Interesting idea to beat crazy health care premiums

[nun]

It sounds like a great plan B option.

My plan B is to establish our primary residence in Europe (instead of Mexico), but the same principle applies.

That's my plan B as well. But as a UK citizen after Brexit, mainland Europe could be difficult soon. I still have the UK and Ireland though and even if Scotland becomes independent the policy of the SNP is to allow all UK passport holders to live in Scotland.

However, I get MA state retiree healthcare and that's still a really good deal.

 

[NW-Bound]

If I were the OP, I'd be thinking about self-insurance. One concern the self-insured have is not having access to negotiated rates for medical care (i.e., paying the 'rack rate'). What's interesting about the STM plan I purchased for 2017 is that the underwriter (National General) and the network provider (Aetna) are different companies. Why couldn't a person interested in self-insuring become the underwriter and pay Aetna a fee to access its network (not necessarily 'as needed', could be a monthly or annual fee)? This access fee should be relatively small: you're paying Aetna for the administrative costs associated with establishing and maintaining its network of medical providers, and that's all. I like this! Of course, the gov't may be displeased.

There are all kinds of things that make sense, but just will not happen. Of course, there should not be any haggling at all, and you should get the same price as the insurance without having to pay a Mafia-like protection fee.

I had a life-threatening disease (I am OK now), and the total bill came to a bit less than $200K for two major surgeries, two minor surgeries, and many procedures, CAT scans, etc...

For $200K, I can self-insure, but would not get that rate on my own.

 

[Fedup]

Unless you're going to be a college student, getting a Visa to live permanently in Europe is very, very difficult.

The Schengen Agreement limits Americans to staying in most of the EU no more than 90 days out of every 180 days. You essentially have to leave every 3 months and cannot return for 3 months.

I think they were trying to keep Americans out of their healthcare system. Property values are already high enough in most of Europe without having us Yankees move in and drive prices even higher.

Our niece married a Belgian and lived in a very high income suburb of London. They discovered she had uterine cancer and received very conservative treatment under the National Healthcare System. We buried her 18 months later in Memphis. Had she come home for treatment, we still believe the outcome may have been different.

I'm sorry about your niece, but this doesn't sound good. Especially the part that you wrote the outcome may have been different.

 

[NW-Bound]

Speaking of healthcare quality, what I got from the local medical organizations here was excellent. I had very little to complain about. And I really mean it. It only cost money!

I am sure people can tell of horrible treatments elsewhere in the US. And I went on the Web, and found stories of terrible conditions in other developed countries too. And these stories were written in their local newspapers, so it is not some foreigners bad-mouthing them.

What is the truth? I think there is no uniformity in healthcare quality in any country. Just the luck of the draw.

 

[samclem]

Women also die from uterine cancer in the U.S. It is probably more helpful for comparison sake to look at overall statistics by large organizations for country comparisons than to go by anecdotal observations:

It's probably more helpful yet if the study/statistics are relevant to the case at hand. In the linked study, the WHO and the OECD marked down the US for having inefficient care (duh--we know that), for having poor "equity" (i.e. some people get better care), as well as something they called "healthy lives," and other categories that deal with overall cost and social goals of the HC systems, not whether sick people who have access tocare in each system (which would appear to have been Bamaman's niece's situation) would be more likely to have positive outcomes. In the case of the US, the country did quite well (3rd overall of 11) in "effectiveness of care."

More specifically, and more relevant than what the OECD or WHO thinks:

79% of women diagnosed with uterine cancer in England and Wales survive their disease 5 years or more

82% of US women diagnosed with uterine cancer survive 5 years or more.

Obviously, early detection matters a lot, as well as the specific type of uterine cancer. Every case is unique and it is not possible to know if a particular patient would benefit from being in a particular nation's health care system. But, overall, women in England and Wales who have been diagnosed with uterine cancer have a 17% higher probability of succumbing to the disease within 5 years than US women with uterine cancer.

 

[daylatedollarshort]

It's probably more helpful yet if the study/statistics are relevant to the case at hand.

The topic of this thread is where can pre-Medicare age posters get quality, affordable healthcare outside the U.S., perhaps in Mexico or the U.K. If I needed to make that choice, I would look at global stats for that kind of info, and not draw conclusions based one poster's anecdotal third hand experience with one relative with a particular disease and a particular doctor / treatment plan in the U.K.

 

[Huston55]

It's probably more helpful yet if the study/statistics are relevant to the case at hand. In the linked study, the WHO and the OECD marked down the US for having inefficient care (duh--we know that), for having poor "equity" (i.e. some people get better care), as well as something they called "healthy lives," and other categories that deal with overall cost and social goals of the HC systems, not whether sick people who have access tocare in each system (which would appear to have been Bamaman's niece's situation) would be more likely to have positive outcomes. In the case of the US, the country did quite well (3rd overall of 11) in "effectiveness of care."

More specifically, and more relevant than what the OECD or WHO thinks:

79% of women diagnosed with uterine cancer in England and Wales survive their disease 5 years or more

82% of US women diagnosed with uterine cancer survive 5 years or more.

Obviously, early detection matters a lot, as well as the specific type of uterine cancer. Every case is unique and it is not possible to know if a particular patient would benefit from being in a particular nation's health care system. But, overall, women in England and Wales who have been diagnosed with uterine cancer have a 17% higher probability of succumbing to the disease within 5 years than US women with uterine cancer.

I don't understand how you get a 17% 5 yr survival rate difference with the links you provided.

 

[NW-Bound]

79% of women diagnosed with uterine cancer in England and Wales survive their disease 5 years or more

82% of US women diagnosed with uterine cancer survive 5 years or more.

Interesting.

About statistics, when I looked deeper, I saw that it is not that simple. For example, after a patient is diagnosed with cancer, they count the time to his death, even if he dies of something else, for example heart attack or diabetes.

I guess the survival period reflects the patients' overall health rather than just that cancer alone. To differentiate it takes too much work, and they do not have the data.

Another thing is the statistics do not differentiate between an 80-year old man surviving for 5 years after cancer detection, vs. a 30-year old. The latter case is more tragic, because the older man is frail and may die of something else, or cannot stand up to surgery and chemo treatment.

 

[NW-Bound]

Here's another piece of statistics, for what it is worth.

5-year survival rate of colorectal cancer: Canada 64%, US 65%
10-year survival rate of colorectal cancer: UK 57%, US 58%

Note: I cannot find 10-year rate for Canada. Same for 5-year rate for UK. Canada number is "age-standardized".

PS. More statistics.

5-year survival rate of breast cancer: Canada 87%, US 89%
10-year survival rate of breast cancer: UK 78%, US 83%

 

[Fedup]

Speaking of healthcare quality, what I got from the local medical organizations here was excellent. I had very little to complain about. And I really mean it. It only cost money!

I am sure people can tell of horrible treatments elsewhere in the US. And I went on the Web, and found stories of terrible conditions in other developed countries too. And these stories were written in their local newspapers, so it is not some foreigners bad-mouthing them.

What is the truth? I think there is no uniformity in healthcare quality in any country. Just the luck of the draw.

I have a few anecdotes evidence from UK. Not good. I think they can do basic care but complex medical operations? Forget about it. Don't believe me? Google Andrew Lloyd Webber, he had 19 operations for nicked nerve from acupuncture. And then there's George Michael's autopsy report. I mean these people are rich. But the healthcare they receive is awful. I hope I'm not awfullrized them. Just reality.

 

[NW-Bound]

Umm... Some freakish things happened. I will look further, but so far the cancer treatments between the US, UK and Canada are comparable.

Here's another one for grin.

5-year survival rate of breast cancer: Canada 87%, US 89%, Australia 90%
10-year survival rate of breast cancer: UK 78%, US 83%

I look for statistics in Mexico, but they do not keep clinical records like other countries. If an American goes there, he is likely to get much better treatments at private hospitals than the natives do, so the statistics may not mean much anyway.

 

[NW-Bound]

Interesting idea. If our insurance goes up too much I may look into it.

Question: if you claim experience is so minimal, why do you buy a Silver plan rather than a Bronze plan?

Or you could just move to Vermont... a bronze plan there is ~$450/month or $10,800/year for the two of you.... but who knows how it will change.

Hmm... $10,800 minus $8000 credit for 2 is $2,800/year. Nice!

I do not need or want another home, but can live in my RV there for 6 months out of the year. That can work.

PS. How do I check the quality of health care in Vermont, cancer survival rates and the like?

 

[NW-Bound]

I don't understand how you get a 17% 5 yr survival rate difference with the links you provided.

It's the death rate that he compared, not the survival rate.

79% of women diagnosed with uterine cancer in England and Wales survive their disease 5 years or more

82% of US women diagnosed with uterine cancer survive 5 years or more.

This means 21% of the Brits die, and 18% of the Americans die. And so, the ratio is 1.166, or 17% more.

 

[jollystomper]

To the OP - did you figure in any tax savings in your calculation? At those premium costs, if they exceed 10% of your income you do get to deduct them. I know it may not be significant, but it is something.

DW and I are in a similar situation she will be medicare eligible in 2022 and I will be in 2023. If I do retire mid year I get up to 18 months on COBRA which takes us to the end of 2018, then there are funds megacorp provides as part of retirement that I can direct towards health insurance premiums and spread them out over perhaps 3 years to keep the premiums reasonable. So we may have only 2-3 years of potentially "bad" premiums, which we would be able to deduct some from our taxes based on our income. We hope ti works out. We are keeping a lot in cash due to this situation.

 

[Alan]

I have a few anecdotes evidence from UK. Not good. I think they can do basic care but complex medical operations? Forget about it. Don't believe me? Google Andrew Lloyd Webber, he had 19 operations for nicked nerve from acupuncture. And then there's George Michael's autopsy report. I mean these people are rich. But the healthcare they receive is awful. I hope I'm not awfullrized them. Just reality.

I've never met those 2 characters but I do have a lot of family and friends with excellent outcomes on the NHS with both detection and treatment of serious diseases, all within the last 8 years.

Sister diagnosed with cervical cancer after routine screening. Within 6 weeks she had had 2 laser treatments and then opted for a hysterectomy when follow up tests still showed cancer cells. She was declared clear of cancer 5 years later and is now back on an annual check-up.

DW's niece with double kidney failure was put on the donor list and 6 weeks later was called for a kidney transplant That was about 6 years ago, and the NHS works on best match rather than last in first out. (We understand that the anonymous donor was a traffic accident fatality).

Good friend where we live here had a heart valve transplant 13 years ago, and in October last year had that artificial valve replaced. We were around to take him to a couple of appointments and was pleased to see that they also did a bunch of tests including where they pass a camera into the arteries to look for blockages as the surgeon told him that if he was going to do open heart surgery anyway that he would do bypasses or other needed maintenance. (Nothing else was needed). A month back we were watching a documentary on one of the NHS hospital trusts in London and a 98 year man presented with the same problem as our friend. He was very fit for 98, used to walking 4 miles a day, but now got winded and was unable to walk more than a few hundred yards. The medical team decided that he was fit enough for the sort of surgery our friend can expect if his new valve lasts him well into his 80's. They insert a new valve inside the failing valve, doing the surgery through an artery instead of open heart. Our friend's surgeon told him that he would be fitting him with a valve that will be plenty big enough for the insert next time around.

I could go on about my BIL with a brain tumor, or my wife's brother with spina bifida from birth, or my wife's sister who had a lumpectomy last year after a routine scan or any of our parents' tests and treatments but it is all too small a sample size, and we are very grateful that we have no health horror stories in our extended family or friends.

Since returning last year we have been impressed at how proactive the NHS has been doing diagnostic tests. Within a week or registering at our local doctors' offices we were invited to do fecal blood test bowel cancer screening then within a few weeks DW had a pap smear and mammogram. A few months later we were invited, and participated in, a heart check and healthy heart education. There are notices at the offices encouraging men over 65 to book appointments for AAA screening. (aneurysms)

 

[samclem]

About statistics, when I looked deeper, I saw that it is not that simple. For example, after a patient is diagnosed with cancer, they count the time to his death, even if he dies of something else, for example heart attack or diabetes.

Right. And the same phenomenon can make early detection look more useful than it is, especially for cancers that are hard to treat. If Patient A and B actually develop cancer on the same date and die 6 years later on the same date, but Patient A's cancer was detected after 1 year, he met the 5 year survival criteria. If Patient B's cancer was detected after 4 years, he officially had a 2 year survival time, though the treatments had no more impact on his true survival time than Patient A's. Heck, he had 3 additional years of cancer-free living (at least as far as he knew).
Does early detection truly lead to longer survival times/better outcomes with cancer? Absolutely. But since we don't know when a particular patient's cancer really begins and we count from the date of detection, programs that detect cancer earlier do have a tendency to make the treatment regimes look more effective than they may actually be.
It's probably more useful to use the stats for survival time with cancers detected at a particular stage. That will control for some of the above.

 

[2017ish]

I have an idea on how to reduce my health insurance burden pre- Medicare and create a more interesting lifestyle at the same time. ...

... Our health insurance premiums from 2016-2024 will be the following:

2018 $22740 x 105% = $23,877
2019 $23,877 x 5/3 x105%-$8000 = $33,784
2020 $41,784 x 105% - $8000 = $35,874
2021 $43,874 x 105% - $8000 = $38,067
2022 $46,067 x 105% - $8000 = $40,371
2023 $48,371 x 105% - $8000 = $42,789
2024 $50,789 x 105% - $8000 = $43,328

Total: $228,023

I know this is a worst case scenario, but that's what we are in right now....

Nah, that isn't worst case scenario. You are assuming that the so-called health insurance market for individuals continues to semi-function for each of those years. Take away that assumption and we start getting closer to worst case.

 

[pb4uski]

.... PS. How do I check the quality of health care in Vermont, cancer survival rates and the like?

No idea, but I think it is pretty good overall... the whole health care system is centered around two teaching hospitals (UVM and Dartmouth) and affiliated community hospitals. We get a lot of good docs who want to live there because of the lifestyle (skiing, boating, hiking, etc.).

 

[Joylush]

If you are healthy what about buying catastrophic coverage only?

There is no such thing anymore. Obamacare did away with affordable catastrophic plans for anyone over 30.

 

[Cobra9777]

Look at Costa Rica whose hospitals do a lot of medical tourism...

+1

Costa Rica is another excellent option for access to low-cost, high-quality medical care. DW and I enjoy staying there more than Mexico. We have seriously considered moving to Costa Rica, although not specifically due to health care costs, as we both have employer-subsidized retiree health insurance. But we would have no hesitation seeking medical treatment there.

 

[pb4uski]

There is no such thing anymore. Obamacare did away with affordable catastrophic plans for anyone over 30.

Not totally correct. There is an obscure ACA provision that allows those over 30 to buy catastrophic coverage if the lowest cost bronze plan is more than 8.13% of your income... we have been doing this ever since ACA started.

In our state, we pay the same premium as a 30 yo... ~45% less than a bronze plan... but in other states even catastrophic coverage is age-rated so there may not be much savings compared to a bronze plan. YMMV

 

[folivier]

Panama is also another country worth looking at.

 

[daylatedollarshort]

Not totally correct. There is an obscure ACA provision that allows those over 30 to buy catastrophic coverage if the lowest cost bronze plan is more than 8.13% of your income... we have been doing this ever since ACA started.

In our state, we pay the same premium as a 30 yo... ~45% less than a bronze plan... but in other states even catastrophic coverage is age-rated so there may not be much savings compared to a bronze plan. YMMV

Catastrophic plans were listed on our exchange choices this past year in our area but the prices were almost as much as the Bronze plans with the potential for much higher out of pocket costs, so we stuck with Bronze.

 

[kgtest]

I have an idea on how to reduce my health insurance burden pre- Medicare and create a more interesting lifestyle at the same time. This is based on assuming some versionPlease find holes in this idea.
What do you all think?

One hole likely unrealistic but possible....MX gets mad due to politics and wall and decides to make us visa impossible to obtain.

Again this would be terrible for both sides. MX has usually had cheaper maintenance and preventative care... but if I had a critical issue I would want to be close to the best paid and educated dr's to ensure best care.

 

[Fedup]

I've never met those 2 characters but I do have a lot of family and friends with excellent outcomes on the NHS with both detection and treatment of serious diseases, all within the last 8 years.

Sister diagnosed with cervical cancer after routine screening. Within 6 weeks she had had 2 laser treatments and then opted for a hysterectomy when follow up tests still showed cancer cells. She was declared clear of cancer 5 years later and is now back on an annual check-up.

DW's niece with double kidney failure was put on the donor list and 6 weeks later was called for a kidney transplant That was about 6 years ago, and the NHS works on best match rather than last in first out. (We understand that the anonymous donor was a traffic accident fatality).

Good friend where we live here had a heart valve transplant 13 years ago, and in October last year had that artificial valve replaced. We were around to take him to a couple of appointments and was pleased to see that they also did a bunch of tests including where they pass a camera into the arteries to look for blockages as the surgeon told him that if he was going to do open heart surgery anyway that he would do bypasses or other needed maintenance. (Nothing else was needed). A month back we were watching a documentary on one of the NHS hospital trusts in London and a 98 year man presented with the same problem as our friend. He was very fit for 98, used to walking 4 miles a day, but now got winded and was unable to walk more than a few hundred yards. The medical team decided that he was fit enough for the sort of surgery our friend can expect if his new valve lasts him well into his 80's. They insert a new valve inside the failing valve, doing the surgery through an artery instead of open heart. Our friend's surgeon told him that he would be fitting him with a valve that will be plenty big enough for the insert next time around.

I could go on about my BIL with a brain tumor, or my wife's brother with spina bifida from birth, or my wife's sister who had a lumpectomy last year after a routine scan or any of our parents' tests and treatments but it is all too small a sample size, and we are very grateful that we have no health horror stories in our extended family or friends.

Since returning last year we have been impressed at how proactive the NHS has been doing diagnostic tests. Within a week or registering at our local doctors' offices we were invited to do fecal blood test bowel cancer screening then within a few weeks DW had a pap smear and mammogram. A few months later we were invited, and participated in, a heart check and healthy heart education. There are notices at the offices encouraging men over 65 to book appointments for AAA screening. (aneurysms)

Interesting. I must know all the bad cases then.
My sister in law never had preventive colonoscopy not mammmogram. However, she did request a colonoscopy because of some problem and was granted.
My husband's best friend has a son with club foot since birth, despite multiple operations with private insurance sometimes, his dad was working for an American company, he can barely walk straight now, near 30, still hobbling, he can only work at a job that allows him to sit.
My husband's best friend had some prostate problem and since he's an engineer, he had to prove to the doctor why he needed surgery, he was really proud of that, but I wonder if a non smart person can really do that.
His wife has fibromyalgia and she kind of gave up on having the problem treated, except on occasions where she could afford a nice deep massage.
The NHS missed diagnosed my MIL diabetes problem until there was ganggreen in her toe and they cut it off. The same thing, they misdiagnosed my FIL throat cancer, they told him something wrong with his teeth, scheduled surgery for an 88 years old man, he had a massive heart attack and had to be kept in the hospital for 8 weeks. He never fullly recovered after the surgery and died soon afterwards.
Granted now that I think about , my husband's cousin did have successful cancer surgery and her grandson did have a successfully kidney transplant. Those are two cases that I know are successful.