Should I move abroad to minimize health care costs?

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FeesR-BullNotBullish
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Should I move abroad to minimize health care costs?

Post by FeesR-BullNotBullish »

One of the biggest wildcards in personal finance is health care costs. We are 37 and 40. DW and I won’t have kids. We are both freelancers and don't qualify for subsidized insurance. We pay around $600 per month for our high deductible health plans. We make $120,000 per year give or take. One of my biggest fears is that unforeseen health care costs can wipe out our savings. Even if we are fortunate and don't get a catastrophic illness like cancer, long term care costs can diminish our nest egg in old age.

Is it wise to explore options to move abroad? My profession is specialized and in demand. I am confident that I can get a job in a developed country with a health care system that provides comparable care at a significantly less personal cost than the U.S. system. My income will likely take a hit but maybe I will come out ahead in the long run due to the savings I would realize with health care costs.

Here are some more details about us. We bought a beautiful house about 7 months ago that I love. The house cost $375,000 and we put 20% down. I would consider renting out the house through a management company should we move abroad. Selling is also an option. Considering for closing costs, I expect we come out ahead thanks to appreciation and demand in our market. Aside from our mortgage we do not have any debts. We have been mostly negligent in saving for retirement. Our combined retirement savings is $60,000 ($40,000 in Roth IRAs + $20,000 taxable). We have mostly replenished our emergency fund that we drained for our down payment (yes, I know big no no!), and we look forward to continuing our retirement savings in the next month.

I greatly value any advice or insight Bogleheads can provide.
bogglizer
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Re: Should I move abroad to minimize health care costs?

Post by bogglizer »

I have a friend who has shared his retirement plan: work until 65, move to a cheap foreign country until 75, then move back to the USA and burn up all his saved retirement money (now compounded) on health care. Is this what you are considering?
aristotelian
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Re: Should I move abroad to minimize health care costs?

Post by aristotelian »

bogglizer wrote:I have a friend who has shared his retirement plan: work until 65, move to a cheap foreign country until 75, then move back to the USA and burn up all his saved retirement money (now compounded) on health care. Is this what you are considering?
He wouldn't retire, he would be working abroad as an independent contractor.

If you are mobile, Canada is looking darn good right now. I would give strong consideration to moving there if I lost my job and could find an employer there.
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JonnyDVM
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Re: Should I move abroad to minimize health care costs?

Post by JonnyDVM »

We're all in the same boat. I'm not moving anytime soon. You already have a high deductible plan. Pick one that won't wipe you out in the event of a catostrophic health crisis. Plan to relocate when you retire when this risk is higher. This is sort of a silly question TBH. By your logic everyone with a high deductible health plan should all be looking to relocate abroad.
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delamer
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Re: Should I move abroad to minimize health care costs?

Post by delamer »

There are websites and books that have loads of information about living as an ex-pat. So start there.

Have you considered having one of you going to work for an employer that offers health insurance? That seems a lot less drastic than leaving the country.
Last edited by delamer on Fri Jun 30, 2017 9:41 pm, edited 1 time in total.
SrGrumpy
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Re: Should I move abroad to minimize health care costs?

Post by SrGrumpy »

Sure, give it a shot. Nothing to lose. Better hurry, though: Many countries give priority to younger workers. Canada and New Zealand, for example, have points systems. You can go online and see if you might qualify. Try not to commit any felonies beforehand. Recent Italian and/or Irish heritage would be really useful, too.
4nwestsaylng
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Re: Should I move abroad to minimize health care costs?

Post by 4nwestsaylng »

The comparison of health care systems is complex. First, younger people in their 20s and 30s in good health regard other "developed" nations' health care systems as "comparable" and miraculously cheaper because they have usually not developed a major illness which tests access to the latest health care. Have you tested your direct (not gatekeepered by a "primary care provider) access to specialists or subspecialists in other countries?

You have a "high deductible" plan, which is fine, but how high is the deductible? Are you establishing a health savings account (HSA)?
Many developed countries have had essentially monocultures for decades, often with a very strong work ethic, and their welfare/health system benefits were predicated upon the majority of its citizens being employed, productive,paying 70 percent income tax and even then, only using the system benefits when absolutely necessary.

Now you see a demographic transformation of European countries, with huge future burdens on those systems. The past is not the future for these health systems,and unfortunately not for ours.

Free long term care in other countries is an illusion. If you go to Canada, there are the same for profit nursing homes until you spend down to the poverty level,then you can get into extended care. At least in South American countries, most families take care of their own,even the poorest families don't send the grandparents to a long term care warehouse.
John Laurens
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Re: Should I move abroad to minimize health care costs?

Post by John Laurens »

Wouldn't it just be easier to increase your income 7k a year where you currently live? Should be easier than finding a new country in which to live.

Regards,
John
Diogenes
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Re: Should I move abroad to minimize health care costs?

Post by Diogenes »

Below topic has discussed this, as have several others. It's always wise to explore your options.
In the 1st world places you would want to be for healthcare, getting a work visa will not be easy. In those 2nd world places with decent care, the wage scale will be low even if you could get the work visa. Having a family connection would help.
You should narrow the list of what you call developed countries that you would consider living in, and see what the actual requirements are to get a longterm work visa In those places. If you are limited to English speaking places, your list will be short. Even in places where English is widely spoken (Europe) you will be expected to be multilingual in the work force.
Then compare cost of living there, and understand that you will still pay U.S. income taxes no matter where you live, and have other new expenses such as travel/moving costs etc. Many other things, such as quality consumer products, are far cheaper in the States.
Being an independent contractor may also make it impossible to get a work visa, as you will not have a sponsor.
The grass is not necessarily greener outside the U.S., certainly not to move just for healthcare. You may find yourself unhappy.


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Watty
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Re: Should I move abroad to minimize health care costs?

Post by Watty »

It varies widely but a potential problem is that in some situations you might also have to leave the country when you eventually retire and stop working. Getting a work visa can be difficult but getting some sort of permanent visa could be even more difficult.

One option to consider would be for one of you to get a regular job with benefits.

Another would be to move to a lower cost area in the US.
FeesR-BullNotBullish wrote:I am confident that I can get a job in a developed country with a health care system that provides comparable care at a significantly less personal cost than the U.S. system.
That might hard to find since many of the developed countries with good health systems have high taxes so your overall costs might actually be higher
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MossySF
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Re: Should I move abroad to minimize health care costs?

Post by MossySF »

Those who work for an employer that covers your health care without you needing to know the details, the U.S. is a great place for healthcare.

For independents (or business owners), ouch!!! Our 15 person company pays $34,000/mo in healthcare premiums -- $3400/mo for our oldest participant. I then checked out individual high deductible plans to compare against myself -- even more expensive! Middle age with family & kids -- $2200-$2500/mo for high deductible bronze plans.

So imagine if you're still working independent at age 60 -- your health is getting poor and you're still 5 years away from Medicare. You will be paying $3500-$4000/mo (today's money) some type of high deductible bronze plan. You're drawing down on most your retirement nest egg to fund health insurance. Somehow, I doubt you'd be paying that much more in taxes if you were in Canada or Australia.

Now whether you can qualify for some type of work/PR visa for these countries is another story if you continue to be an independent. Most countries like people who get official jobs -- unless you have enough money to qualify for an investment visa.
zuma
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Re: Should I move abroad to minimize health care costs?

Post by zuma »

Don't let the naysayers keep you down.

My wife and I moved abroad four years ago and it was one of the best decisions we've ever made.

I think health care should be one of many factors to consider, but not the only one. In the US, health care is obviously a broken system -- or, more generously, a system in flux. In many parts of the world, health care is affordable and accessible and typically not tied to your employer. My wife and I pay the equivalent of $400 per month for coverage. My visits to the doctor and the emergency room are free.

If living outside the US is something you've thought about before, and if you think you'd enjoy the experience, then go for it. You can always move back.

One of the best parts about living abroad is gaining a different perspective on your home culture. Things that you once took for granted will no longer seem inevitable or even desirable anymore. You'll certainly miss friends and family, but over time you'll realize that you were simply conditioned in a certain way. When that conditioning no longer controls you, your world opens up. You can read about living abroad and understand intellectually what I'm talking about, but actually experiencing it is another thing. Yes, there are practical hurdles to get over (securing a work visa, etc) and the journey will be challenging, but don't be afraid to try it.
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Re: Should I move abroad to minimize health care costs?

Post by zuma »

Diogenes wrote:Even in places where English is widely spoken (Europe) you will be expected to be multilingual in the work force.
Not necessarily. Many companies in the EU have a high percentage of international employees and it's common for those companies to do business in English (at least internally). Of course, it depends on the industry and the company, but there are many opportunities for English speakers in the EU.
Diogenes wrote:Then compare cost of living there, and understand that you will still pay U.S. income taxes no matter where you live, and have other new expenses such as travel/moving costs etc.
Don't forget Foreign Tax Credit. I file US taxes but I usually pay very little.
Diogenes wrote:Many other things, such as quality consumer products, are far cheaper in the States.
Not in my experience. YMMV.
Diogenes wrote:You may find yourself unhappy.
That is certainly a possibility. There's one way to find out.
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Re: Should I move abroad to minimize health care costs?

Post by AlohaJoe »

zuma wrote:Don't let the naysayers keep you down.
I sort of agree but sort of disagree.

I think "I want to move SOMEWHERE in the world because I'm afraid that in 30 or 40 years I might need long-term care and that's really expensive in the US" is a completely crazy, totally horrible, absolutely wrong reason to move to a new country.

You should be saying, "I'm thinking about moving to Scotland because 'I Would Walk 10,000 Miles' is my favorite song"
Or, "I'm thinking about moving to Hong Kong because the challenge of driving on the wrong side of the road sounds amazing."
Or, "I'm thinking about moving to Nepal because I love yak milk."

You need to move TO something. Not AWAY from something.
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Re: Should I move abroad to minimize health care costs?

Post by zuma »

AlohaJoe wrote:You need to move TO something. Not AWAY from something.
I think moving away from something can be a valid consideration! But yes, positive factors should be the primary force. Our decision to move abroad was informed by a combination of push/pull factors -- we were definitely moving away from some parts of life in America. I do agree that if a fear of future health care costs is the only factor, you should reconsider.
cap396
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Re: Should I move abroad to minimize health care costs?

Post by cap396 »

If you have a few countries you are considering, I would suggest visiting one or two of them before making the move. Make sure you can see yourself living there permanently first.

My wife and I are mid 40s, no kids, and are currently preparing to move overseas. Not mainly for the reduced healthcare costs, but more because we think we'll like the experience. But the reduced healthcare costs are an added bonus, which is allowing us to do this at a younger age.

If your line of freelance work is mobile, you might also consider country hopping. Then there is no need to deal with work visas, immigration, residency, etc. Plus then you get to experience more of the world, if that interests you. But there are drawbacks as well (not having permanent social connections, the hassle of moving every few months, etc.). You can get a health policy that covers the world (except for a few countries) at a fraction of the cost of a comparable US policy.
fishmonger
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Re: Should I move abroad to minimize health care costs?

Post by fishmonger »

IMO this seems like an incredibly rash decision. You just bought your house 7 months ago? What changed so dramatically that you now want to sell and move to a foreign country, for some health event that may or may not happen years from now?

How much would you lose on transaction costs from selling your house? Probably enough to pay for a couple years' health premiums
Rupert
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Re: Should I move abroad to minimize health care costs?

Post by Rupert »

I choose to be optimistic about this issue. I'm convinced that by the time I want to retire in 20 years or so we will have improved our healthcare system. The present system may have to completely collapse first (that appears where we're headed at the end of this week), but we're going to get somewhere better eventually because people are going to demand it. We are in a particularly dark place at the moment, but this too shall pass. And who knows what shape the systems in the rest of the world will look like in 20 years? Remember Theresa May's recent attempt to shift the burden of caring for the elderly onto the elderly in Britain? An acquaintance in Canada recently told me it takes about 3 years to get a first appointment with a rheumatologist there. It is not all rainbows and unicorns in most foreign systems either. So think twice about leaving your new house and family just for healthcare. If you have another reason to move in addition to healthcare, that's another matter.
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Watty
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Re: Should I move abroad to minimize health care costs?

Post by Watty »

cap396 wrote: You can get a health policy that covers the world (except for a few countries) at a fraction of the cost of a comparable US policy.
I'd love to hear about those if you have a link.

The travel policies I have seen only cover emergency care and if I recall right they may only sell those for tips of a few months duration.
cap396
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Re: Should I move abroad to minimize health care costs?

Post by cap396 »

Watty wrote:
I'd love to hear about those if you have a link.

IM Global is one company that sells international policies (there are other's too).

Link for a price quote: https://purchase.imglobal.com/Quote/glo ... gac=182036

Link for a summary of coverage: https://www.imglobal.com/docs/library/f ... ochure.pdf
wrongfunds
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Re: Should I move abroad to minimize health care costs?

Post by wrongfunds »

You just bought your house 7 months ago? What changed so dramatically that you now want to sell and move to a foreign country, for some health event that may or may not happen years from now?
OP, please don't answer the question. It will most likely get the topic locked! Hint: 7 month ago was Nov 2016
AntsOnTheMarch
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Re: Should I move abroad to minimize health care costs?

Post by AntsOnTheMarch »

My Opinion
It's not a crazy idea but take some time to let the reality of such a move set it. Your anxieties may be getting the better of you now (not that they're unjustified). My wife and I were in a similar position at your age and I thought, oh well, they'll certainly fix this healthcare mess by the time I'm 50 and since I like my chances of avoiding a serious illness until then, I'll roll the dice. That didn't really work out for us (avoided illness but healthcare/insurance problem only got worse and now remain vulnerable to high insurance cost and possible serious illness without adequate protection). And we are 60 now and a move is not feasible. But the healthcare situation seems to really be coming to a head now and I would guess that in the next 10 years or less, something will have to be done. It will be less than perfect but better than what we have now (could it be worse?). Some sort of public/private mix, I imagine will be hammered out.

The reasons I believe this:
  • Health care is 1/6 of the economy, IIRC. With an aging population, a technology job/environment where more and more people are laid off before retirement and can't find work for the same salary and health benefits, and ever-increasing costs due to new treatments available, the problem is only going to get worse. So I doubt this can be ignored much longer.
  • This is now staring to effect the reasonably well-employed as many companies are feeling pinched by the costs and passing them on. As the number of Americans with skin in the game increases, so will a demand for solutions.
  • Some states are attempting to address this with their own solutions. Maybe in 10 years you will have some options that don't necessitate moving out of the country—only to a different state.
  • The country that looks good for healthcare today may not be so good tomorrow. Systems are stressed everywhere and I don't see many solutions so the imperfect plan we may come up with here in the next 10 years could end up being as good or better than what you have in your imagined ideal country. One can only however, speculate.

More...
First, I would separate your immediate concern of health insurance costs and possible catastrophic illness from longterm care and nursing homes. It's going to muddle your choices and decision. At your age, I wouldn't even think about longterm care right now. Focus instead on the next two+ decades (until retirement) and then cross that bridge when you get to it. Your focus should be (1) to stay healthy, (2) build wealth, and (3) always be upgrading your human capital.

1. Health? Without that, you won't be able to do 2 and 3. What are you doing about diet, exercise, and stress management? Do you indulge in dangerous hobbies? Take stock and make any changes that will improve your longterm chances. Lastly, and maybe most importantly, relationship health. How's your relationship? In the end, how you work things out with your wife as problems and stresses arise—how healthy you can keep the relationship—will pay rewards to your health, balance sheet, and happiness. So make that job 1!

2. Build wealth. My wife and I (we also have no children) were in an almost identical position in 1995, so I have a point of reference. If you decide to stay in the US, how fast can you pay off your house while still contributing towards retirement savings? I'm a big believer in eliminating debt so we paid off our house 7 years after purchase. Basically, every single left over dollar went towards paying down the mortgage. I don't regret that. There's nothing I could have bought that would have given us more satisfaction or a better outcome down the road. I suppose a case could be made that I'd have had a better return for the money in the market but a 6+% (mortgage rate at the time) guaranteed return isn't bad when it comes with a peace of mind bonus.

3. What looks like great career at 40 can go south fast in your 50s. Maintain your networks and build your skills. Be proactive about what you see coming down the pike in your field.

As for the unknown gotcha: It's probably going to happen and at the worst time. For us it was multiple family health situations (parents), plus 2008 plus downward pressure on wages due to technology/global labor market. So we are limping into retirement rather coasting. Best laid plans...

My suggestion...
I'd probably stay put, ride the horse you're on, and keep your fingers crossed. If I were in your position and still thought I'd move, I would look at developing countries with decent healthcare options (as in cheap but good medical—not necessarily insurance) and a good standard of living for what you earn. Maybe Asia or Latin America? You can probably research by working backwards. Find where ex-pats are going in droves and assume that there are good prospects there.

Good luck.
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Pajamas
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Re: Should I move abroad to minimize health care costs?

Post by Pajamas »

No, you can't really afford to move to another country. It's not as easy as you must think, unless you have skills in high demand in your country of choice and are eligible for immediate employment or have enough wealth to get some kind of an investor visa. Look at moving to Canada or New Zealand to see if you are eligible as those countries are some of the easiest developed, English-speaking ones to move to.

Being an absentee landlord using your expensive house (especially when it is such a major component of your net worth) is not a good idea in general.
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Re: Should I move abroad to minimize health care costs?

Post by VictoriaF »

zuma wrote:
AlohaJoe wrote:You need to move TO something. Not AWAY from something.
I think moving away from something can be a valid consideration! But yes, positive factors should be the primary force. Our decision to move abroad was informed by a combination of push/pull factors -- we were definitely moving away from some parts of life in America. I do agree that if a fear of future health care costs is the only factor, you should reconsider.
I agree. When I was making a decision to retire early, I was retiring "to," not "from," and this attitude has made my retirement much more enjoyable than if I just wanted to tell my office good-bye. A decision to relocate abroad would also benefit from the "to" attitude. A good way to start is to visit candidate countries and linger there imagining that you live there.

As I have mentioned in several threads I am now enamored by the Czech Republic. If I were to relocate abroad, it would be my first choice. I like the Czech culture (literature, films, humor), I like Czech mineral spas, and I have good friends there. Many people were speaking English to me, defeating my attempts to practice Czech. The medical care, from what I've glimpsed, is excellent.

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Re: Should I move abroad to minimize health care costs?

Post by nisiprius »

Just keep in mind that over time things can change everywhere. Beware of "the grass is always greener on the other side of the fence."

I won't say we seriously thought about moving there, but we spent ten days driving through Venezuela in 1971 and were impressed with what a lovely place it was, how comfortingly familiar and modern and up-to-date Caracas was--all seemingly prosperity, stability, and--of course--a sounder currency than the dollar....
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Re: Should I move abroad to minimize health care costs?

Post by celia »

FeesR-BullNotBullish wrote:I am confident that I can get a job in a developed country with a health care system that provides comparable care at a significantly less personal cost than the U.S. system. My income will likely take a hit but maybe I will come out ahead in the long run due to the savings I would realize with health care costs.
Maybe or maybe not. So if you move abroad and you make less and still have to pay into the nationalized health care system, isn't that the same as making more and paying more for US health insurance? Sounds like a "wash" to me.

I would budget $10K a year for health care expenses here, then adjust it for inflation each year. That covers insurance premiums, out-of-pocket costs, and meds. Why don't you take taxes into account too? To do a fair comparison of how much you would have available to spend in the U.S. and other countries, estimate your income and subtract medical expenses and taxes from both cases.
AntsOnTheMarch
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Re: Should I move abroad to minimize health care costs?

Post by AntsOnTheMarch »

celia wrote:
I would budget $10K a year for health care expenses here, then adjust it for inflation each year. That covers insurance premiums, out-of-pocket costs, and meds.
This is not realistic. Anything from that, to tens of thousands per year, to infinite is the actual cost. Bankruptcy for all but the most high net worth individuals is always possible due to imminent changes; eliminating protection for everything from pre-existing conditions to lifetime caps. I wouldn't encourage the op to move but let's not pee on his leg and tell him it's raining.
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Re: Should I move abroad to minimize health care costs?

Post by sawhorse »

celia wrote: I would budget $10K a year for health care expenses here, then adjust it for inflation each year. That covers insurance premiums, out-of-pocket costs, and meds.
$10k gets you very little in healthcare in the United States today. There are prescription drugs that cost over $10k per MONTH, and because of that, many insurance plans won't cover them. A few of them are generics for not uncommon conditions. They cost a few hundred 5 years ago but have been jacked up egregiously.

My out of pocket costs will be $45-50k this year even with insurance, and I haven't even had a hospitalization this year. We're bleeding our savings.

Thankfully my husband is from another country, so we could move there and are seriously considering it. My body can't handle a move though.

That's another thing to consider. When you actually need major healthcare, you might not be able to move because of your poor condition and the fact that said condition can prevent you from working.

I'm in my mid-30s.
Last edited by sawhorse on Sat Jul 01, 2017 1:51 pm, edited 2 times in total.
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Re: Should I move abroad to minimize health care costs?

Post by bottlecap »

I suspect the answer is yes, unless you get a life threatening illness.

JT
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Re: Should I move abroad to minimize health care costs?

Post by neilpilot »

sawhorse wrote: $10k gets you very little in healthcare in the United States today. My out of pocket costs will be $45-50k this year even with insurance, and I haven't even had a hospitalization this year. I'm in my mid-30s.

There are prescription drugs that cost over $10k per MONTH, and because of that, many insurance plans won't cover them. A few of them are generics for not uncommon conditions. They cost a few hundred 5 years ago but have been jacked up egregiously.
I feel for your particular medical issues, but please don't say that "$10k gets you very little in healthcare in the United States today". Last year, as a 66 yo couple, our actual healthcare expenses were $3600 for medicare insurance (including supplements), $1600 LTC premiums, and under $2k out of pocket for medical & dental, or just over $7k total for 2016.

Maybe we are not typical, but certainly your $45-50k isn't either.
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Re: Should I move abroad to minimize health care costs?

Post by sawhorse »

neilpilot wrote:
sawhorse wrote: $10k gets you very little in healthcare in the United States today. My out of pocket costs will be $45-50k this year even with insurance, and I haven't even had a hospitalization this year. I'm in my mid-30s.

There are prescription drugs that cost over $10k per MONTH, and because of that, many insurance plans won't cover them. A few of them are generics for not uncommon conditions. They cost a few hundred 5 years ago but have been jacked up egregiously.
I feel for your particular medical issues, but please don't say that "$10k gets you very little in healthcare in the United States today". Last year, as a 66 yo couple, our actual healthcare expenses were $3600 for medicare insurance (including supplements), $1600 LTC premiums, and under $2k out of pocket for medical & dental, or just over $7k total for 2016.

Maybe we are not typical, but certainly your $45-50k isn't either.
You're on Medicare, hence the low premiums. If you were 60 instead of 66, your premiums would be extremely high. There's a long time until the OP hits Medicare age.
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Re: Should I move abroad to minimize health care costs?

Post by AntsOnTheMarch »

sawhorse wrote:
neilpilot wrote:
sawhorse wrote: $10k gets you very little in healthcare in the United States today. My out of pocket costs will be $45-50k this year even with insurance, and I haven't even had a hospitalization this year. I'm in my mid-30s.

There are prescription drugs that cost over $10k per MONTH, and because of that, many insurance plans won't cover them. A few of them are generics for not uncommon conditions. They cost a few hundred 5 years ago but have been jacked up egregiously.
I feel for your particular medical issues, but please don't say that "$10k gets you very little in healthcare in the United States today". Last year, as a 66 yo couple, our actual healthcare expenses were $3600 for medicare insurance (including supplements), $1600 LTC premiums, and under $2k out of pocket for medical & dental, or just over $7k total for 2016.

Maybe we are not typical, but certainly your $45-50k isn't either.
You're on Medicare, hence the low premiums. If you were 60 instead of 66, your premiums would be extremely high. There's a long time until the OP hits Medicare age.
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Re: Should I move abroad to minimize health care costs?

Post by delamer »

sawhorse wrote:
neilpilot wrote:
sawhorse wrote: $10k gets you very little in healthcare in the United States today. My out of pocket costs will be $45-50k this year even with insurance, and I haven't even had a hospitalization this year. I'm in my mid-30s.

There are prescription drugs that cost over $10k per MONTH, and because of that, many insurance plans won't cover them. A few of them are generics for not uncommon conditions. They cost a few hundred 5 years ago but have been jacked up egregiously.
I feel for your particular medical issues, but please don't say that "$10k gets you very little in healthcare in the United States today". Last year, as a 66 yo couple, our actual healthcare expenses were $3600 for medicare insurance (including supplements), $1600 LTC premiums, and under $2k out of pocket for medical & dental, or just over $7k total for 2016.

Maybe we are not typical, but certainly your $45-50k isn't either.
You're on Medicare, hence the low premiums. If you were 60 instead of 66, your premiums would be extremely high. There's a long time until the OP hits Medicare age.
We are a non-Medicare family of four. Last year we spent $8300 on medical care, including health/dental insurance. That included one minor surgery and medication for two chronic conditions.

Clearly, many families are not as fortunate as ours because we have relatively low premiums and no conditions that require high-priced drugs or extended hospitalizations.

We all are guilty, at times, of extrapolating our personal situation to others. And clearly there is much room for improvement in the pricing of and payment for health care. But $10,000 buys all the healthcare needed for many people/families.
AntsOnTheMarch
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Re: Should I move abroad to minimize health care costs?

Post by AntsOnTheMarch »

delamer wrote:
sawhorse wrote:
neilpilot wrote:
sawhorse wrote: $10k gets you very little in healthcare in the United States today. My out of pocket costs will be $45-50k this year even with insurance, and I haven't even had a hospitalization this year. I'm in my mid-30s.

There are prescription drugs that cost over $10k per MONTH, and because of that, many insurance plans won't cover them. A few of them are generics for not uncommon conditions. They cost a few hundred 5 years ago but have been jacked up egregiously.
I feel for your particular medical issues, but please don't say that "$10k gets you very little in healthcare in the United States today". Last year, as a 66 yo couple, our actual healthcare expenses were $3600 for medicare insurance (including supplements), $1600 LTC premiums, and under $2k out of pocket for medical & dental, or just over $7k total for 2016.

Maybe we are not typical, but certainly your $45-50k isn't either.
You're on Medicare, hence the low premiums. If you were 60 instead of 66, your premiums would be extremely high. There's a long time until the OP hits Medicare age.
We are a non-Medicare family of four. Last year we spent $8300 on medical care, including health/dental insurance. That included one minor surgery and medication for two chronic conditions.

Clearly, many families are not as fortunate as ours because we have relatively low premiums and no conditions that require high-priced drugs or extended hospitalizations.

We all are guilty, at times, of extrapolating our personal situation to others. And clearly there is much room for improvement in the pricing of and payment for health care. But $10,000 buys all the healthcare needed for many people/families.
Hmm... :shock:
sawhorse
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Re: Should I move abroad to minimize health care costs?

Post by sawhorse »

delamer wrote:We are a non-Medicare family of four. Last year we spent $8300 on medical care, including health/dental insurance. That included one minor surgery and medication for two chronic conditions.

Clearly, many families are not as fortunate as ours because we have relatively low premiums and no conditions that require high-priced drugs or extended hospitalizations.

We all are guilty, at times, of extrapolating our personal situation to others. And clearly there is much room for improvement in the pricing of and payment for health care. But $10,000 buys all the healthcare needed for many people/families.
How are your premiums so low?
mouses
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Re: Should I move abroad to minimize health care costs?

Post by mouses »

fishmonger wrote:IMO this seems like an incredibly rash decision. You just bought your house 7 months ago? What changed so dramatically that you now want to sell and move to a foreign country, for some health event that may or may not happen years from now?

How much would you lose on transaction costs from selling your house? Probably enough to pay for a couple years' health premiums
The strangeness of the OP's question right after buying a house and the small retirement savings makes it seem like there is not a lot of calm planning going on about anything.

I would address the retirement savings issue before anything else.
delamer
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Re: Should I move abroad to minimize health care costs?

Post by delamer »

sawhorse wrote:
delamer wrote:We are a non-Medicare family of four. Last year we spent $8300 on medical care, including health/dental insurance. That included one minor surgery and medication for two chronic conditions.

Clearly, many families are not as fortunate as ours because we have relatively low premiums and no conditions that require high-priced drugs or extended hospitalizations.

We all are guilty, at times, of extrapolating our personal situation to others. And clearly there is much room for improvement in the pricing of and payment for health care. But $10,000 buys all the healthcare needed for many people/families.
How are your premiums so low?
Very large employer with outstanding negotiating power (federal government), although my spouse's much smaller employer actually has plans with lower employee premiums and better coverage. And we chose a plan with a lower premium that isn't as generous as many other fed plans, but with an out-of-pocket limit that made us comfortable.
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VictoriaF
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Re: Should I move abroad to minimize health care costs?

Post by VictoriaF »

mouses wrote:The strangeness of the OP's question right after buying a house and the small retirement savings makes it seem like there is not a lot of calm planning going on about anything.
When the OP was buying his house the American health insurance landscape was different than it is today.

Victoria
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AntsOnTheMarch
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Re: Should I move abroad to minimize health care costs?

Post by AntsOnTheMarch »

delamer wrote:
sawhorse wrote:
delamer wrote:We are a non-Medicare family of four. Last year we spent $8300 on medical care, including health/dental insurance. That included one minor surgery and medication for two chronic conditions.

Clearly, many families are not as fortunate as ours because we have relatively low premiums and no conditions that require high-priced drugs or extended hospitalizations.

We all are guilty, at times, of extrapolating our personal situation to others. And clearly there is much room for improvement in the pricing of and payment for health care. But $10,000 buys all the healthcare needed for many people/families.
How are your premiums so low?
Very large employer with outstanding negotiating power (federal government), although my spouse's much smaller employer actually has plans with lower employee premiums and better coverage. And we chose a plan with a lower premium that isn't as generous as many other fed plans, but with an out-of-pocket limit that made us comfortable.
You fit the description completely atypical. No one with your situation would bother to ask if they should relocate to another country to save on healthcare. Enjoy your gold-plated plan.
delamer
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Re: Should I move abroad to minimize health care costs?

Post by delamer »

AntsOnTheMarch wrote:
delamer wrote:
sawhorse wrote:
delamer wrote:We are a non-Medicare family of four. Last year we spent $8300 on medical care, including health/dental insurance. That included one minor surgery and medication for two chronic conditions.

Clearly, many families are not as fortunate as ours because we have relatively low premiums and no conditions that require high-priced drugs or extended hospitalizations.

We all are guilty, at times, of extrapolating our personal situation to others. And clearly there is much room for improvement in the pricing of and payment for health care. But $10,000 buys all the healthcare needed for many people/families.
How are your premiums so low?
Very large employer with outstanding negotiating power (federal government), although my spouse's much smaller employer actually has plans with lower employee premiums and better coverage. And we chose a plan with a lower premium that isn't as generous as many other fed plans, but with an out-of-pocket limit that made us comfortable.
You fit the description completely atypical. No one with your situation would bother to ask if they should relocate to another country to save on healthcare. Enjoy your gold-plated plan.
I was not responding to the original question; I was responding to the comment that $10,000 does not buy much healthcare in the US.

And the larger point is that while my situation is totally different than the OP's, it is not atypical. There are many families with good employer-sponsored healthcare. It does not make sense to have a system that ties your healthcare to your employment, but that is the system we have to live with now.
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seed4great
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Re: Should I move abroad to minimize health care costs?

Post by seed4great »

Moving abroad is more and more difficult, and eventually will be almost impossible for Americans. Tax is not the most critical issue, although tax return indeed become really complicated. In order to live somewhere, you would need a bank account. You cannot even apply for residence without a bank account, as you need to report the required amount of money to demonstrate that you can support yourself. US account would not work in most countries. Unfortunately, many banks are refusing to open accounts for US citizens, because of FATCA regulations. At the moment, there are still banks willing to work with US citizens. But their number is shrinking rapidly. Moreover, some of them are closing existing accounts.
The greatest lesson in life is to know that even fools are right sometimes.
Rupert
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Re: Should I move abroad to minimize health care costs?

Post by Rupert »

neilpilot wrote:
sawhorse wrote: $10k gets you very little in healthcare in the United States today. My out of pocket costs will be $45-50k this year even with insurance, and I haven't even had a hospitalization this year. I'm in my mid-30s.

There are prescription drugs that cost over $10k per MONTH, and because of that, many insurance plans won't cover them. A few of them are generics for not uncommon conditions. They cost a few hundred 5 years ago but have been jacked up egregiously.
I feel for your particular medical issues, but please don't say that "$10k gets you very little in healthcare in the United States today". Last year, as a 66 yo couple, our actual healthcare expenses were $3600 for medicare insurance (including supplements), $1600 LTC premiums, and under $2k out of pocket for medical & dental, or just over $7k total for 2016.

Maybe we are not typical, but certainly your $45-50k isn't either.
You're forgetting to count all the money you paid into Medicare during your working life.
neilpilot
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Re: Should I move abroad to minimize health care costs?

Post by neilpilot »

Rupert wrote:
neilpilot wrote:
sawhorse wrote: $10k gets you very little in healthcare in the United States today. My out of pocket costs will be $45-50k this year even with insurance, and I haven't even had a hospitalization this year. I'm in my mid-30s.

There are prescription drugs that cost over $10k per MONTH, and because of that, many insurance plans won't cover them. A few of them are generics for not uncommon conditions. They cost a few hundred 5 years ago but have been jacked up egregiously.
I feel for your particular medical issues, but please don't say that "$10k gets you very little in healthcare in the United States today". Last year, as a 66 yo couple, our actual healthcare expenses were $3600 for medicare insurance (including supplements), $1600 LTC premiums, and under $2k out of pocket for medical & dental, or just over $7k total for 2016.

Maybe we are not typical, but certainly your $45-50k isn't either.
You're forgetting to count all the money you paid into Medicare during your working life.
I'm not forgetting a thing. I responded to Rupert's "out of pocket costs". My medicare tax was $1271, so if you consider that "out of pocket", even though it was never "in my pocket", then sure my expenses rise to $8k. Still a far fetch from $45-50k.
Zea Mays
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Re: Should I move abroad to minimize health care costs?

Post by Zea Mays »

Right now, you are making $60 K each? If your skills are as good as you imply, it would be fairly easy to get work at that level, with decent insurance and probably a 401K with a match. What with raises and promotions, you might be able to retire in your 50's. The house does not look too expensive from here; just don't be talked into 'trading up'. Then, living abroad becomes a simpler problem, because you would not need to seek employment there.
To be observed, to be attended to, to be taken notice of with sympathy, complacency, and approbation, are all the advantages which we can propose to derive from wealth. Plus healthcare.
sawhorse
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Re: Should I move abroad to minimize health care costs?

Post by sawhorse »

Zea Mays wrote:Right now, you are making $60 K each? If your skills are as good as you imply, it would be fairly easy to get work at that level, with decent insurance and probably a 401K with a match. What with raises and promotions, you might be able to retire in your 50's. The house does not look too expensive from here; just don't be talked into 'trading up'. Then, living abroad becomes a simpler problem, because you would not need to seek employment there.
One benefit of moving to a country with universal health care is that it won't depend on your employment.

Depending on your job for health coverage means depending on your health. If you develop a health problem that prevents you from working, you'll be in a tough situation.

Also, if you retire in your 50s, you will no longer have that health coverage from your job.
sawhorse
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Re: Should I move abroad to minimize health care costs?

Post by sawhorse »

delamer wrote:
AntsOnTheMarch wrote:
delamer wrote:
sawhorse wrote:
delamer wrote:We are a non-Medicare family of four. Last year we spent $8300 on medical care, including health/dental insurance. That included one minor surgery and medication for two chronic conditions.

Clearly, many families are not as fortunate as ours because we have relatively low premiums and no conditions that require high-priced drugs or extended hospitalizations.

We all are guilty, at times, of extrapolating our personal situation to others. And clearly there is much room for improvement in the pricing of and payment for health care. But $10,000 buys all the healthcare needed for many people/families.
How are your premiums so low?
Very large employer with outstanding negotiating power (federal government), although my spouse's much smaller employer actually has plans with lower employee premiums and better coverage. And we chose a plan with a lower premium that isn't as generous as many other fed plans, but with an out-of-pocket limit that made us comfortable.
You fit the description completely atypical. No one with your situation would bother to ask if they should relocate to another country to save on healthcare. Enjoy your gold-plated plan.
I was not responding to the original question; I was responding to the comment that $10,000 does not buy much healthcare in the US.

And the larger point is that while my situation is totally different than the OP's, it is not atypical. There are many families with good employer-sponsored healthcare. It does not make sense to have a system that ties your healthcare to your employment, but that is the system we have to live with now.
You have low health costs because you can work. For people employed by generous employers, $10k can get you a lot because your employer pays part of the premium.

$10k gets you little when you have a major debilitating health problem because you can no longer get employer coverage due to not being able to work or not being able to work the hours required for benefits.

In other words, $10k gets you little when you actually need it.
richardglm
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Re: Should I move abroad to minimize health care costs?

Post by richardglm »

I agree with others to avoid discussion that could get this locked. Discussion of how to deal with uncertain healthcare costs pre-Medicare age in an actionable way is a 100% legitimate and extremely frequent concern among a very large number of people.
FeesR-BullNotBullish wrote:Is it wise to explore options to move abroad? My profession is specialized and in demand. I am confident that I can get a job in a developed country with a health care system that provides comparable care at a significantly less personal cost than the U.S. system.
One thing you can do now is look up grandpa and grandma. Within a marriage there are 8 grandparents and if one was born in a foreign country, the grandchild is often eligible for citizenship and can sponsor their spouse. Some countries go even further back to great-grandparents or more (I hear Italian ancestry is great for this) If the citizenship is EU, that gives right to work and reside in the entirety of the EU/EEA.

It is virtually always easier to immigrate and use social services if one spouse already has citizenship. No matter how in demand your profession is.

And obviously it is different if you move while both are healthy, but I would not count on being able to move, after developing a preexisting condition, based only on your profession. For example if one spouse gets disabled. Getting an immigrant visa for someone with potential draw on social services could be difficult or impossible even if their spouse is job recruited.
FeesR-BullNotBullish wrote:We bought a beautiful house about 7 months ago that I love.
Many people never get their dream or forever home. Don't neglect the importance of being where you love, for financial reasons.
FeesR-BullNotBullish wrote:We have been mostly negligent in saving for retirement. Our combined retirement savings is $60,000 ($40,000 in Roth IRAs + $20,000 taxable). We have mostly replenished our emergency fund that we drained for our down payment (yes, I know big no no!), and we look forward to continuing our retirement savings in the next month.
The best thing about building up savings is that it will give you only more options, not less.
seed4great wrote:Moving abroad is more and more difficult, and eventually will be almost impossible for Americans. Tax is not the most critical issue, although tax return indeed become really complicated. In order to live somewhere, you would need a bank account. You cannot even apply for residence without a bank account, as you need to report the required amount of money to demonstrate that you can support yourself. US account would not work in most countries. Unfortunately, many banks are refusing to open accounts for US citizens, because of FATCA regulations. At the moment, there are still banks willing to work with US citizens. But their number is shrinking rapidly. Moreover, some of them are closing existing accounts.
I would dispute this, at least a little. Yes, there was rapid contraction in the number of banks willing to do business with US citizens particularly after the Swiss banks got hammered, and the international banking market is still in flux for US persons. However there are banks who are now beginning to show FATCA compliance and are working with their national regulators to reopen access to US citizens resident in their countries. Particularly if you are high net worth and/or willing to open current accounts with monthly fees (which are far more common outside of the US, any ways) it is slowly becoming possible again.
sawhorse
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Re: Should I move abroad to minimize health care costs?

Post by sawhorse »

richardglm wrote:It is virtually always easier to immigrate and use social services if one spouse already has citizenship. No matter how in demand your profession is.

And obviously it is different if you move while both are healthy, but I would not count on being able to move, after developing a preexisting condition, based only on your profession. For example if one spouse gets disabled. Getting an immigrant visa for someone with potential draw on social services could be difficult or impossible even if their spouse is job recruited.
This is great advice. I would add that even if one of you has citizenship, the other may not be eligible for health services right away. My husband is from an EU country so while getting a visa to live there would be no problem for me, I would have to pay for private health coverage for a certain time period before becoming eligible for the national plan. He is eligible immediately.

The time to move is before you develop a health problem. If we could have foreseen my disease we would have moved beforehand, but now I'm not in a condition to move, and I would have to pay for private coverage when I get there. The care is much less expensive though, so I wouldn't be paying as much.
Zea Mays
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Re: Should I move abroad to minimize health care costs?

Post by Zea Mays »

sawhorse wrote:
Zea Mays wrote:Right now, you are making $60 K each? If your skills are as good as you imply, it would be fairly easy to get work at that level, with decent insurance and probably a 401K with a match. What with raises and promotions, you might be able to retire in your 50's. The house does not look too expensive from here; just don't be talked into 'trading up'. Then, living abroad becomes a simpler problem, because you would not need to seek employment there.
One benefit of moving to a country with universal health care is that it won't depend on your employment.

Depending on your job for health coverage means depending on your health. If you develop a health problem that prevents you from working, you'll be in a tough situation.

Also, if you retire in your 50s, you will no longer have that health coverage from your job.
True but not on point. Any way of making money, 1099 or W2, depends on your health. I proposed moving *after* employment, with a large sum, to a country with lesser health costs; that you would no longer have employment coverage at that time, goes without saying.
To be observed, to be attended to, to be taken notice of with sympathy, complacency, and approbation, are all the advantages which we can propose to derive from wealth. Plus healthcare.
sawhorse
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Re: Should I move abroad to minimize health care costs?

Post by sawhorse »

Zea Mays wrote:
sawhorse wrote:
Zea Mays wrote:Right now, you are making $60 K each? If your skills are as good as you imply, it would be fairly easy to get work at that level, with decent insurance and probably a 401K with a match. What with raises and promotions, you might be able to retire in your 50's. The house does not look too expensive from here; just don't be talked into 'trading up'. Then, living abroad becomes a simpler problem, because you would not need to seek employment there.
One benefit of moving to a country with universal health care is that it won't depend on your employment.

Depending on your job for health coverage means depending on your health. If you develop a health problem that prevents you from working, you'll be in a tough situation.

Also, if you retire in your 50s, you will no longer have that health coverage from your job.
True but not on point. Any way of making money, 1099 or W2, depends on your health. I proposed moving *after* employment, with a large sum, to a country with lesser health costs; that you would no longer have employment coverage at that time, goes without saying.
What type of visa would that be on? The countries that Americans would most seriously consider moving to aren't going to let someone move there with no job and immediately use healthcare services. You'd have to get an investment visa which could well require more money than you have, in addition to limiting the number of country choices.
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