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Continuous US health coverage while overseas?
Old 01-30-2007, 04:49 PM   #1
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Continuous US health coverage while overseas?

I will probably be semi-FIREing soon at age 41 (single). My plan the first year is to do some relaxing, spend time with family, do a couple of extensive international trips, and get trained for my next career. That second career may be teaching English overseas. I am figuring to teach for at least two of my first five years of FIRE. I am not sure how things will turn out, but right now I do not intend to do it permanently. I have always wanted to try out living overseas, and by doing it for 2 years out of my first 5 years of semi-retirement it gets my withdrawal rate below 2% for my first 5 years of semi-retirement.

So this would mean a semi-FIRE in 2007 and an overseas deployment in 2008 timeframe. The overseas deployment of two to three years duration would probably be mostly continuous but there may be several month gaps so that I can come back to the US to visit family, friends, etc. When I come back to live more permanently in the states, I may come back to live in a different state than where I will be living before all this takes place (Southern California).

My plan is to go on COBRA immediately after I quit my job (~$400/month). Then I would do one of two things: 1) find a high deductible US health policy ASAP and drop COBRA or 2) stay on COBRA. My COBRA lasts for 3 years because I am in California (Cal-COBRA program). My COBRA is not international (30 days overseas limit). So the policy does not fit me very well. Also, it includes dental and eye check coverage, which I would rather get done overseas or in Mexico (I just want the core health insurance part). I am getting a physical soon but as far as I know I am healthy. Also, the US coverage is really only regional (Kaiser).

On any deployment overseas, I would have local health insurance coverage and I will be researching just how good it really is (varies by country, this will be one of my criteria for choosing a country). But if I like some place and the coverage is decent, I would rather drop my US coverage for that time since I will be covered overseas. Then when I visit the US, I can buy emergency health coverage (basically travel health insurance which is around $100/month) -- I would return to my overseas base if I got more seriously ill. In most countries where I would be teaching, I would buy one of their private health plans, which are typically much less expensive than the US.

But eventually I would want to return home to the US for good in a few years (probably). This would mean reapplying for US health insurance, say at age 45 or 46.

I know there is some risk to this plan because of pre-existing conditions (e.g., develop diabetes in a couple of years on an overseas deployment). My backup plan if I could only get US coverage at a very high cost would be to live in Mexico, a place that I enjoy and am somewhat familiar with (language, culture, etc.).

Can anyone comment on the idea of "continuous coverage" in this context. I would be able to show continuous coverage, just not all of it in the US. How important is continuous coverage?

My initial take on this is that if I am on COBRA, which is expensive (and covers more than I would like), then I would drop it once I am established overseas rather than pay $5K/year plus co-pays and not really be covered overseas anyway. But if I got a cheaper high deductible US-based plan, health coverage only (not dental/eye), then I would probably keep it throughout my "deployments." And anything that I paid cash for overseas could go for the deductible. Or should I buy international coverage from some place like BUPA in Thailand?

Kramer
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Re: Continuous US health coverage while overseas?
Old 01-31-2007, 07:31 PM   #2
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Re: Continuous US health coverage while overseas?

Hi Kramer,

If you drop coverage in the USA and carry private insurance abroad, that coverage will not count as creditable continuous coverage when you come back. No matter what you do, you will face the possibility of have a pre-existing condition issue should you develop one prior to coming back to the USA.

If you are worried about that, then what I would do is pickup a high deductible major medical plan in the USA (maybe a 5000 deductible HSA plan) now. I would just keep that plan in place while you are travelling abroad. If you do one with Anthem BCBS, Anthem offers international coverage on all of their healthplans, so you wouldn't necessarily need to purchase supplemental travel coverage. Here is the link to Anthem's worldwide coverage information:

http://www.bcbs.com/coverage/types/

You would get this coverage as part of any Blue Cross Individual plan that you purchase in the USA.

I hope this info. helps.

MKLD
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Re: Continuous US health coverage while overseas?
Old 01-31-2007, 09:44 PM   #3
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Re: Continuous US health coverage while overseas?

on similar track, though after i spend time exploring this continent, i'm considering spending either a few months overseas or even years if i take to it. but i think i've decided i'll keep my u.s. private insurance which pays 75% out of network. i might raise the deductible when out of country, especially if i wind up in southeast asia where, i've read, medical care is pretty reasonably priced.

i was very glad to drop cobra and had i given it better thought earlier on i never would have kept cobra for as long as i did because of the possiblities of developing pre-existing conditions as you mention.

the last thing i would consider doing before securing private health insurance would be to get a full physical. who knows what they'll find. (i'm sorry to inform you that we found a tumor that won't kill you until you are 105 years old, only now you can't get coverage for any tumors ever again.) in fact, i wouldn't go to the doctor for even a rash on my bottom until i've been covered by this new plan for at least 6 months. i've been continually covered my entire life yet i'd be afraid to make use of this plan until it is in full effect. i might be a bit paranoid in this, but at least i think i'm safe.
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Re: Continuous US health coverage while overseas?
Old 01-31-2007, 11:12 PM   #4
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Re: Continuous US health coverage while overseas?

Hello group nice to meet everyone. Great forum.

I am also interested in health coverage after ER to do some long term traveling.

I have checked into individual plans and the premiums will differ from state to state but from what I understand every state requires you to be a resident of that state to get coverage.

New Jersey a guarantee issue state will get you a policy regardless of health conditions but a resident must reside 6 months out of the year in NJ.

Florida will write an individual plan (if you qualify) but you need to be a Florida resident (whatever the state defines residency as).
In non guarantee issue states like Florida, if you have prexisting conditions its probably necessary to stay on Cobra for 18 months then get Hippa at about twice the cost. (But the only option).

New Mexico and Texas offer risk pools but again you must be a resident of the state and residency should have a definition.

So for those that may be outside the US for an extended period of time, Do you plan on keeping a physical residency in the US? Will you use your aunts address?
Or a mail forwarding company?
In any case it may be important to find out from the insurance company what exactly they require as residency.
We dont need to file a claim against our state side insurance to find out our policy is invalid because we did not meet residency requirements.

Being out of the US for a couple of years may mean filing Federal Tax as one who is residing outside the US. That will contridict state residency.

From what I understand Cobra does not require residency.

Anyone have any ideas?


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Re: Continuous US health coverage while overseas?
Old 02-01-2007, 12:29 PM   #5
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Re: Continuous US health coverage while overseas?

Thanks, knowing that foreign coverage does not count as continuous coverage for USA health insurance purposes is helpful. Outside of the issue of pre-existing conditions, it is not clear to me how important continuous domestic coverage is. For instance, I know for car insurance, you get dinged if you have not had continuous coverage, and this is independent of any accidents you might have had.

I do like the idea of a high deductible HSA that I can also use overseas. I will definitely research this this weekend.

I need to get the physical because I have neglected getting fully checked for so long. It is just something that can't wait until I switch. This is something, along with establishing better credit, that I should not have put off close to ER (so that is advice for other posters ER'ing soon).

I was also wondering what Tommy asked, about residency requirements. For instance, when I return to the US, I may not be living in California. So I would want something that would cover me in another state, and would like to consider that possibility when first purchasing a high deductible HSA plan. I am not sure if buying a certain health insurance policy nowadays makes you a prisoner of a certain state for residency purposes.

Quote:
Being out of the US for a couple of years may mean filing Federal Tax as one who is residing outside the US. That will contridict state residency.
Agreed. Yes, I would be filing with a foreign address.

Kramer
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Re: Continuous US health coverage while overseas?
Old 02-01-2007, 02:47 PM   #6
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Re: Continuous US health coverage while overseas?

Quote:
Originally Posted by kramer

I am not sure if buying a certain health insurance policy nowadays makes you a prisoner of a certain state for residency purposes.




Agreed. Yes, I would be filing with a foreign address.

Kramer
When the policy is purchased in Califormia the details of where it is valid can be explained. Usually HMO's are limited to the same state. PPO's have doctors throughout the US. HSA's probably have out of state provisions.

My question to the insurance company in addition to where am I covered? would be what is the criteria to keep the policy valid after I am approved? beside making payments.

They may require California residency to be maintained which may mean you need to be in California X months a year. If one is outside the US for 2 years they cannot be in their home state at the same time.
An apartment can be maintained but then there is the expense.
A friends address is used probably OK to receive any mail they will send. Even a Mail Boxes etc should be OK for mail. But in any case there may be an issue with state income tax.

If Federal Income tax is filed as living outside the US then we do not need to pay state taxes since we are not living there.

But the insurance company may have a problem with that.

They may never know unless they look at the stamps on your passport or ask to see your tax returns but we dont need to be overseas come back to the US for medical care and find out they wont pay because we were not a state resident the past 2 years, if residency is required to maintain the policy.

I would ask all questions up front upon approval of the policy.
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Re: Continuous US health coverage while overseas?
Old 02-01-2007, 03:07 PM   #7
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Re: Continuous US health coverage while overseas?

If you teach English abroad through a US contractor they may offer a health insurance policy with both US and foreign coverage. Explore that.
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Re: Continuous US health coverage while overseas?
Old 02-01-2007, 03:33 PM   #8
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Re: Continuous US health coverage while overseas?

Quote:
Originally Posted by Brat
If you teach English abroad through a US contractor they may offer a health insurance policy with both US and foreign coverage. Explore that.
Hello Brat, Actually, very few of these jobs are structured like that. Also, my understanding is that if the company you work for is incorporated in the US, you also pay FICA taxes. Ouch.

But my situation would almost certainly be working for a foreign entity.

I thought of one other issue. Let's say you do a 2 year teaching gig in Korea. Well, if the employer is providing insurance (which is how it works there, they are providing access to public health system under your work permit), then when your contract is up you are not really covered (contracts are usually one year in length). Other places, like Thailand, revoke your work permit 7 days after you lose your job (of course, in Thailand you would probably have private insurance so you could come back as a tourist for treatment).

It does seem like the safest approach is to have catastrophic/HSA type coverage in the US, as long as it is priced reasonably. Or to have some kind of international coverage not tied to your job. Thailand has some good policies like that. Being familiar enough with the system in your health insurance home to feel comfortable with it is definitely a FIRE skill.

Tommy, yeah I can see that this will take some research as far as residency issues. It is harder when you are not sure when/where you will be doing this.

Kramer
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Re: Continuous US health coverage while overseas?
Old 02-01-2007, 04:28 PM   #9
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Re: Continuous US health coverage while overseas?

Quote:
Originally Posted by Tommy
In any case it may be important to find out from the insurance company what exactly they require as residency.
when i was being sold my policy i specifically said that i intended to do extended travel in my retirement. the salesguy said that wouldn't be a problem because i would be covered 75% out of network after deductible.

but now that you ask this question i wonder if either i wasn't bamboozled or if maybe the sales guy thought extended vacation meant two weeks away.

good point too on what happens when you move. i never thought to question whether my insurance would move with me. just assumed it would.

guess i should read my policy more closely huh?
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Re: Continuous US health coverage while overseas?
Old 02-01-2007, 04:53 PM   #10
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Re: Continuous US health coverage while overseas?

I will be sure to report any of my findings in glorious detail on this board

My current HMO, Kaiser, allows you to be out of state 6 months but within the US for 6 months to be covered for emergency care at non-Kaiser facilities. I am not sure whether this is continuous (i.e., whether it is 6 months out of any year as opposed to continuous absence).

My dad had emergency end of life care last year while out of state and out of Kaiser system (he was on Kaiser Medicare), and Kaiser is now simply billing my mom for what the emergency room doctors and surgeon at their out-of-state location billed that was above Kaiser standard rates. They want my mom to pay 100% of the difference. I am not sure about the status of this right now. My sister is a nurse and it happened in their local emergency room and she was handling the details.

Also, Kaiser covers you for 30 days out of country for emergency care, and then you are on your own.

So that coverage does not fit me very well.

Kramer
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Re: Continuous US health coverage while overseas?
Old 02-03-2007, 09:26 PM   #11
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Re: Continuous US health coverage while overseas?

Quote:
Originally Posted by kramer
My dad had emergency end of life care last year while out of state and out of Kaiser system (he was on Kaiser Medicare), and Kaiser is now simply billing my mom for what the emergency room doctors and surgeon at their out-of-state location billed that was above Kaiser standard rates. They want my mom to pay 100% of the difference. I am not sure about the status of this right now. My sister is a nurse and it happened in their local emergency room and she was handling the details.
Treatment and stabilization at an emergency room should always be covered as if in-network. I would fight that claim if Kaiser isn't paying for the ER treatment as "in-network". If he was then hospitalized in the same out of network facility, the hospital does have the right to "balance bill" above what Kaiser is willing to pay (what they pay for in-network services). But the ER bills should be treated as "in-network".
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Re: Continuous US health coverage while overseas?
Old 02-03-2007, 10:19 PM   #12
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Re: Continuous US health coverage while overseas?

I agree I would fight it if the only reason for non-payment is that your father utilized out of area emergency care. Even when there is a Kaiser facility in the community emergency care until the patient can be stabilized and moved has always been covered, in my experience.

If the policy is through employment the determination my be subject to arbitration.
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Re: Continuous US health coverage while overseas?
Old 02-05-2007, 12:10 AM   #13
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Re: Continuous US health coverage while overseas?

Quote:
Originally Posted by mykidslovedogs
Treatment and stabilization at an emergency room should always be covered as if in-network. I would fight that claim if Kaiser isn't paying for the ER treatment as "in-network". If he was then hospitalized in the same out of network facility, the hospital does have the right to "balance bill" above what Kaiser is willing to pay (what they pay for in-network services). But the ER bills should be treated as "in-network".
That is it, they are "balance billing," I guess. My dad had emergency surgery there. He could not be moved to a Kaiser facility several states away as the doctors at the out of state hospital said he needed surgery quickly. From entrance to when he died was probably about two full days. He was covered by Kaiser (on the Kaiser medicare plan) because they say you can be out of state for 6 months. Now, the hospital is saying that Kaiser's payments are insufficient to cover their higher fees.

Kramer
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Re: Continuous US health coverage while overseas?
Old 02-05-2007, 11:34 AM   #14
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Re: Continuous US health coverage while overseas?

Ah, your fight is with the hospital that treated him.
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