing conditions handled? (fully excluded? any “acute onset” benefit? age limits?)

If reading the policy feels overwhelming, you can:

Ask a trusted family member who is comfortable with English to review it with you
Talk with someone familiar with U.S. healthcare and visitor plans
Write down key clauses in your own words to check whether you truly understand them

None of this requires you to buy from any particular company. It’s simply a way of being more prepared and intentional.

🔗 8. Where This Article Fits in the Visitor Insurance Series

This is the second step in a larger series on visitor insurance for parents and relatives visiting the U.S.:

Part 1: What Is Visitor Insurance and Why Trip Insurance Alone Is Not Enough
Part 2 (this article): Fixed-Benefit vs Comprehensive Visitor Plans
Coming next: Plans for Seniors 70+ / 80+
And: Chronic Conditions & Visitor Insurance: Diabetes, Hypertension, Heart Disease

Once you’ve read through these, you won’t have to rely on hearsay or random forum posts. Instead, you can make decisions based on:

Your parents’ age
Their health and medical history
The length and nature of their trip
Your family’s ability to handle unexpected medical costs

Insurance doesn’t erase risk, but it can change the kind of day you have when something unexpected happens.
Instead of facing both medical and financial shock at the same time, you may at least have one major piece under better control.

🧮 便宜一定好嗎？Visitor Insurance 固定給付 vs 綜合型：爸媽來美醫療保險大解析 Fixed-Benefit vs Comprehensive Visitor Insurance: What Families Should Know Before Parents Visit the U.S.