Should I move abroad to minimize health care costs?

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

Post by ikowik »

Five years ago the thought of moving back to a developing-third world- whatever country would have been dismissed instantly. But now we are in our 60s, and itching to retire, that is looking good.
What a sad state of affairs in the healthcare area of USA!
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FeesR-BullNotBullish
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Re: Should I move abroad to minimize health care costs?

Post by FeesR-BullNotBullish »

OP here. I am humbled with the advice, stories, and lessons posted thus far. I am touched that so many have reached out to a stranger to share. I realize my initial post sounds rash, but we have by no means decided to move. I just think it should be a consideration. We likely have at least a year of research ahead of us and then another year to implement a move if we decide it is right for us. For those who say we need to move to something rather than away from something, I appreciate that sentiment. DW and I are both reasonably adventurous and intrigued by the opportunity to live abroad. We would happily visit for an extended period to get a feel for the culture and environment. There are myriad places in the world we would love to live in. We would approach such a transition with a sense of excitement and adventure.

As mentioned it is important to note that just because insurance has out of pocket maximums doesn't mean insurance will cover the care a doctor recommends. Recently my wife was prescribed antibiotics by two MDs. Insurance rejected both prescriptions. This is just the latest episode ongoing chronic health struggles my wife has had for six + years. We can easily afford the prescriptions at $400. However, what happens if down the road the insurance company won't approve a treatment that will set us back $4,000 or $40,000?

I do share some sense of optimism regarding prospects for reform. However, I feel like reform will be beneficial mostly to low earners and elderly. At this point I have lost hope for systematic reform that will benefit freelancers like my wife and I who earn more than $100,000 combined.

I will consider taking a job as an employee if we move abroad. I will also consider looking at second world countries as has been suggested. They might provide ease of immigration along with lower cost of living. By no means am I looking to move somewhere just to mooch social services. I will happily contribute to a system that I feel provides me a worthy return. I just don't think we're getting that here.

Once again, thank you for the thoughtful posts. Keep them coming if you have something to add!
delamer
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Re: Should I move abroad to minimize health care costs?

Post by delamer »

sawhorse wrote:
delamer wrote:
AntsOnTheMarch wrote:
delamer wrote:
sawhorse wrote:
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.
I am sympathetic to your situation, and do not think health insurance should be tied to employment.

But my family needed its $8,300 in health care, and were fortunately able to get it. The difference, I suppose, is that ours will prevent some debilitating conditions rather than treat them. (I am not implying that your condition was preventable, just that preventive care is very valuable.)
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MossySF
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Re: Should I move abroad to minimize health care costs?

Post by MossySF »

sawhorse wrote: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.
Some of the EU countries are relatively cheap for an investment visa. 350K euros ($400K USD) invested in housing (can be combination of personal residence and rental) can get you a Portugal visa. So somebody who saw lots of RE gains in the U.S. could easily sell their house here, buy a place for 200K to live in and another place for 200K to rent out for some income -- and continue their existing freelance work (for what can be done remotely). No employment offer needed to make this happen. If you like Spain instead, they have slightly higher requirements -- 500K euros ($570K USD) -- which again is like nothing for those who saw major RE appreciation.

Lots of British retire to these countries so it seems possible to get by with English. (I did a meet & greet with a string trio from Barcelona and tried my broken Spanish with them. While they were happy/surprised to hear Spanish in China, they immediately replied back using English.)
4nwestsaylng
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Re: Should I move abroad to minimize health care costs?

Post by 4nwestsaylng »

Title of this thread is ironic.

It is true that if you come to many of these developed countries through the legal process you cannot expect to be immediately provided "free" health care.You didn't pay into the system. We do see millions entering the U.S., Canada, the Western European countries, either illegally or as "refugees" granted free access to their healthcare systems. How long that is sustainable in quality national healthcare systems is unknown.
visualguy
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Re: Should I move abroad to minimize health care costs?

Post by visualguy »

MossySF wrote: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.
Not really... If you get seriously sick, you can't keep your job, and you lose your employer insurance - you get thrown into the individual market with a major pre-existing condition. The connection between employment and health insurance makes zero sense because serious illness and employment simply don't go together.

I guess moving to a country where you speak the language may make sense, but a lot needs to fall into place for that to work. Immigrating isn't easy... It's hard to get motivated to do that and be happy with that just based on the US health care mess.
SrGrumpy
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Re: Should I move abroad to minimize health care costs?

Post by SrGrumpy »

4nwestsaylng wrote:
It is true that if you come to many of these developed countries through the legal process you cannot expect to be immediately provided "free" health care.You didn't pay into the system.
Not sure if that is completely true. You pay for healthcare one way or another - through taxes and payroll deductions. Even as an EU citizen, I can't got go back to Europe and demand free healthcare. I need to have a European Health Insurance Card, which is available only to residents - and I am not one. And in many countries, people supplement their national healthcare with private insurance - except in Canada, where I believe the latter is illegal. So an American expatriating to the EU, for sure, will not be freeloading.
4nwestsaylng
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Re: Should I move abroad to minimize health care costs?

Post by 4nwestsaylng »

Again the irony of it.
scubadiver
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Re: Should I move abroad to minimize health care costs?

Post by scubadiver »

OP is worried about healthcare costs draining his nest egg? What nest egg? The OP is 40 and barely has anything worth mentioning in retirement savings on a salary of $120K per year.

Yes, poverty in old age is a very real risk here, but not because of healthcare costs, just good old fashioned lack of savings.
windrose
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Re: Should I move abroad to minimize health care costs?

Post by windrose »

Why not do some research and give it a try?

"They" say people tend to regret what they didn't do...rather than what they did do. As long as you can rent out the house, and can keep the door open for an eventual return if you decide it is not for you, you seem like perfect candidates.

However, without access to citizenship, I don't think getting a job will be as easy as you think...which is not to say it would be impossible, either. If you are considering any non-English speaking countries, I'd recommend signing up at a language school for 3 months. The school will help you find you housing, and while working on fluency, you will have a daily M-F routine, which would give you a better feel for what it would be like to live and work there, rather than just kind of hanging out as a tourist.

I have access to EU citizenship, and have considered moving there when I retire at 55, as a plan B....so I started doing a bit of research myself. I found book to download from my library about how to retire overseas, written by Kathleen Peddicord. While I would hesitate to recommend actually buying it, since it contains a lot of price/cost info which is already outdated... you could see if your library also has a copy.

The book is really not a comprehensive how-to manual...it is more like a nice long chat with someone who has lived in several countries (Ireland, France, and now Panama) who shares her mistakes, gives pointers, and makes you think about things you might not have even considered.

In the book she covers costs/budgets for cities in Europe, Central America, South America, and Asia, and the cost comparisons are useful and interesting. Even if they are somewhat out of date, you at least get a starting point and general idea of what is higher/lower in some of the places.

She likes/recommends a UK insurance company called BUPA for private health insurance policies.
J295
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Re: Should I move abroad to minimize health care costs?

Post by J295 »

I haven't read the other posts, but absent very extraordinary circumstances we would not move just for health insurance cost savings ..... to me that's the tail wagging the dog ..... now, if you are looking for an adventure and taking health care/health care costs generally out of the equation you want to move then go for it (we have considered this and are taking a 3 month adventure later this year) .....

We transitioned away from full time work 5 years ago at age 53, and health care was and unknown, and still is, but so what .... nearly everything in life is fluid and in large part unknown ... so we go with the flow and navigate the speed bumps and make it work (and that includes health insurance) ...
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VictoriaF
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Re: Should I move abroad to minimize health care costs?

Post by VictoriaF »

J295 wrote:I haven't read the other posts, but absent very extraordinary circumstances we would not move just for health insurance cost savings ..... to me that's the tail wagging the dog.
If you had read other posts, particularly sawhorse's, you would have noticed that the tail can be many times heavier than the dog.

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

Post by mouses »

What happens to Social Security if one moves abroad? What happens to it if the person changes citizenship?
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dodecahedron
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Re: Should I move abroad to minimize health care costs?

Post by dodecahedron »

mouses wrote:What happens to Social Security if one moves abroad? What happens to it if the person changes citizenship?
Yes, US citizens living overseas can continue to receive Social Security, though there are a few countries (e.g., North Korea, Cuba) where SSA can't mail checks. There are additional restrictions on SS eligibility for non-US citizens living outside the US. See here for details.
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HueyLD
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Re: Should I move abroad to minimize health care costs?

Post by HueyLD »

mouses wrote:What happens to Social Security if one moves abroad? What happens to it if the person changes citizenship?
https://www.ssa.gov/pubs/EN-05-10137.pdf

This social security publication has everything you need to know about receiving SS while living in another country.
marko21
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Re: Should I move abroad to minimize health care costs?

Post by marko21 »

Hey guys,

Thanks for your post Windrose!

I agree on all accounts, the information in Kathleen's book is probably a bit dated now (although I follow her e-letter and I believe an updated version is coming out later this year?). For the budgets, I find the ones on her website https://www.liveandinvestoverseas.com/budgets/ to be pretty handy. Depending on the location, some are more detailed than others but it helped me to rule out some places and consider some other ones. I know she offers paid subscriptions that have more info, but I haven't bought any yet. If you are just looking for a free resource to see the general budgets and other info about the place from expats who live there right now, the website is a good place. I think the best international health insurance providers are probably BUPA and Cigna, they seems to be the most mentioned in the forums and recommended expat sites.

A few other links from her site I found interesting:
https://www.liveandinvestoverseas.com/h ... ng-abroad/-- I liked this one b/c it made me look at the budgets not just in the $ but in the value and what I could get for my lifestyle.

https://www.liveandinvestoverseas.com/country-hub/ - This lists out all the countries that they cover on their website, although i think they might have more if you do some searches.

All the best,
Marko
windrose wrote: I found book to download from my library about how to retire overseas, written by Kathleen Peddicord. While I would hesitate to recommend actually buying it, since it contains a lot of price/cost info which is already outdated... you could see if your library also has a copy.

The book is really not a comprehensive how-to manual...it is more like a nice long chat with someone who has lived in several countries (Ireland, France, and now Panama) who shares her mistakes, gives pointers, and makes you think about things you might not have even considered.

In the book she covers costs/budgets for cities in Europe, Central America, South America, and Asia, and the cost comparisons are useful and interesting. Even if they are somewhat out of date, you at least get a starting point and general idea of what is higher/lower in some of the places.

She likes/recommends a UK insurance company called BUPA for private health insurance policies.
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magellan
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Re: Should I move abroad to minimize health care costs?

Post by magellan »

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.

...But $10,000 buys all the healthcare needed for many people/families.
Actually, it often doesn't.

My guess is that the cost for your family's health insurance and healthcare last year was north of $20k, probably closer to $25k. The thing you're missing is that your employer paid somewhere around $15k to your insurance company on your behalf. You've gotta add that back in when calculating how much healthcare was purchased for your family last year.
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magellan
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Re: Should I move abroad to minimize health care costs?

Post by magellan »

For the OP, one thing to consider is that depending on where you live, you may be able to get more stability and security just by moving to a different state. Several states have reasonably well-functioning individual insurance markets that are backstopped by a state level commitment to keeping things running smoothly.

Most of the talk about Obamacare focuses on worst-case scenarios or nationwide averages. These can obscure very large differences in how individual markets are functioning from state to state.

As an example, Massachusetts had Romneycare and its own individual mandate before it had Obamacare. It seems fairly likely that MA would do whatever it takes to keep its individual market functional, regardless of what happens at the federal level.
Last edited by magellan on Tue Jul 04, 2017 2:35 pm, edited 1 time in total.
TIAX
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Re: Should I move abroad to minimize health care costs?

Post by TIAX »

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.
What countries are you considering? How difficult is it to immigrate to those countries? What are the taxes in those countries compared to the U.S.?
truenorth418
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Re: Should I move abroad to minimize health care costs?

Post by truenorth418 »

I am disappointed with this thread. The affordable care act was designed to help protect against the sort of catastrophic events the OP is referring to. That's why it includes annual out of pocket caps. For a single person the 2017 cap is a little over $7,000 which means with premiums the grand total out of pocket would be a little over $10,000 in any given year? Would it suck to have to pay that- especially for a couple of years running? Sure. That's why I budget for it every year. Thankfully I have not had to pay much more that a couple thousand out of pocket since these plans were put in place. But I sleep at night knowing the money is there when I need it.

Will the new version of this system eliminate these annual caps? We're not supposed to speculate about politics on the forum so I won't do so. But I plan to wait and see what the new rules look like and adapt as best I can.
truenorth418
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Re: Should I move abroad to minimize health care costs?

Post by truenorth418 »

As for the much heralded Canadian system, run the numbers yourself before drawing any conclusions. I looked into moving to British Columbia from NYC last year and I created a pro forma budget including taxes, health insurance, etc etc. Guess what? My health insurance costs went down to practically zero (BC requires a nominal payment of monthly premiums). However my income taxes went up substantially, meaning I had to pay far more out of pocket every year for the grand total cost of making the move. And this was moving from one of the highest taxed jurisdictions in the USA.

So everyone's situation is different - all I am saying is do your homework before drawing conclusions about how great and more "affordable" these other countries' systems are.
richardglm
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Re: Should I move abroad to minimize health care costs?

Post by richardglm »

truenorth418 wrote:I am disappointed with this thread. The affordable care act was designed to help protect against the sort of catastrophic events the OP is referring to. That's why it includes annual out of pocket caps. For a single person the 2017 cap is a little over $7,000 which means with premiums the grand total out of pocket would be a little over $10,000 in any given year? Would it suck to have to pay that- especially for a couple of years running? Sure. That's why I budget for it every year. Thankfully I have not had to pay much more that a couple thousand out of pocket since these plans were put in place. But I sleep at night knowing the money is there when I need it.

Will the new version of this system eliminate these annual caps? We're not supposed to speculate about politics on the forum so I won't do so. But I plan to wait and see what the new rules look like and adapt as best I can.
We're not allowed to discuss pending legislation, and even if we were I'm not sure that we'd know how different it would be from now. I'm sure a lot of anxiety comes from the uncertainty, which drives us here in search of answers (as long as we don't say why we're anxious :wink: ). We can discuss and focus on the things we can control, like savings, living location, medical tourism, etc and can hope that it lessens people's anxiety to discuss options.

Still I think it has been true for a long time that the 45-64 age range has been the most vulnerable (besides kids) to healthcare costs and that is again true today. It may be more manageable right now but most Americans probably don't even have the savings to cover several years of max out-of-pocket if they get sick and lose work. I fully understand then why a lot of people are worrying about healthcare costs in this age range even if they have good income and savings.

There's some health costs which aren't included in OOP, too. The best standard of care nowadays for tooth extraction is to provide for an implant, with lots of OOP costs even with dental insurance. There's a wide variety of prices and qualities available too and needing 2-3 implants (not unreasonable for some 50-60 year olds) can hammer your savings too.
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Watty
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Re: Should I move abroad to minimize health care costs?

Post by Watty »

truenorth418 wrote:I am disappointed with this thread. The affordable care act was designed to help protect against the sort of catastrophic events the OP is referring to. That's why it includes annual out of pocket caps. For a single person the 2017 cap is a little over $7,000 which means with premiums the grand total out of pocket would be a little over $10,000 in any given year? Would it suck to have to pay that- especially for a couple of years running? Sure. That's why I budget for it every year.
One thing to keep in mind when looking at the numbers is that the median household income is only about $56,000 so at those levels the OP's question about moving is a valid one to consider but their options would likely be limited to less developed countries which some people do move to to get lower health care costs.

Your example would be with a $250 a month premium which may not be realistic. I am 60 and my ACA silver plan premium is about $500 a month with a subsidy and it would be $850 a month without it. That is $6,000 and $10,200 a year for and many if not most people are a couple so the amounts would be higher. I'm able to afford that but I know exactly home many months it will be until I can switch to Medicare.
halfnine
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Re: Should I move abroad to minimize health care costs?

Post by halfnine »

FeesR-BullNotBullish wrote: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....
After near 20 years traveling/living abroad my spouse and I now have citizenship/residency available to us in developed countries on four continents. A few comments...

I am not entirely sure you can get a work visa. It's gotten a lot more difficult to get a visa to work in developed countries recently without an employer sending you abroad. I'd say circa 2002 it was pretty easy and then every five years or so since then it's gotten harder and harder. I am not going to say it's impossible, but your age and income are too high and too low respectively for many countries.

A visa to work doesn't get you much in terms of long term rights. You will need permanent residency and this is likely to take you at least 5 years and it won't be a given as you'll still have to be working and meeting qualifications. And permanent residency comes with a catch. You'll lose it if you leave to live elsewhere for a few years. As such, citizenship is really the only guaranteed method to maintaining long term rights. And there are a few developed countries that won't allow dual citizenship so you'd likely want to eliminate these from your choices.

Residency/citizenship abroad in a developed country is most beneficial not for healthcare (quality care can be provided for reasonable prices in many non-developed countries) but for those with minor children. Not only are university costs a fraction of what they are in the USA but it provides your children with the opportunity to work/live in more than one country.
madbrain
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Re: Should I move abroad to minimize health care costs?

Post by madbrain »

FeesR-BullNotBullish wrote: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.
Your health plan costs $600 * 12 = $7200 per year. The maximum deductible is $13,100 . Even if you hit the maximum deductible, your healthcare cost is 16.9% of gross income.

Most countries that have better healthcare systems also have higher payroll & income taxes - certainly higher than in the United States. I can certainly tell you this is the case in France where I grew up. The costs of most things over there tend to be higher, also. I would not assume that your cost of living will be necessarily lower abroad, unless you go to a developing country as opposed to a developed country. However, the quality of your healthcare will be much lower as well. I don't think there is a free lunch.

That said, I'm sympathetic to your concerns. I think most of us are given the huge political uncertainty in the US right now. If things continue to get much more expensive, I will likely make a move myself. But I already have that flexibility from dual citizenship. It would probably be a move that I make in early retirement if things like Medicaid and ACA premium subsidies disappear or are severely cut back. We already do have very expensive medical conditions (both with HIV), but the cheap health coverage at my Megacorp means we are paying less than 5% of gross income to treat it.
madbrain
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Re: Should I move abroad to minimize health care costs?

Post by madbrain »

truenorth418 wrote:I am disappointed with this thread. The affordable care act was designed to help protect against the sort of catastrophic events the OP is referring to. That's why it includes annual out of pocket caps. For a single person the 2017 cap is a little over $7,000 which means with premiums the grand total out of pocket would be a little over $10,000 in any given year? Would it suck to have to pay that- especially for a couple of years running? Sure. That's why I budget for it every year. Thankfully I have not had to pay much more that a couple thousand out of pocket since these plans were put in place. But I sleep at night knowing the money is there when I need it.
You are assuming catastrophic events are short lived and non recurring - if they are chronic conditions, then the costs are every year. Our HIV meds cost $30k per person per year and there are two of us. Currently we pay $8000 in premium per year with a Megacorp, less $5000 employer subsidy, plus about $500 out of pocket. Ie. about $3500/year in net costs - negligible, really. If not working anymore, but with income too high for subsidies (anything over $64,000) our costs could be as high as $27,000 each year, including premiums and out of pocket costs. That would be 42% of gross income for $64,001 income. Even if we were $1 below the cliff for subsidies, it would still be over $15,000 or 23% of gross income. There are many problems with the ACA, and in many situations, it is not really so affordable. And of course, much of it is in the process of being repealed/phased out, even though we can't go into the details of that on this forum.
jmw
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Re: Should I move abroad to minimize health care costs?

Post by jmw »

First, I agree with those of you who thought $10k doesn't buy much in US healthcare and there are plenty of ways to blow right through $10k every year indefinitely.

If you continue to live in the US, I would strongly encourage you to move from the individual health insurance market (no more ACA or equivalent replacement) and go to employer based subsidized corporate health insurance. The best health insurance policies available in the US are subsidized employer based coverage for age 0-64 and traditional Medicare with a supplement from age 65 onward. This means at least one of you should find a corporate salaried job with generous health insurance. The US individual health insurance market has always been a disaster whether it's a pre-existing condition leading to denial of coverage or unaffordable premiums/copays/deductibles. Honestly, health insurance makes freelancing a bad idea unless you are making huge bank like $200k+. $60k/person freelance is not worth it. The move to employer health insurance may not save you any money since you actually use the insurance for chronic health problems, but you will be out of that sad joke of a marketplace.

In the United States, long term care is via insurance, self funded, or Medicaid. Long term care insurance is super expensive, insufficient to pay for all long term care expenses, and you will probably be fighting the insurance companies hard to draw benefits. The very few folks that can afford LTCI can also afford to self fund. If you can afford to self fund, look at CCRC and other similar retirement communities with multiple levels of long term care (independent living, assisted living, nursing home). These places don't take Medicaid. With your current savings and real estate equity, you are very far from being able to afford this. That leaves Medicaid, which is the long term care option for the nearly all of the middle class and below. With Medicaid, you drain all of your assets before the taxpayer kicks in a dime. Once you have no more assets left, Medicaid will take virtually 100% of the nursing home resident's income and pay for the rest of the nursing home. Medicaid nursing homes are pretty bad. I don't think nursing homes that require private pay for x months and then allow Medicaid are any better than pure Medicaid nursing homes although many will say that's not true. How is a nurse supposed to know whether the old person in the bed is private pay or Medicaid? If you want a good nursing home, it won't be taking Medicaid under any circumstances.

As far as moving abroad, there are so many issues to cover. I'll go over a very few, but there are many more. One of them is that many countries require a medical exam of you, your spouse, and your children even if some of them are not moving overseas. The standard to pass is similar to passing a life insurance medical exam with no surcharge. You also need a path to permanent residency and citizenship. Otherwise you will be coming back here for healthcare after a layoff in the foreign country. Finally, are you really going to be able to get a job overseas? For example, IT folks are a dime a dozen in Asia. That eliminates a whole continent right there.
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seed4great
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Re: Should I move abroad to minimize health care costs?

Post by seed4great »

truenorth418 wrote:My health insurance costs went down to practically zero (BC requires a nominal payment of monthly premiums). However my income taxes went up substantially, meaning I had to pay far more out of pocket every year for the grand total cost of making the move. And this was moving from one of the highest taxed jurisdictions in the USA.
You must be a permanent resident in Canada in order to use their public healthcare system, correct? Which is hard to obtain, especially if you are over 50. I wish I'm wrong, but as it seems to me Canada is a nice country but out of reach for most retirees from US.
The greatest lesson in life is to know that even fools are right sometimes.
msk
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Re: Should I move abroad to minimize health care costs?

Post by msk »

I think the rough guide for most countries is, "You pay local income tax, you get local privileges like healthcare, etc." Sounds very fair to me... Of course, you can look for countries where there is no personal income tax (I think there are 11 in the entire world according to the UK Daily Telegraph?) but have free healthcare (presumably a much smaller subset that will set all kinds of hurdles for free loaders). Basically healthcare costs are two tiered, USA+Canada then the rest of the world. High quality healthcare is now widely available at "rest of the world" pricing. Think of Bangkok and India, probably even cheaper than Australia or Germany. Nevertheless you have to experience the efficiency of the Bangkok hospitals to appreciate it. I did once for an elective surgery. They asked me when would you like to have it done? Answered, tomorrow. Done! A friend went to India for an inexpensive second opinion on a suspected noncancerous brain tumor. I saw him a few weeks later with his operation done! Scalp cut, tumor out. He was so impressed with the facilities he felt that was the place to get his head cut open. Cost? < $20k. There will always be centers of excellence for specific, cutting edge, experimental treatments, and while these experimental facilities are almost always in developed countries, they are not exclusively in N.America. But let's face it, most of us die with a whimper following run-of-the-mill established treatment available worldwide. As for experimental treatments? Depends on your age. The older I get the less I would be tempted to undergo a heart transplant, even if free. At age 40 my attitude would have been quite different. Long term care? If my family wishes to dump me into an institution, I'd much rather I end up on a beach with plentiful, inexpensive domestic help available than in some super expensive place in a HCL state. Perhaps a new LTC industry ought to be launched at some remote beach in Central America for US youngsters to dump us oldies. At least they can also enjoy a beach holiday when our kids come to visit occasionally :mrgreen: Most of us will die with either a whimper or a sudden heart attack/stroke. Worrying too much for a possible but very rare event is unwise, IMHO.
zuma
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Re: Should I move abroad to minimize health care costs?

Post by zuma »

msk wrote:Basically healthcare costs are two tiered, USA+Canada then the rest of the world. High quality healthcare is now widely available at "rest of the world" pricing.
I recently stumbled upon this interesting paper on the history of the German health care system:
Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition

This chart in particular stood out:

Image
Regarding health outcomes as a function of health-system performance as a whole, amenable mortality is increasingly used as a valid indicator for quality since it shows the number of deaths related to certain diseases that could have been prevented by accessible, timely, and effective health care. This approach provides an opportunity to assess the contribution of health care to population health. Although amenable mortality seems to have decreased as total health expenditures have increased, the absolute amenable mortality and the rate by which it has decreased vary between countries (figure 6).
msk
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Re: Should I move abroad to minimize health care costs?

Post by msk »

Very eye-popping! Didn't expect Canada to have such low costs and I wonder whether it's all that wining and dining that keeps the French so healthy (and merry?) :greedy
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