Couple retires in Spain and lives comfortably on $2000 per month.

[AbbA]

Medicare is no bargain when you need expensive drugs. This coming year, my DW's OOP for her drugs will be over $15,000 and that doesn't include Part D plan premiums or Part B costs. Yes, Medicare is good, just don't get COPD or Cancer.

Between the two of us, with plan premiums and drug costs, we are looking at $22K OOP. (and I am healthy and take one med).

Holy cow!! Do all people get hit with such exorbitant costs when they're unfortunate to have cancer or COPD (sorry not sure what kind of disease this is)? I thought once one is on Medicare and buys a drug plan, they're good, but I never imagined that it takes $22k+/year. Or is this for people with very high income?

Sorry to hijack this threat, but I'm flabbergasted...

On the other note, MarketWatch seems to have a column about expats or something because just the other day I was reading about Americans living in Portugal:
https://www.marketwatch.com/story/i...-you-can-live-well-on-2000-a-month-2019-10-09

 

[Vacation4us]

COPD = chronic obstructive pulmonary disease

 

[aja8888]

Holy cow!! Do all people get hit with such exorbitant costs when they're unfortunate to have cancer or COPD (sorry not sure what kind of disease this is)? I thought once one is on Medicare and buys a drug plan, they're good, but I never imagined that it takes $22k+/year. Or is this for people with very high income?

[/url]

My wife requires a drug named Breo by Glaxo for her COPD. Drug plans show this drug's retail cost of ~$20,000/month. It's a "Tier III" drug under Medicare Part D and is not discounted very much. According to Texas Part D plans, we will be paying over $1,100/month (average) for that drug. Last year we paid about 1/4th of that cost.

Remember, when our illustrious government was looking out for us citizen's best interests.... but, for some reason, they did not negotiate drug pricing with drug companies when Medicare was started. In essence, doctors and hospitals have negotiated rates, but not drug companies.

 

[NW-Bound]

Denia does look like a small Spanish coastal town that is not touristy, despite being a ferry port to Ibiza. That does not mean it's bad. In fact, I would not be surprised if this quiet town has a much lower crime rate than in cities like Barcelona.

I have told this story before. As our Barcelona hotel was right on the famed La Rambla avenue, we took an early stroll one morning, and saw all the restaurants having their workers screwing in the bulbs to the strings of lights on their sidewalk patios. They had to go through this routine every night of removing the light bulbs because they would get stolen.

 

[brett]

Living in North America is great. But it certainly is not the ‘be all and end all’ of places to live, let alone retirement locations.

There are a numerous countries and locations that are equally as good. And, depending on one’s preferences, finances, and health may actually be better.

So it is no surprise to me that some retirees make the change. And more power to them for moving ahead with their lives and not being inhibited by the status quo or by what others may think.

 

[lordjust]

Our apartment is in the mountains of Washington state, not on the coast, although the coastal towns of Washington ARE really cheap. I am not talking about the Puget Sound but the actual Pacific Ocean coast. In Ocean Shores, Westport, or even that sparkly vampire area Forks.

On the east coast you can get a cheap apartment in the Florida panhandle in Carabelle or Apalachicola. Heck, we rented a 3 bedroom vacation home on a private lake 5 blocks from the beach for $1600 a month in Carabelle and that was vacation rental prices, not long term lease prices.

I am sure there are cities in Spain that have high rents just as there are places in the USA with high rents.

It has been shown that healthcare in the USA can be as cheap or cheaper than Spain.

So really it is all about where do you want to live, not so much about how this place is cheaper than that place. If you want to retire in the USA, there are plenty of areas where you can do it cheaper than most of the other first world countries.

Do you have a url or site that shows healthcare in the US is as cheap or cheaper? Very interested in this one.

 

[bmcgonig]

Gorgeous weather there that's for sure. I looked up the largest private health insurance provider and got a quote for someone my age, 63. Looks very thorough. More like a Cadillac plan on US? Makes little sense to compare it to anything free in MN or any other state. Only €158. There are cheaper plans.

https://www.healthplanspain.com/sanitas/sanitas-health-plans/sanitas-mas-90-plus.html

 

[Freedom56]

My wife requires a drug named Breo by Glaxo for her COPD. Drug plans show this drug's retail cost of ~$20,000/month. It's a "Tier III" drug under Medicare Part D and is not discounted very much. According to Texas Part D plans, we will be paying over $1,100/month (average) for that drug. Last year we paid about 1/4th of that cost.

Remember, when our illustrious government was looking out for us citizen's best interests.... but, for some reason, they did not negotiate drug pricing with drug companies when Medicare was started. In essence, doctors and hospitals have negotiated rates, but not drug companies.

You should call a Costco pharmacy in Canada to see what that drug costs. It may be worthwhile to fly/drive up there with the prescription and see a doctor in a walk-in clinic and get him/her to re-write the prescription and fill the prescription up there. You have some assurances that you are getting the proper medication by buying at Costco.

 

[Fermion]

I put in a quote for the Sanitas Mundi 1 million plan (which is acceptable for residency/visa) and for a single person age 51 the premium is 408.86 euro per month. So $456 a month roughly.


That actually IS pretty good but you can get cheaper insurance in the USA if you qualify for a subsidy, which it is likely that this couple would if their only income is $2000 a month.

 

[Fermion]

My wife requires a drug named Breo by Glaxo for her COPD. Drug plans show this drug's retail cost of ~$20,000/month. It's a "Tier III" drug under Medicare Part D and is not discounted very much. According to Texas Part D plans, we will be paying over $1,100/month (average) for that drug. Last year we paid about 1/4th of that cost.

I am very sorry your wife is having to pay so much for that drug, that is crazy!

When I looked up BREO (I trade biotech but had not really dug into this particular drug) there was a website called mybreo.com which seemed to indicate there are ways to qualify for the drug at a lower cost.

Specifically:

Read Full Requirements and Restrictions. For eligible commercially insured patients. Maximum savings $100/month.
Eligible commercially insured patients will pay as little as $10 per 30-day supply of BREO.
Eligible patients without insurance to cover the cost of their prescription will receive up to $100 in savings on each 30-day supply of BREO. You will be responsible for any remaining out-of-pocket cost.


Is it the case where you could get the drug cheaper before you turn 65 and then after 65 the drug gets more expensive? $100 a month doesn't sound like much saving on a drug that costs $20000 a year.

This is way off this topic I guess but it does seem to me like a person might be better off under the ACA than medicare, at least for drugs like this.

 

[Fermion]

I just looked at the 5 year stock chart for GSK (GlaxoSmithKline) and it does not look that great. Essentially it has gone nowhere in the last 5 years while stocks like Amazon, Microsoft, Google have been much better investments. Heck, even Boeing, with all its problems has done way better than GSK.

So who is making bank off this $20,000 a year drug?

 

[aja8888]

Is it the case where you could get the drug cheaper before you turn 65 and then after 65 the drug gets more expensive? $100 a month doesn't sound like much saving on a drug that costs $20000 a year.

This is way off this topic I guess but it does seem to me like a person might be better off under the ACA than medicare, at least for drugs like this.

DW is 74 and has been using Breo for 3 years now. Same drug plan under Part D. Last year, OOP on drugs for her was just under $4,000 not including the plan premium of $75/month. This year OOP automatically jump to ~$15,000 with the only cost difference is in Breo. Plain and simple, Glaxo is screwing older people who need this.

Based on being married and our income (which isn't much) , she doesn't qualify for much. if any, assistance on drugs.

Looks like Canada purchasing is our only real option here. I just have to get her doc to hand write the prescription. Interestingly, looking at a Canada pharmacy and adding this drug to the cart, shows it shipping to us from England where Glaxo has facilities.

 

[Freedom56]

DW is 74 and has been using Breo for 3 years now. Same drug plan under Part D. Last year, OOP on drugs for her was just under $4,000 not including the plan premium of $75/month. This year OOP automatically jump to ~$15,000 with the only cost difference is in Breo. Plain and simple, Glaxo is screwing older people who need this.

Based on being married and our income (which isn't much) , she doesn't qualify for much. if any, assistance on drugs.

Looks like Canada purchasing is our only real option here. I just have to get her doc to hand write the prescription. Interestingly, looking at a Canada pharmacy and adding this drug to the cart, shows it shipping to us from England where Glaxo has facilities.

My wife's OBGyn prescribed medication common to women over 50 that has been around for decades for menopause symptom relief. A one month supply through CVS Caremark of the brand name prescription was $394 per month out of pocket. We are on a bronze PPO with high deductibles so it would be 100% OOP. The generic version is $266 per month OOP. The quoted prices are from a Costco in Southern California. We bought a one year supply of the same medication (brand name) at a Costco in Canada for about $185 USD (after the exchange). We have traveled to Canada two years in a row and saved a bundle. I can see why people in the border states have been crossing over to Canada to buy their medication over the past decade. I don't mind spending money, but I would rather spend money on things that benefit us rather than greedy executives at pharmacy benefit managers or pharma companies.

 

[Fermion]

One would think that if it were pure greed, the stock would do better, as a greedy executive generally would lead to a well performing stock for investors.

Somewhere along the line the money is disappearing. Maybe lawsuits? I do know that the opiod lawsuits are siphoning billions out of the drug companies and have bankrupted at least one.

 

[Freedom56]

One would think that if it were pure greed, the stock would do better, as a greedy executive generally would lead to a well performing stock for investors.

Somewhere along the line the money is disappearing. Maybe lawsuits? I do know that the opiod lawsuits are siphoning billions out of the drug companies and have bankrupted at least one.

The pharmacy benefit managers such as CVS Caremark are the one's doing most of the mark-up. It's often cheaper for people to pay cash for their prescription drugs rather than use their insurance. This is where the lawsuit stands now:

https://www.sfchronicle.com/news/article/Appeals-court-reinstates-generic-drug-lawsuit-13977326.php'

 

[Sunset]

DW is 74 and has been using Breo for 3 years now. Same drug plan under Part D. Last year, OOP on drugs for her was just under $4,000 not including the plan premium of $75/month. This year OOP automatically jump to ~$15,000 with the only cost difference is in Breo. Plain and simple, Glaxo is screwing older people who need this.

Based on being married and our income (which isn't much) , she doesn't qualify for much. if any, assistance on drugs.

Looks like Canada purchasing is our only real option here. I just have to get her doc to hand write the prescription. Interestingly, looking at a Canada pharmacy and adding this drug to the cart, shows it shipping to us from England where Glaxo has facilities.

Have you checked goodRx.com , basically using a coupon from that site at your pharmacy and paying cash (not allowed to use insurance with coupon).

https://www.goodrx.com/breo-ellipta...dosage=60-blisters-of-200mcg-25mcg&quantity=1

 

[Offgrid Organic Farmer]

True but the quality of life here would suck.

I have lived in Europe [including owning a home], as a retiree I now live in the US. I feel that our Quality of Life is much better here stateside.

Wow, which village near Seattle has this kind of COL? I'd be curious to learn more about it. Replace some food with rice and it's $1k/mo. and it's for a couple too. No need to leave the greatest country in the world . WA doesn't have the same weather but one can adapt.
How can we pull a list of such super affordable places in the US?

Before I retired, I owned a home in Bremerton Washington. We found the COL in Washington to be fairly high.

After I retired when returned stateside and decided to settle in Maine. This is much more affordable for us.

Those can't be Seattle prices.

A lot more sun in Spain than in Washington State.

Also within a 1-2 hour flight to all of Europe.

A 2-hour flight from Seattle would put you in Europe?

I don't think so.

 

[Teacher Terry]

The poster was talking about Spain being a short flight for most of Europe.

 

[Offgrid Organic Farmer]

Holy cow!! Do all people get hit with such exorbitant costs when they're unfortunate to have cancer or COPD (sorry not sure what kind of disease this is)? I thought once one is on Medicare and buys a drug plan, they're good, but I never imagined that it takes $22k+/year. Or is this for people with very high income?

I have Prostate Cancer. The first year, for all the tests, biopsies, and robotic surgery to remove my prostate, my co-pay was $37.

Four years later, my cancer returned. I went through radiation treatments for a year, and I started hormone therapy. The co-pays for these have been $20 a quarter.

My hormone therapy uses 'Lupron' the market price for it is $6,000 for 6 months. My co-pay just for the shot is $12.

 

[aja8888]

Have you checked goodRx.com , basically using a coupon from that site at your pharmacy and paying cash (not allowed to use insurance with coupon).

https://www.goodrx.com/breo-ellipta...dosage=60-blisters-of-200mcg-25mcg&quantity=1

Yes and It's better than the Part D plan cost. But the Walmart she gets her drugs at does not take "coupons". That seems to be the trend around here. I'm sure if we shopped the coupon someone will take it. I like the Canada mail order route better as we could set up a monthly deal.

 

[Freedom56]

Yes and It's better than the Part D plan cost. But the Walmart she gets her drugs at does not take "coupons". That seems to be the trend around here. I'm sure if we shopped the coupon someone will take it. I like the Canada mail order route better as we could set up a monthly deal.

I personally would not go the Canada mail order route. Those mail order companies are not well regulated and you don't know the origin of the drugs. This is why we travel to Canada to get the prescription filled. The drugs are sourced in Canada when you buy at pharmacies in Canada. All the major pharma companies have manufacturing operations in Canada due to the tax incentives from the government. The fact that on-line Canadian pharmacies are sourcing drugs from outside Canada is a red flag.

This is a list of drugs GSK produces in Canada:

https://ca.gsk.com/en-ca/products/our-prescription-medicines-and-vaccines/

 

[aja8888]

I personally would not go the Canada mail order route. Those mail order companies are not well regulated and you don't know the origin of the drugs. This is why we travel to Canada to get the prescription filled. The drugs are sourced in Canada when you buy at pharmacies in Canada. All the major pharma companies have manufacturing operations in Canada due to the tax incentives from the government. The fact that on-line Canadian pharmacies are sourcing drugs from outside Canada is a red flag.

This is a list of drugs GSK produces in Canada:

https://ca.gsk.com/en-ca/products/our-prescription-medicines-and-vaccines/

Thanks!

 

[lordjust]

I put in a quote for the Sanitas Mundi 1 million plan (which is acceptable for residency/visa) and for a single person age 51 the premium is 408.86 euro per month. So $456 a month roughly.


That actually IS pretty good but you can get cheaper insurance in the USA if you qualify for a subsidy, which it is likely that this couple would if their only income is $2000 a month.

I would have to see the total cost of having the plan. The monthly premium isnt where the large cost is that I have run into. What was the plan's deductible?

I see quite a few people choosing to pursue healthcare in other countries which is why i asked what you found in the US that is similar cost. I started investigating cigna but didnt get to far into it. Not sure if we getting off topic here or to far into the weeds but i find it interesting for those that want to travel a lot or be an expat in another country.

https://www.cignaglobal.com/dvc-pdfs/GENERIC-48/en/200019 CGHO Sales brochure DTC EN Final.pdf

 

[Sunset]

Yes and It's better than the Part D plan cost. But the Walmart she gets her drugs at does not take "coupons". That seems to be the trend around here. I'm sure if we shopped the coupon someone will take it. I like the Canada mail order route better as we could set up a monthly deal.

Until you get the mail order set up, you could transfer your prescription to some pharmacy that does take coupons.

You could phone around asking for drug "x" what is the cost , and if I use Rx codes "zz" "yy" (that is what is on the coupon) what is the price ?

I know Costco takes it, (and you don't need a membership to buy prescriptions there).
Same with Sam's club. (although note, Sam's club does offer incredible drug discounts on about 600 drugs with their premium membership).

 

[bigreader]

If you plan to live long term outside the US, it might help to start with figuring out how to get legal residency in the place you want to call home. I say that because in a lot of countries in the EU, legal residents (not only citizens) are entitled to very good public health care. Initially, you will need to have a plan like this to get a visa, but you can drop it once you are a legal resident.

If you are not living abroad but just traveling, there are separate travel insurance programs (Cigna and others) that are a lot cheaper. Your US plan may also cover you in the case of an emergency. Of course, you are limited by the length of your travel visa and your appetite for filing foreign tax returns!
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