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Old 04-12-2012, 09:10 PM   #61
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It does, but it's non-HIPPA and it looks like you're ineligible for coverage or renewal if you're in the U.S. for more than six months per year. So it's probably not a good option for someone who expects to, or even might, return to the U.S.



I know I worry about developing a condition that makes me uninsurable outside my state. I'd like the option to live wherever I want, not where my health insurance policy is. I can't imagine putting myself in the postion where I couldnt return home to the U.S. if I wanted.
Thanks for digging deeper.

I would have the same concerns.
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Old 04-12-2012, 09:41 PM   #62
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What kind of policy and with which company did you get this evacuation coverage?

Typically, medical evacuation is with travel insurance policies.
I got the plan from this place: On Call International - Emergency Medical and Travel Assistance

They call it travel assistance, not travel insurance. I do not know if that is just wording or if there is some legal difference.

I believe it is for trips of 90 days and less, not for long term life as an ex-pat. It is just evacuation insurance, nothing for medical care, lost luggage, cancellation refunds, terrorist attacks, changes in romatic partners, etc.
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Old 04-13-2012, 03:50 AM   #63
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Not sure I understand your comment about HIPAA (you mean HIPAA, not HIPPA, correct ?). Why wouldn't your care in the US covered by HIPAA laws and regulations ?

Why wouldn't this coverage be appropriate for someone who wishes to return to the US full time at say age 60 or 65?

Sorry, just trying to understand your comments.

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It does, but it's non-HIPPA and it looks like you're ineligible for coverage or renewal if you're in the U.S. for more than six months per year. So it's probably not a good option for someone who expects to, or even might, return to the U.S.



I know I worry about developing a condition that makes me uninsurable outside my state. I'd like the option to live wherever I want, not where my health insurance policy is. I can't imagine putting myself in the postion where I couldnt return home to the U.S. if I wanted.
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Old 04-13-2012, 08:01 AM   #64
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I got the plan from this place: On Call International - Emergency Medical and Travel Assistance

They call it travel assistance, not travel insurance. I do not know if that is just wording or if there is some legal difference.

I believe it is for trips of 90 days and less, not for long term life as an ex-pat. It is just evacuation insurance, nothing for medical care, lost luggage, cancellation refunds, terrorist attacks, changes in romatic partners, etc.
Our World Nomads policy had that as part of the coverage. I wanted to have the medical as well, because, well, there are a ton of places we've been and are probably going that you couldn't get evacuated out of unless you were important enough to have a Blackhawk touch down and snatch you out of there!
But I can say that I spent a mind-numbing few days researching policies and finally just gave in to what most backpacker/budget travelers use rather than the bells and whistles favored by many Americans traveling short-term.
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Old 04-13-2012, 08:45 AM   #65
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Why wouldn't this coverage be appropriate for someone who wishes to return to the US full time at say age 60 or 65?

Sorry, just trying to understand your comments.
I'd never say this insurance isn't appropriate for anyone. There are plenty of people who this might just work fine for. But for U.S. citizens the eligibility and rewewal requirements should be carefully considered and disclosed.

With this insurance, if I develop an expensive chronic medical condition, I'm effectively prevented from permanently returning to the US without losing my health insurance. That's a big deal. At least it is to me.

It might be less of a problem for someone a couple years away from Medicare eligibility. I'm 25 years away, and quite likely more. But even if I were 55, I think I'd want to preserve the option of coming back home if I choose.

People change their minds and situations change, sometimes surprisingly quickly. A younger me never dreamed I'd be living the life I am now. I have no idea what I'll be doing five or ten years down the road. The last thing I want to do is make a choice that potentially limits those future options. That doesn't mean this insurance isn't right for anyone. It's just not right for me.
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Old 04-13-2012, 09:45 AM   #66
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I'd never say this insurance isn't appropriate for anyone. There are plenty of people who this might just work fine for. But for U.S. citizens the eligibility and rewewal requirements should be carefully considered and disclosed.

With this insurance, if I develop an expensive chronic medical condition, I'm effectively prevented from permanently returning to the US without losing my health insurance. That's a big deal. At least it is to me.

It might be less of a problem for someone a couple years away from Medicare eligibility. I'm 25 years away, and quite likely more. But even if I were 55, I think I'd want to preserve the option of coming back home if I choose.

People change their minds and situations change, sometimes surprisingly quickly. A younger me never dreamed I'd be living the life I am now. I have no idea what I'll be doing five or ten years down the road. The last thing I want to do is make a choice that potentially limits those future options. That doesn't mean this insurance isn't right for anyone. It's just not right for me.
I agree with this. The thought of being seriously ill, in another country, and not being able to come "home", is a total freak-out for me. I'm okay with dealing with acute situations (I think), but I keep remembering that girl on the Mototaxi Junket who wound up with an emergency appendectomy in Pisco (a fairly small city south of Lima, Peru). You think she didn't want to get home ASAP after that? Whew!
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Old 04-13-2012, 10:24 AM   #67
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When living abroad, you're probably going to make acquaintance with a couple lawyers and learn about their healthcare system in the first few months. Not too much different than the states. Then find a GP who can help you through the process of the possibility of a major problem.

We also have a hospital liason group in our area who assist in many ways free to the congregations here in our religious organization.

Also the out of pocket costs are minimal and the health insurance is very reasonable if you go that way.
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Old 04-13-2012, 10:42 AM   #68
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When living abroad, you're probably going to make acquaintance with a couple lawyers and learn about their healthcare system in the first few months. Not too much different than the states. Then find a GP who can help you through the process of the possibility of a major problem.
Sure. Some people effectively relocate overseas, building a network of friends and acquaintances. For them, home is abroad. If they get sick, they have their support network on hand, a relationship with a GP, and fluency in the local language. The insurance described sounds perfect for them (although I'd still be wary of giving up my option to return to the US with health insurance).

For others, like me, "abroad" means travel; sampling different regions, countries and cultures. If we settle anywhere for any length of time we don't intend it to be permanent. Our friends and family remains in our home country. If either one of us gets seriously ill, we'll be back to the U.S. as soon as we're able to fly because that is where our support network resides. Maybe we could change that with time, but that is a hard thing to do and one best not planned on in advance.
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Old 04-13-2012, 12:16 PM   #69
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We were looking for a shorter period like ~2 weeks but the best deals seemed to be for 4 adults in an apartment. So maybe best for 2 compatible couples. I think occasionally a new listing will pop up and be grabbed if it's really a good price.

We would up just staying in a hotel in the Rue Cler for 115 Euros/night.
We did Rue Cler for 2 nights, then (after my bucket list trip to Normandy) returned to Marais for a condo with another couple for a week. It was VRBO and worked fine: owned by a couple from Irleand and totally remodelled about 5 years ago.

Then we did VRBO again in Nice with the same couple after we separated to see different parts of France.
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Old 04-14-2012, 06:37 AM   #70
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Hello Gone4Good. I understand your concern, but please could you let me know what about IMG worldwide coverage (e.g. US included) makes you believe that if you develop an expensive chronic medical condition, you are effectively prevented from permanently returning to the US ? There is no discontinuity of coverage as far as I am aware (as long as you continue to pay your annual premiums).
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With this insurance, if I develop an expensive chronic medical condition, I'm effectively prevented from permanently returning to the US without losing my health insurance. That's a big deal. At least it is to me.
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Old 04-14-2012, 08:31 AM   #71
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Hello Gone4Good. I understand your concern, but please could you let me know what about IMG worldwide coverage (e.g. US included) makes you believe that if you develop an expensive chronic medical condition, you are effectively prevented from permanently returning to the the US ? There is no discontinuity of coverage as far as I am aware (as long as you continue to pay your annual premiums).
You're only eligible for coverage and for renewal of coverage if you spend six months or more out of the US every year. That pretty much prevents you from permanently returning to the US and keeping your IMG insurance. That is true regardless of whether you're sick or healthy, but is obviously a bigger issue if you're sick.

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Eligibility: U.S. citizens must reside abroad or plan to leave the U.S. on their effective date and plan to reside abroad for at least six of the next 12 months.

Renewal of Coverage: You must continue to meet the eligibility requirements outlined above in order to renew.
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Old 04-14-2012, 08:54 AM   #72
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Sorry I was not clear. Someone in his/her 40s could theoretically travel 6 months a year until the age of 65, pay annual his/her IMG premiums for coverage (i.e. to cover diabetes type 2 treatment for example starting in his/her 50s) and return to the US permanently when Medicare starts. Correct ?
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You're only eligible for coverage and for renewal of coverage if you spend six months or more out of the US every year. That pretty much prevents you from permanently returning to the US and keeping your IMG insurance. That is true regardless of whether you're sick or healthy, but is obviously a bigger issue if you're sick.
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Old 04-14-2012, 09:20 AM   #73
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Sorry I was not clear. Someone in his/her 40s could theoretically travel 6 months a year until the age of 65, pay annual his/her IMG premiums for coverage (i.e. to cover diabetes type 2 treatment for example starting in his/her 50s) and return to the US permanently when Medicare starts. Correct ?
Yes, of course they could.

Once they've decided to go that route, our 40 year old may discover within the next two and one half decades:

1) Medicare eligibility has been dramatically altered
2) He can no longer afford to travel six months of every year
3) He's become too sick to travel six months of every year
4) His mother has become very ill and he wants to be home to take care of her
5) He's met a girl who wants to settle down in the states
6) He just doesn't feel like traveling any more

Now it's certainly reasonable that our 40 year old would consider everything that could potentially go wrong with his plan, and decide that they're all low probability events that are worth risking. Terrific! Bon voyage! My point isn't that it's impossible for a U.S. citizen to make an IMG policy work, it's just that it has specific risks that are worth considering.
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Old 04-14-2012, 09:58 AM   #74
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Maybe I missed it in this thread, does Medicare + a Medicare Advantage program generally give you some overseas coverage on short trips -- maybe up to 1 month?
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Old 04-14-2012, 05:50 PM   #75
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Perfect. We agree.

We could also envision a situation where the 40 year old would travel abroad 6 months a year for say 10 years, then buy a good healthcare coverage from UH, BCBS, etc to make sure there is continuity of insurance, then wait for Medicare to kick in.

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Yes, of course they could.
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Old 04-14-2012, 06:13 PM   #76
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For others, like me, "abroad" means travel; sampling different regions, countries and cultures. If we settle anywhere for any length of time we don't intend it to be permanent. Our friends and family remains in our home country. If either one of us gets seriously ill, we'll be back to the U.S. as soon as we're able to fly because that is where our support network resides. Maybe we could change that with time, but that is a hard thing to do and one best not planned on in advance.
+1 If we were seriously ill, we would want to get back to US as soon as possible and have our loved ones with us.

Also, the 40 year old could go overseas and come back at say age 50, and get health insurance until Medicare, but heaven help them, if they have developed any major health problems. They will be paying through the nose for health insurance and might not be able to get it for the pre-existing conditions. I would never give up my US health care insurance either!
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Old 04-14-2012, 06:52 PM   #77
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Well we should know later this year how the Supreme Court rules and whether the pre-existing condition exclusion survives or not. But who knows what would happen to the individual insurance market in that case.

FWIW, Duval Patrick, the MA governor, said Romneycare had expanded coverage and while premiums are higher than many states, they were higher before this law and now, premiums and costs are going up slower in MA than in other states.
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Old 04-15-2012, 01:41 AM   #78
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Hello Dreamer
Not sure what you mean with "...but heaven help them, if they have developed any major health problems. They will be paying through the nose for health insurance and might not be able to get it for the pre-existing conditions." Let's take an example : a 47 year old early retired guy can go overseas 6 months a year, get IMG worldwide coverage for $150 a month, makes sure he pays his annual premiums to have continuity of insurance. He gets throat cancer at age 52 but survives. Age 53, he decides to stay in the US full time to take care of his mother. He decides to get coverage from United Healthcare now - he can still do it, even with a higher premium, correct ?

Now what difference would there be with another 47 year old early retired guy living in the US, buys United healthcare coverage for $240 / month, makes sure he pays his annual premiums to have continuity of coverage. He gets throat cancer at age 52 but survives. Age 53, he would still have to pay a higher premium even if he had stayed in the US full time, correct?

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Also, the 40 year old could go overseas and come back at say age 50, and get health insurance until Medicare, but heaven help them, if they have developed any major health problems. They will be paying through the nose for health insurance and might not be able to get it for the pre-existing conditions. I would never give up my US health care insurance either!
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Old 04-15-2012, 07:52 AM   #79
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Age 53, he decides to stay in the US full time to take care of his mother. He decides to get coverage from United Healthcare now - he can still do it, even with a higher premium, correct ?

Now what difference would there be with another 47 year old early retired guy living in the US, buys United healthcare coverage for $240 / month, makes sure he pays his annual premiums to have continuity of coverage. He gets throat cancer at age 52 but survives. Age 53, he would still have to pay a higher premium even if he had stayed in the US full time, correct?
This doesn't sound right to me. Mostly it depends on which state he resides in.

In some states he may not be able to get insurance at all when he comes back after an illness, in others he may be able to get coverage in a very high cost risk pool (although I know TX requires you to be a resident of the state for 3 years before you can get risk pool insurance), in others he may be able to get insurance at "guaranteed issue" rates but without coverage for his pre-existing conditions, and elsewhere he might get guaranteed issue coverage with only a limited exclusion for his pre-existing condition. So it depends.

If he keeps his US insurance, he doesn't have to worry about not having his medical conditions covered or paying a dramatically higher price for coverage. I think in all 50 states (or at least everyone I'm aware of) insurers can't raise your premiums because you get sick. But many can charge different rates, or deny coverage altogether, for new applicants. So your hypothetical person would likely pay significantly more for insurance having left the US market then if he had stayed insured.

On the other hand, if he lives in a high cost "guaranteed issue" state IMG probably makes a lot of sense, although I'd still want to dig into the details of how pre-existing conditions get treated.
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Old 04-15-2012, 08:10 AM   #80
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OBY @ G4G, I think one piece of info missing is if the IMG policy is considered individual or group coverage. If it is group, when the insured returns permanently to the US he/she is entitled (by regulation) to a conversion type policy. If IMG is considered individual coverage, the insured will be subject to underwriting and individual state regulations, which we already know are of little help. The key is not returning to the US with proof of coverage but instead proof of group coverage.
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