Budgeting for new immigrant dad health care

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Topic Author
newseahorse
Posts: 44
Joined: Sun Nov 04, 2012 11:36 pm

Budgeting for new immigrant dad health care

Post by newseahorse »

Hello,
Plan is for my father, age 70, to come live with me on a Green Card.
He will be eligible for ACA. Then after 5 years *buy* medicare, since he has not paid (and will never get around to paying) medicare taxes for 40 quarters.
He has some health issues but nothing serious. Also I see him staying with me till the end and never moving out to a senior/care facility.

The question is what should we be budgeting for his medical expenses in my overall financial plans. I understand lots of variables here so large ranges in response are understandable.

thanks in advance!
Topic Author
newseahorse
Posts: 44
Joined: Sun Nov 04, 2012 11:36 pm

Re: Budgeting for new immigrant dad health care

Post by newseahorse »

Bump. Any elder immigrant sponsors out there?
If not, maybe I can find public data for health costs for pre medicare years (say 60 to 65) and multiply it out with life expectancy and add a weighting factor of some sort?
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HueyLD
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Re: Budgeting for new immigrant dad health care

Post by HueyLD »

It is impossible to help you with your questions.

At his age, all it takes is one serious illness to incur hundreds of thousands of dollars in medical expenses in this country. However, sign him up for the best ACA insurance you can find in your area and the choices again vary widely by state and by location within each state.

I know that some older immigrants had to go back to their home country (with universal health care) for serious health issues. Best of luck to you and your father.
Rupert
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Joined: Fri Aug 17, 2012 12:01 pm

Re: Budgeting for new immigrant dad health care

Post by Rupert »

There have been prior threads on this topic. See, e.g.:

viewtopic.php?t=253715

viewtopic.php?t=177430

viewtopic.php?t=133456

HueyLD is correct that it's impossible to answer your questions re cost. There is no ceiling to healthcare costs in this country, and insurance costs will vary from person to person and state to state today and will be god knows what in a few years. All you can count on is more uncertainty. The trend seems to be for elderly people to emigrate out of this country for healthcare, not immigrate into the country for healthcare.
Topic Author
newseahorse
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Re: Budgeting for new immigrant dad health care

Post by newseahorse »

Thanks for the replies and the links! Much appreciated.

Sorry if this is naive - but doesn't the healthcare cost have some kind of upperbound like:

(higher end of life expectancy - current age)* (worst case ACA/Medicare premiums + worst case deductibles) ?

If yes we just need to plug in those datapoints.
But I suspect from the responses I am missing something. Care to point that out?
Last edited by newseahorse on Tue Feb 19, 2019 6:20 pm, edited 1 time in total.
cashheavy18
Posts: 131
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Re: Budgeting for new immigrant dad health care

Post by cashheavy18 »

We have the same situation for a family member who came to the US age early 90s, and thankfully ACA was/is available. This will be the 5th year.

Costs have ranged from $600-$1000/month with very high deductibles for the bronze option.

Relative has NEVER been hospitalized. We still get all medications filled annually in home country.

You can go onto healthcare.gov to get estimates for your specific location.
codedude
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Re: Budgeting for new immigrant dad health care

Post by codedude »

Will he have perm residency when he enters the country? In which case, he can get an ACA plan within a couple of weeks.

Or will he apply for perm residency in the US, in which case you are looking at a minimum of 6 months to years of not having an ACA plan.

Also does he have income/rent/pension in his home country? Depending on the amounts, as a US taxpayer, he may get an ACA subsidy (or not).

As suggested by other posters, your best bet is to run a hypothetical scenario on healthcare.gov to get healthcare premium estimates and deductibles.

You said no nursing home, but if the need arises, will you or another family member be able to stay at home full time? If not you need to budget for a caregiver.
Topic Author
newseahorse
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Re: Budgeting for new immigrant dad health care

Post by newseahorse »

Yep, plan is to get GC prior to arrival.
No rent income. Some paltry pension (not sure)

Yes, in that situation, pbbly get a caregiver. I should look into what that costs. Thanks for pointing it out.
clip651
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Re: Budgeting for new immigrant dad health care

Post by clip651 »

How will he be eligible for ACA? He will need to have income in the right range to be eligible for subsidized plans. What sort of income will he have?

ACA, medicaid, and even medicare are subject to potential future changes depending on what the government (congress, etc) does in the future. We aren't allowed to discuss details of possible future changes here, but just be aware that any of those programs could change any number of ways in coming years.

Are you married? Is your spouse/family on board with having your dad become part of your local family? Sorry to state the obvious, but it's a long term commitment, and you don't know what the future holds for his health and needs.

Best wishes for figuring this out for your dad. I hope it works out for both of you. Just adding some food for thought.
cj
cashheavy18
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Re: Budgeting for new immigrant dad health care

Post by cashheavy18 »

clip651 wrote: Tue Feb 19, 2019 8:11 pm How will he be eligible for ACA? He will need to have income in the right range to be eligible for subsidized plans. What sort of income will he have?

ACA, medicaid, and even medicare are subject to potential future changes depending on what the government (congress, etc) does in the future. We aren't allowed to discuss details of possible future changes here, but just be aware that any of those programs could change any number of ways in coming years.

Are you married? Is your spouse/family on board with having your dad become part of your local family? Sorry to state the obvious, but it's a long term commitment, and you don't know what the future holds for his health and needs.

Best wishes for figuring this out for your dad. I hope it works out for both of you. Just adding some food for thought.
cj
Green card holders, without income in the US are eligible with NO subsidies.

For many cultures outside of the US, taking care of a parent is part of one's duty (as our parents took care of us in childhood and have helped in raising grandchildren as well). It is done, regardless of the hardship or sacrifice. It is certainly not easy, as we have experienced in our extended family. Even with the hardship, no one in the family would consider an alternate option.
clip651
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Re: Budgeting for new immigrant dad health care

Post by clip651 »

cashheavy18 wrote: Tue Feb 19, 2019 8:17 pm
clip651 wrote: Tue Feb 19, 2019 8:11 pm How will he be eligible for ACA? He will need to have income in the right range to be eligible for subsidized plans. What sort of income will he have?

ACA, medicaid, and even medicare are subject to potential future changes depending on what the government (congress, etc) does in the future. We aren't allowed to discuss details of possible future changes here, but just be aware that any of those programs could change any number of ways in coming years.

Are you married? Is your spouse/family on board with having your dad become part of your local family? Sorry to state the obvious, but it's a long term commitment, and you don't know what the future holds for his health and needs.

Best wishes for figuring this out for your dad. I hope it works out for both of you. Just adding some food for thought.
cj
Green card holders, without income in the US are eligible with NO subsidies.

For many cultures outside of the US, taking care of a parent is part of one's duty (as our parents took care of us in childhood and have helped in raising grandchildren as well). It is done, regardless of the hardship or sacrifice. It is certainly not easy, as we have experienced in our extended family. Even with the hardship, no one in the family would consider an alternate option.
Thank you cashheavy18, I wasn't aware of the ACA difference for green card holders.

Many of us born and raised in the US feel the same about taking care of parents, myself included, so I certainly understand. OP didn't say either way, so I was just suggesting considering this situation fully with family as part of the decision-making process, if s/he hadn't already done so. I didn't mean to suggest it is a bad idea or anything else negative. Just best to go into situations with eyes wide open, everyone on board, and an understanding of what may be ahead, as with any long term commitment.

cj
cashheavy18
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Re: Budgeting for new immigrant dad health care

Post by cashheavy18 »

clip651 wrote: Tue Feb 19, 2019 9:01 pm
cashheavy18 wrote: Tue Feb 19, 2019 8:17 pm
clip651 wrote: Tue Feb 19, 2019 8:11 pm How will he be eligible for ACA? He will need to have income in the right range to be eligible for subsidized plans. What sort of income will he have?

ACA, medicaid, and even medicare are subject to potential future changes depending on what the government (congress, etc) does in the future. We aren't allowed to discuss details of possible future changes here, but just be aware that any of those programs could change any number of ways in coming years.

Are you married? Is your spouse/family on board with having your dad become part of your local family? Sorry to state the obvious, but it's a long term commitment, and you don't know what the future holds for his health and needs.

Best wishes for figuring this out for your dad. I hope it works out for both of you. Just adding some food for thought.
cj
Green card holders, without income in the US are eligible with NO subsidies.

For many cultures outside of the US, taking care of a parent is part of one's duty (as our parents took care of us in childhood and have helped in raising grandchildren as well). It is done, regardless of the hardship or sacrifice. It is certainly not easy, as we have experienced in our extended family. Even with the hardship, no one in the family would consider an alternate option.
Thank you cashheavy18, I wasn't aware of the ACA difference for green card holders.

Many of us born and raised in the US feel the same about taking care of parents, myself included, so I certainly understand. OP didn't say either way, so I was just suggesting considering this situation fully with family as part of the decision-making process, if s/he hadn't already done so. I didn't mean to suggest it is a bad idea or anything else negative. Just best to go into situations with eyes wide open, everyone on board, and an understanding of what may be ahead, as with any long term commitment.

cj
cj - your response is a good reminder for me to realize that I shouldn't "read into" responses. Thank you for correctly pointing out that many cultures value the importance of taking care of their elders. You are also correct that it is best to go into it with considering all scenarios, it is a very long road to travel and at times feels like a thankless one to go down.
AlohaJoe
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Re: Budgeting for new immigrant dad health care

Post by AlohaJoe »

newseahorse wrote: Tue Feb 19, 2019 6:02 pm Sorry if this is naive - but doesn't the healthcare cost have some kind of upperbound like:

(higher end of life expectancy - current age)* (worst case ACA/Medicare premiums + worst case deductibles) ?
Add in exceeding lifetime limits, uncovered things (experimental treatments for dementia?, in house care?, dental?, physiotherapy after a fall? etc), payments for anything that isn't 100% covered (e.g. if the insurance pays 80% of all prescriptions and you have to pay 20%, what's the maximum you can pay?). Probably even more things if you're trying to count up some kind of theoretical upper limit.

I think that you can't set an upper limit. You can get quotes on current pricing and then just try to adjust to whatever happens in life over the next few decades and hope nothing too ruinous happens.
Topic Author
newseahorse
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Re: Budgeting for new immigrant dad health care

Post by newseahorse »

Yeah well aware of the ramifications here. Spouse is on board.
Topic Author
newseahorse
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Re: Budgeting for new immigrant dad health care

Post by newseahorse »

@alohajoe - thanks - these are exactly the kind of edge cases I was hoping to learn about. Since I am (relatively) young and an immigrant myself haven't tangled much with the medical machinery in the US.

One specific followup - so when you say "for anything that isn't 100% covered". I thought the uncovered portion will eventually hit the deductible/out of pocket maximum before it becomes 100% covered. That is not necessarily true I gather from your comment?

Let me make the conversation more concrete:
I plan to budget maybe $1 to $2k per month premium and $10k deductible. So ~$30k per year for many years to come.
If there are more outlier expenses I can cushion them for a few hundred thousand before putting a serious dent in my own FI plans.
If all of those thresholds are exceeded we figure out how to get cheaper medical care from our country of origin. But that would be super disruptive for the family with all the uprooting involved.
Last edited by newseahorse on Tue Feb 19, 2019 9:50 pm, edited 2 times in total.
AlohaJoe
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Re: Budgeting for new immigrant dad health care

Post by AlohaJoe »

newseahorse wrote: Tue Feb 19, 2019 9:39 pm One specific followup - so when you say "for anything that isn't 100% covered". I thought the uncovered portion will eventually hit the deductible/out of pocket maximum before it becomes 100% covered. That is not necessarily true I gather from your comment?
I haven't lived I'm the US for over a decade, so I am far from an expert. But I don't think there are necessarily any caps on things like co-insurance payments. And prescriptions and maybe some kinds of medical devices/equipment are often not covered by the out-of-pocket maximums.
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ram
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Re: Budgeting for new immigrant dad health care

Post by ram »

I do not know the answer to your question but I have some patients like your dad who get a lot of heath care in their country of birth where it tends to be cheaper. They use US healthcare only for emergencies (which still can be plenty costly). Many get prescriptions filled from overseas.
Ram
vsad
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Re: Budgeting for new immigrant dad health care

Post by vsad »

Would your father be your dependent on the tax returns or will he file his own returns ? If he has pension and it crosses the threshold then I am not sure if you can consider him as a dependent .
MrJones
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Re: Budgeting for new immigrant dad health care

Post by MrJones »

There seems to be a bit of fud here mixed with good advice and facts.

1. Co-insurance and co-pays eventually hit the out of pocket max beyond which you would pay neither. This works exactly as you'd think.

2. ACA did away with lifetime and annual limits on essential care, which covers pretty much everything.
https://www.hhs.gov/healthcare/about-th ... index.html

3. Health insurance in the ACA world covers almost everything that's medically needed. Yes, physiotherapy is included. Yes, with limits. Yes, the limits are typically reasonable and hard to hit. Of course this does not include certain types of optional experimental approaches or, more importantly, in-house care.

4. The biggest unmentioned concern is getting a plan with a good enough network containing a wide range of doctors located close to you. This is not too hard, but you may not have too many choices depending on the plans offered in your area. Going outside your network in a PPO or HSA plan is where the costs don't have a calculable upper bound.

OP, practically speaking, you can very well compute a maximum that's the premium plus costs until OOP max reach year. In practice, you're unlikely to exceed it, not counting things like in house care.

Good luck. Your dad is lucky to have you!
MrJones
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Re: Budgeting for new immigrant dad health care

Post by MrJones »

clip651 wrote: Tue Feb 19, 2019 9:01 pm Thank you cashheavy18, I wasn't aware of the ACA difference for green card holders.
This is not specific to green card holders. Any citizen or green card holder without income can choose to get an unsubsidized ACA plan. Citizens typically get Medicaid instead, or Medicare if they're old enough. Green card card holders are typically not eligible for the latter because they don't have work credits.
Topic Author
newseahorse
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Re: Budgeting for new immigrant dad health care

Post by newseahorse »

Would your father be your dependent on the tax returns or will he file his own returns ? If he has pension and it crosses the threshold then I am not sure if you can consider him as a dependent .
Yeah I am not sure either. Does being a tax dependent or not have bearing on the ACA front for him?



Unrelated - thank you MrJones for weeding out the FUD :)
simas
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Re: Budgeting for new immigrant dad health care

Post by simas »

Wait, I thought as part of sponsoring your parents (immediate relatives) you sign the affidavit of support guaranteeing that they will not be 'public charge' for 5 years. This makes your parents ineligible for Federal help (they may still get state assistance by state rules). Did this change with ACA??
Topic Author
newseahorse
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Re: Budgeting for new immigrant dad health care

Post by newseahorse »

Did this change with ACA??
https://www.healthcare.gov/immigrants/i ... on-status/

Does that answer your question?
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