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Old 11-16-2015, 10:30 AM   #181
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Is there a healthcare plan that provides national healthcare network? It seems everything is turning into non PPO local care. We travel a good bit and wondered if there are supplemental policies or better policies I am missing?
Good post. Didn't really think about this until seeing your post.

Supplemental polices are big for Medicare covering stuff that Medicare does not. You'd think that since the trend is towards limited networks, there might be a business in covering the everything else part.
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Old 11-16-2015, 10:37 AM   #182
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Originally Posted by audreyh1 View Post
I sometimes hear people talking as if maintaining a healthy lifestyle will mean they don't get sick or need expensive medical attention.
Really? Where do you hear that talk? I always hear it as meaning reducing your risks of unnecessary illness & accidents: Regular vigorous activity, not smoking, controlling alcohol, not doing drugs, not using phone while driving, not speeding, using seat belts, controlling blood pressure & cholesterol, regular mammograms & prostate testing.
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Old 11-16-2015, 10:55 AM   #183
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Originally Posted by easysurfer View Post
Good post. Didn't really think about this until seeing your post.

Supplemental polices are big for Medicare covering stuff that Medicare does not. You'd think that since the trend is towards limited networks, there might be a business in covering the everything else part.
I just did a quick search to see if you could buy "balanced billing insurance", but didn't find anything. But it would seem that, and "out of network gap insurance" could be products.

Just for those interested in balanced billing risk, here's a paper on it, from June 2015: http://www.rwjf.org/content/dam/farm...015/rwjf420966

And here's a non-profit petition you can sign, purportedly to shake the list in the face of lawmakers, and maybe email you when a bill is up for vote in your state.
https://consumersunion.org/surprise-medical-bills/
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Old 11-16-2015, 12:25 PM   #184
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We may improve our outcomes by being healthier, but that doesn't mean we have control over our health or our medical costs.
I'm an actuary. I know about averages and standard deviations and I never claimed that living a healthy lifestyle was a 100% guarantee of lower medical costs- in fact, I wonder about my 42-year old former boss who runs 50-mile races, as well as another actuary who's been on a quest to run a marathon in every state.

But, to anyone who shrugs and says that a healthy lifestyle has little effect on healthcare costs, I'll make you a deal. Let's create a sub-group of insureds who are normal BMI, don't smoke, exercise moderation with alcohol, get a reasonable level of exercise and eat healthy most of the time. Let's put everyone else into another group. The insureds in each group are charged according to average costs in their group. Which one do you want to join?
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Old 11-16-2015, 12:37 PM   #185
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Originally Posted by bigcanoe View Post
Is there a healthcare plan that provides national healthcare network? It seems everything is turning into non PPO local care. We travel a good bit and wondered if there are supplemental policies or better policies I am missing?
Lots of plans do have national networks and if you are traveling you can use those providers. This isn't true for all plans. Some plans don't provide anything other than emergency coverage while traveling. This is something to look at on the specific plan you are interested in.
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Old 11-16-2015, 01:56 PM   #186
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Yet, you are retired and I assume that your current income is less than that when you were both working and the tax would have been much higher.
Yes, I have benefited from much lower taxes in my high income job while living in the USA.

In the UK we will be paying ~$9k in taxes on ~$81k income and that income is well above the median for the UK.

Let me answer your question from a UK perspective for a more typical wage earning tax payer. (no tax advantaged dividend or capital gains).

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To an American who longs for other countries' "free" healthcare, I will ask if they have looked to see how much their citizens pay in taxes. To a foreigner who says that their system is superior, I will ask if they know how much lower in taxes an American pays? There's never anything "free".
My sister and her husband live in the UK and the husband's income is from a job that I know brings in ~22,000. They have one child, aged 16, which gives them a tax credit of 924. His tax bill from my reckoning will be 1,356 (~$2,100).

My sister also works and earns ~17,000, her tax will be 1,280. (the only filing status in the UK is single, no MFJ or any thing else). That brings their total tax bill to $4,086 on a combined regular income of $60,450. (Median household income in 2013 was $31,617)
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Old 11-16-2015, 02:14 PM   #187
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The U.S. has lower income tax rates than many other developed countries, but taxes pay for many services besides healthcare. There are developed countries with some form of universal care with the same or lower overall income tax rates as the U.S., including New Zealand, Canada and Australia, per this analysis from the Tax Foundation based on data from the OECD (see the chart at the bottom of the article)

A Comparison of the Tax Burden on Labor in the OECD | Tax Foundation

U.K. income taxes are not much higher than U.S. income taxes.
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Old 11-16-2015, 02:42 PM   #188
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The U.S. has lower income tax rates than many other developed countries, but taxes pay for many services besides healthcare. There are developed countries with some form of universal care with the same or lower overall income tax rates as the U.S., including New Zealand, Canada and Australia, per this analysis from the Tax Foundation based on data from the OECD (see the chart at the bottom of the article)

A Comparison of the Tax Burden on Labor in the OECD | Tax Foundation

U.K. income taxes are not much higher than U.S. income taxes.
Great link, thanks. Last year while staying with my brother in Australia he was complaining like crazy about the high taxes there. I can see from this link that Australia is way down the list, below the UK and US.
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Old 11-16-2015, 05:46 PM   #189
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I would wonder how your insurance would cover tests ordered by your non-network doctor. Say you needed an MRI. Do you need to get an in network doctor to write a script for that?
I have a PPO. Worst case, he would refer me to a specialist (who charges insurance) who orders the MRI. This happened because my situation required a specialist's insight into my problem.

My most recent test (colonoscopy) he just set up the appointment for me and I went in. BCBS paid the bill, minus of course, their usual dickering over prices.

If insurance really, really got hung up on it, I could get myself an in-network PCP and use them for such things and still go to my pre-paid PCP for better care.

The whole point is to allow my PCP to spend as much time as he needs to work with me instead of the usual 15 minutes dictated by insurance.
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Old 11-16-2015, 06:01 PM   #190
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Bruce Bartlett did a comparison of tax rates among OECD countries that included state and local taxes and also health care costs. His conclusion is the US is still slightly less the OECD average, 36.4% vs 34.7%, all based on '08 data. The article can be seen here.
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As one can see, the burden of taxes plus private health care spending substantially equalizes the loss of disposable income in the United States and other countries, because we pay 8.6 percent of G.D.P. for health care over and above what the government pays, whereas those in other major countries pay an average of just 2.3 percent of G.D.P. out of their pockets.
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Old 11-17-2015, 01:12 AM   #191
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Yes, I have benefited from much lower taxes in my high income job while living in the USA.

In the UK we will be paying ~$9k in taxes on ~$81k income and that income is well above the median for the UK.

Let me answer your question from a UK perspective for a more typical wage earning tax payer. (no tax advantaged dividend or capital gains).



My sister and her husband live in the UK and the husband's income is from a job that I know brings in ~22,000. They have one child, aged 16, which gives them a tax credit of 924. His tax bill from my reckoning will be 1,356 (~$2,100).

My sister also works and earns ~17,000, her tax will be 1,280. (the only filing status in the UK is single, no MFJ or any thing else). That brings their total tax bill to $4,086 on a combined regular income of $60,450. (Median household income in 2013 was $31,617)

But IIRC there are very low property (or council) taxes...

Then again, there is a yearly TV tax... not sure what else is out there that could bite you....
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Old 11-17-2015, 08:13 AM   #192
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But IIRC there are very low property (or council) taxes...

Then again, there is a yearly TV tax... not sure what else is out there that could bite you....
Let's not forget the VAT tax system in England, which is paid in addition to any income tax. It is built in the purchase price of almost everything you buy.
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Old 11-17-2015, 08:22 AM   #193
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Originally Posted by MichaelB View Post
Bruce Bartlett did a comparison of tax rates among OECD countries that included state and local taxes and also health care costs. His conclusion is the US is still slightly less the OECD average, 36.4% vs 34.7%, all based on '08 data. The article can be seen here.
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As one can see, the burden of taxes plus private health care spending substantially equalizes the loss of disposable income in the United States and other countries, because we pay 8.6 percent of G.D.P. for health care over and above what the government pays, whereas those in other major countries pay an average of just 2.3 percent of G.D.P. out of their pockets.
That is interesting - I've wondered if the total burden was about the same.
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Old 11-17-2015, 08:45 AM   #194
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Let's not forget the VAT tax system in England, which is paid in addition to any income tax. It is built in the purchase price of almost everything you buy.

If done right and efficiently, I wouldn't be upset with a VAT to fund healthcare only. At least everyone is paying something for their "free health care". Even the bums who just like to drink and smoke will be pitching in some.


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Old 11-17-2015, 08:59 AM   #195
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But IIRC there are very low property (or council) taxes...

Then again, there is a yearly TV tax... not sure what else is out there that could bite you....
Yes, the council tax where we will be moving is much lower than for the equivalent where we live in Texas for the same value house.

The TV tax is trivial compared to the savings in property tax.

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Let's not forget the VAT tax system in England, which is paid in addition to any income tax. It is built in the purchase price of almost everything you buy.
We are fully aware of hidden costs as we did a trial run, renting and living in a house for 7 months, furnishing the house, paying all the council taxes, utilities etc. Some things are more expensive but some things are cheaper. Cell phones, internet services and bread are much cheaper in the UK for some reason.

As I said above we are not moving for financial reasons. The small town we are moving back to has strong family ties, our children were born there and baptized in the same church where my direct relatives have been baptized all the way back to the 17th century.

This is the thread I started on living there including the costs.
Long vacation in England

Back on topic, the reason I have been doing Roth conversions to the top of the 25% bracket is that the marginal tax rate in the UK for me will jump from 20% to 40% with RMD's. Fortunately the Dual Tax Agreement between the US and UK states that Roth conversions are taxable in the US only, but IRA distributions are taxable in the UK first so I should have all of my IRA money converted by age 70.
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Old 11-17-2015, 09:48 AM   #196
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Is there a healthcare plan that provides national healthcare network? It seems everything is turning into non PPO local care. We travel a good bit and wondered if there are supplemental policies or better policies I am missing?
It depends on what plans are available on-exchange and off-exchange in your area. See the post below for some possible options.
Question about insurance while travelling in US
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Old 11-17-2015, 10:25 AM   #197
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My Humana ACA plan is a National Access POS plan and as stated above, my wife's broken leg accident was in-network in DC (we live in Atlanta).

Kaiser also offers a national plan here, of course using their network. So they do exist on the exchange in some areas but I fear not for longer and/or they'll be way too expensive (ours went up 23% for 2016).
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