Places abroad to retire, claimed to be affordable.

[sengsational]

I would assume the overseas facilities, even if you pay out of pocket, are nicer then what's in the U.S no?

I'd make that same assumption. I'd presume higher staffing level and probably workers willing to provide a bit of TLC occasionally. My impression, totally based on zero facts, is that those employed at lower rung US facilities are there because many of the positions require no previous experience, training or certifications. In the US, people who fill those positions are looking to move up and out, and might not be very dedicated. That same position in other countries might be quite relished and so generate some pride in doing the job well. All speculation, though.

 

[kcowan]

We are considering moving full-time to Mexico. Not for a couple of years. Just evaluating possibilities. One of our concerns is that septicemia seems to claim many hospitalized patients. OTOH a friend just had his wife succumb in Seattle.

But we are trading off the higher quality of life with the risks. The home bias is very much at work.

 

[brett]

That is exactly where we have been in the past and where we are now.

I suspect our future will hopefully look like a place in winter for six months and a place where we live for six months. Undecided as to whether we own or buy, sell or current home at some place.

One thing for certain, we do not want to own two properties. Perhaps not even one. We owned for many years then rented for four. Now we own. Renting opened our eyes to the financial and the lifestyle benefits. Now we view renting primarily as a financial and flexibility decision.

 

[ShokWaveRider]

We are considering moving full-time to Mexico. Not for a couple of years. Just evaluating possibilities. One of our concerns is that septicemia seems to claim many hospitalized patients. OTOH a friend just had his wife succumb in Seattle.

But we are trading off the higher quality of life with the risks. The home bias is very much at work.

What will you do for healthcare? Very difficult for over 65s I hear.

 

[sengsational]

One of our concerns is that septicemia seems to claim many hospitalized patients.

I wonder what the rates are between the best hospitals in each country. I can't imagine the rates are much different, but who knows. I bet without big pharma breathing down their necks, the Mexican hospitals will employ Marik's regimen more often.

 

[kevink]

What will you do for healthcare? Very difficult for over 65s I hear.

On the contrary access to care is far easier in expat enclaves in Mexico than it is in the U.S. The issue isn't health care, it's health insurance. Gringos can join the Mexican national insurance system (IMSS and/or Seguro Popular) but many pre-existing conditions aren't covered and without fluent Spanish such coverage is really only useful for emergencies in a few instances.

Private insurance is available but becomes prohibitively expensive after age 70 or so. The majority of older retirees we know down there self-insure while in Mexico while maintaining basic Medicare coverage in the U.S. as a hedge against expensive treatment for, say, cancer or heart disease.

Routine and preventive care are easy to pay for out-of-pocket. And we've known numerous people who've "gone naked" insurance-wise and had to pay for serious illnesses such as triple/quintuple bypass surgery or breast cancer treatment and in all cases complete courses of treatment including surgery, drugs and stays in the best private hospitals haven't exceeded 30-40K total. Not pocket change, but add a few zeroes to get to U.S. costs, obviously.

Much harder choice for Canadians like Keith since Canada does have excellent universal health care. Most Canadians we know in Mexico limit their stays there to less than 6 months in order to maintain coverage back home.

 

[brett]

Maintaining our Canadian healthcare coverage is one of the key reasons why we view a six month horizon as being optimum.

 

[JakeinChina]

I'd make that same assumption. I'd presume higher staffing level and probably workers willing to provide a bit of TLC occasionally. My impression, totally based on zero facts, is that those employed at lower rung US facilities are there because many of the positions require no previous experience, training or certifications. In the US, people who fill those positions are looking to move up and out, and might not be very dedicated. That same position in other countries might be quite relished and so generate some pride in doing the job well. All speculation, though.

Yeah I would totally agree with you on this.

Plus, in many of these countries, a lot of the infastructure like buildings and such may tend to be new, where in the U.S. they might be old and a bit run down.

 

[kcowan]

Much harder choice for Canadians like Keith since Canada does have excellent universal health care. Most Canadians we know in Mexico limit their stays there to less than 6 months in order to maintain coverage back home.

Maintaining our Canadian healthcare coverage is one of the key reasons why we view a six month horizon as being optimum.

Yes we are covered with up to 212 days absent (Ontario and BC) so the trade-off is maintaining a residence in a LCOL area versus heading to the mountains in Mexico summers. Self-insurance is certainly feasible. I did it this year as a trial. So far only 1300 pesos with 2 weeks to go.

 

[sengsational]

The majority of older retirees we know down there self-insure while in Mexico while maintaining basic Medicare coverage in the U.S. as a hedge against expensive treatment for, say, cancer or heart disease.

Routine and preventive care are easy to pay for out-of-pocket. And we've known numerous people who've "gone naked" insurance-wise and had to pay for serious illnesses such as triple/quintuple bypass surgery or breast cancer treatment and in all cases complete courses of treatment including surgery, drugs and stays in the best private hospitals haven't exceeded 30-40K total. Not pocket change, but add a few zeroes to get to U.S. costs, obviously.

That's some really good information there, thanks for sharing it. Doing the expat thing is more of a plan B for me because DW is just not interested (doesn't even want to move unless it's to be near the grandkids that we don't even have). But it's nice to know that getting caught out on health insurance can be so "cheap".

 

[sengsational]

Yes we are covered with up to 212 days absent (Ontario and BC) so the trade-off is maintaining a residence in a LCOL area versus heading to the mountains in Mexico summers. Self-insurance is certainly feasible. I did it this year as a trial. So far only 1300 pesos with 2 weeks to go.

Out of curiosity, you need to keep a residence in Canada and be in- country a couple of months or so? They use border crossing records? I thought those only had arrivals.

 

[brett]

To compound matters, each Province in Canada has slightly different medicare rules as it pertains to maximum number of days one can spend outside the country. It is typically six months give or take some days.

I do not know the residence requirements. For some I suppose it might be what province they pay their income tax. Some provinces collect medicare premiums direct, others do it through tax returns, still other base the premium in part on income. Where we live there are no premiums as such. Health care is funded from general revenues and is included in the provincial tax rate. Every Province that we have lived in requires 3 month residency in order to get service. Until that time you are covered by your previous plan.

Some provinces also have a cap on how much seniors pay for prescriptions. Where we live, on turning 65, we only pay a maximum of 30 percent (sometimes much less in our experience) on many prescription drugs but not all. Blue Cross administers it. Covers both married couples as long as one is over 65, the other also gets the benefit of the plan.

 

[youbet]

In the U.S. they'd quickly spend down their assets to nothing leaving no options but a grim Medicaid-eligible nursing home (and of course no inheritance for their kids), while in Mexico the cost for care can be paid for completely using social security alone.

https://www.focusonmexico.com/assisted-living-lakeside/

I've also heard that the price of LTC is cheaper in Mexico and some other countries. But your description of the typical USA based couple "quickly spending down their assets to nothing" might not be all that true for the FIRE types here. For example, like DW and I, many have planned to self-insure or have LTCI to cover these issues without having to move far away from family and friends to secure a less expensive situation.

 

[UnrealizedPotential]

I have read that Ukraine, Belarus, Poland, and Moldova are rather cheap places to retire to. I'm not sure about that. I know Ukraine is rather cheap, although Kiev itself can be expensive if you wanted the best, it can be that way. The rest of the country, is cheaper. But in Ukraine there is the war and the language barrier for those who don't speak Russian in the eastern part of Ukraine and Ukrainian in the western part.
I would think the language would be a huge barrier for most of the English speaking World to move to those countries. But it is still an option for some I suppose willing to go that path. I know some are talented in languages and for those who would have an income stream and could adjust to the culture, some might be able to make a go of it.

 

[Teacher Terry]

Poland is cheap if you stay out of Warsaw and Kraków. However, outside of the big cities no one speaks English. It’s a beautiful country but long dreary winter with short days. They heat with coal so air quality not good in winter.

 

[youbet]

Both my grandma’s were in the same nice nursing home and one self paid and one was on Medicaid.

Managing NH services paid for by Medicaid to be equal to those achieved by private pay (or LTCI) is possible but can be tough. MIL (passed about a year ago) spent five years in a NH. The first 1.5 years as private pay and the following 3.5 years on Medicaid. DW and her brother spent a LOT of effort learning the ropes prior to their mother needing full time care and only execution of a plan they researched enabled my MIL to continue in a mid-tier, predominantly private pay NH even after her funds were depleted.

This was in the Chicago area and results can vary significantly depending on your state and your location within the state. In many areas, seeking entrance to a quality NH when you're broke and on Medicaid from the beginning can result in only being accepted by "icky" places that specialize in Medicaid clients.

The devil is in the details and the uninformed are at risk. It's NOT a good idea to assume you'll get NH residency in a quality place of your choosing everywhere and anytime if you're depending on Medicaid from the get-go.

 

[Teacher Terry]

Youbet, yes I know you are right. My grandma’s were in Wisconsin. When I placed a friend of mine in a home here I looked for one that she could private pay for a year and a place that doesn’t throw you out once on Medicaid because I know what you are saying is true.

 

[gattara]

But your description of the typical USA based couple "quickly spending down their assets to nothing" might not be all that true for the FIRE types here. For example, like DW and I, many have planned to self-insure


Exactly. DH and I will be self-insuring for possible long-term care expenses.

We will have Medicare, of course, but my husband was a federal employee, and we have a Blue Cross/Blue Shield plan with his retirement. Whenever we travel internationally we are told that we are covered for healthcare, just go to where we need to go for medical care and we'll be reimbursed by BC/BS. I don't know if that is supposed to be used solely in emergency situations. We have never had to do it, and now I wonder, if we were to live at an assisted living place in Mexico, if our BC plan could be used consistently for medical care and prescriptions.

 

[kcowan]

Out of curiosity, you need to keep a residence in Canada and be in- country a couple of months or so? They use border crossing records? I thought those only had arrivals.

The rule in BC is to maintain an official residence and to be present for 365-212 days during the calendar year. Not consecutive. Paying the monthly premium unless you are low income. Partial days absent count. e.g. an afternoon shopping trip to Bellingham.

The tracking is based on them asking you to prove your residence if you are undergoing an expensive procedure, as sharing between federal and provincial records is not automatic. So it remains an honour system.

 

[kevink]

But your description of the typical USA based couple "quickly spending down their assets to nothing" might not be all that true for the FIRE types here. For example, like DW and I, many have planned to self-insure


Exactly. DH and I will be self-insuring for possible long-term care expenses.

We will have Medicare, of course, but my husband was a federal employee, and we have a Blue Cross/Blue Shield plan with his retirement. Whenever we travel internationally we are told that we are covered for healthcare, just go to where we need to go for medical care and we'll be reimbursed by BC/BS. I don't know if that is supposed to be used solely in emergency situations. We have never had to do it, and now I wonder, if we were to live at an assisted living place in Mexico, if our BC plan could be used consistently for medical care and prescriptions.

I'd guess that there are many who post on these forums who don't have the spare ~$2 million (see Christine Benz article link below) to self-insure - or would rather spend that money on other things.

I'd check with BC/BS but would be surprised if they'd cover much on an ongoing rather than emergency basis in Mexico or any other foreign locale. There's more and more of an effort from expat advocacy groups to get insurers to expand such coverage and several pilot programs from BC/BS and others looking at funding surgery in lower-cost locales like India, Thailand and Mexico but I've not read of anything beyond that.

Even with BC/BS coverage I personally would opt for World Nomads or other inexpensive supplemental cover if I were traveling internationally in any place other than Mexico where I know the ropes - and maybe even there if I were going to remote areas.

https://www.morningstar.com/articles/887642/theres-no-magic-number-for-selffunding-longterm-ca.html

 

[gattara]

Kevink, thanks for the link and your perspective. I will have a chat with BC/BS about how their coverage works internationally. I wasn't aware of World Nomads and will investigate.

 

[ShokWaveRider]

I think the issue with respect to healthcare retiring abroad is coverage for those over 65. That seems to be the cutoff, between getting insurance and going self insured.

 

[youbet]

I'd guess that there are many who post on these forums who don't have the spare ~$2 million (see Christine Benz article link below) to self-insure

Call me a wild and crazy risk taker if you must, but somehow I find myself comfortable with needing less than $2MM in my LTC self-insurance bucket. If your pension and SS covers a good chunk of your monthly NH bill, the difference would likely be generated by much less than $2MM.

If you and others are happier living in other parts of the world, that's what you should do. Many of us would not be and can afford to stay here. It's not as black and white as you attempt to make it sound.

 

[kevink]

I agree with you completely youbet! And like you I prefer to live in the U.S. but am glad to know that I do have viable low-cost options for longer-term care in a beautiful place for a fraction of U.S. costs if need be. That's all I was trying to say. Long-term care costs and health care costs in general are so full of expensive unknowns that it's good to have lots of options. And I say that knowing full well that very few who post here would even consider non-U.S. options.

 

[ShokWaveRider]

The US has been good to us and we are fortunate to have earnt choices. Money does buys you choices. But If I had the stones, I would move overseas in a heartbeat. We feel the US is going in the complete wrong direction for our liking. But due to some pending surgery that is due for me in about 1 years time, it is on hold.