Returning to Canada for Health Insurance

Meadbh said:
Canadian residents can invest wherever they wish. They do have to declare foreign investments.
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For foreign investments with a cost base of over $100k, they have to declare the maximum value of the holdings in C$ for the year. This requires a spreadsheet. I have no idea why they need this. But there are severe fines for failing to file.
 
This isn't about taxes, but I suggest you talk to your brokerage firms to make sure you can still invest the way you want to, or at least learn the rules in advance, so you can take action before moving your residency to Canada.

I am a US citizen living in Canada. Before my move in 2015, I had all my investment accounts (After tax, rollover IRA, and Roth IRA) at Vanguard. Vanguard has very tight rules for Canadian residents (not with UK or MX residents from what I can see. Check out Financial Wisdom forum), and Vanguard reps (I called them multiple times talking to multiple people to confirm) said all my accounts, including my rollover IRA and Roth IRA will be frozen, except for selling shares. Fidelity said the after-tax accounts will get frozen (except for selling shares), but I can still trade within my Roth and rollover IRA as long as I already have such accounts with them BEFORE the move. (BTW, they will not do EFT transfer of your money to a Canadian bank unless you already had a Canadian bank defined before your move to Canada, which I found out after my move.... ) So before my move to Canada, I had to move all my money from Vanguard to Fidelity. I have done partial rollovers of my 401K to my Fidelity rollover IRA since my move without any issues. I imagine things may be different if you keep an address in the US, but I didn't want to go that route.

As for taxes, I heard 85% of social security is taxed in Canada, but it sounds like you are going back to the US before Age 65, so as long as you take SS at full retirement age, I don't see that being an issue for you. This is only my first full year in Canada tax wise, so I don't know for sure, but running tax estimators online, it looks like my tax burden in Canada will be higher. I didn't move here for the healthcare, but just as a comparison, I do think the extra money I pay for taxes is probably less than what I might have ended up paying for for healthcare in the US.
 
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I though you can make about $100k before you have to pay US taxes, you do have to file a return though, if you live in Canada that is. But you will have to pay taxes on your USA SS and Retirement account withdrawals.

Not sure about income from investments.
 
tmm99 said:
This isn't about taxes, but I suggest you talk to your brokerage firms to make sure you can still invest the way you want to, or at least learn the rules in advance, so you can take action before moving your residency to Canada.

I am a US citizen living in Canada. Before my move in 2015, I had all my investment accounts (After tax, rollover IRA, and Roth IRA) at Vanguard. Vanguard has very tight rules for Canadian residents (not with UK or MX residents from what I can see. Check out Financial Wisdom forum), and Vanguard reps (I called them multiple times talking to multiple people to confirm) said all my accounts, including my rollover IRA and Roth IRA will be frozen, except for selling shares. Fidelity said the after-tax accounts will get frozen (except for selling shares), but I can still trade within my Roth and rollover IRA as long as I already have such accounts with them BEFORE the move. (BTW, they will not do EFT transfer of your money to a Canadian bank unless you already had a Canadian bank defined before your move to Canada, which I found out after my move.... ) So before my move to Canada, I had to move all my money from Vanguard to Fidelity. I have done partial rollovers of my 401K to my Fidelity rollover IRA since my move without any issues. I imagine things may be different if you keep an address in the US, but I didn't want to go that route.

As for taxes, I heard 85% of social security is taxed in Canada, but it sounds like you are going back to the US before Age 65, so as long as you take SS at full retirement age, I don't see that being an issue for you. This is only my first full year in Canada tax wise, so I don't know for sure, but running tax estimators online, it looks like my tax burden in Canada will be higher. I didn't move here for the healthcare, but just as a comparison, I do think the extra money I pay for taxes is probably less than what I might have ended up paying for for healthcare in the US.
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Thanks very much for your input, TMM99. I will be reviewing all of this going forward. For whatever reason, some people on the FWF (the same forum you refer to above) led me to believe that Canada pushed people into moving their non-retirement investments into Canada. Several posters there made it sound as though renouncing U.S. citizenship was the only way to avoid an onerous level of taxation while living in Canada.
I have a lot of info to review and will keep the forum posted regarding what I find.
 
Also be aware that, depending on your province, you may not be insured when you arrive, even as a Canadian citizen. For example, in Ontario, you don't qualify for OHIP until you have been here three months. You can get temporary insurance from private providers to cover the gap.
 
Davis65 said:
Also be aware that, depending on your province, you may not be insured when you arrive, even as a Canadian citizen. For example, in Ontario, you don't qualify for OHIP until you have been here three months. You can get temporary insurance from private providers to cover the gap.
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Exactly, The company covered returning employees from Saudi until eligibility was re-established, through Blue Cross IIRC.
 
kcowan said:
For foreign investments with a cost base of over $100k, they have to declare the maximum value of the holdings in C$ for the year. This requires a spreadsheet. I have no idea why they need this. But there are severe fines for failing to file.
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It is the same in the USA except the limit is only a maximum of $10k. It is reporting only, and the name of the site you must use to file these reports on your foreign financial interests makes it obvious why. (Financial Crimes Enforcement Network). When completing this filing each year I always feel that I am guilty until proven innocent.

https://www.fincen.gov/
 
Alan said:
When completing this filing each year I always feel that I am guilty until proven innocent.

https://www.fincen.gov/
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I have been audited every year for my medical expenses and I have detected an attitude shift as they have come to understand that I am being honest with them. As lons as they can find some small item that justifies their work, they are OK. So I pay rather than fight.

And they are all electronic so I can file easily from Mexico.
 
6miths said:
Gee I'm a doctor in Ontario and I'm not unhappy... quite the contrary in fact, I am very happy. There are always things to complain about and lobby for. Who doesn't want to work fewer hours for more money or feel that they have better representation or have more control of their life or a gold-plated government pension plan. When I sit around with my colleagues and talk turkey, there is seldom a one that doesn't think that Canada has one of the best healthcare systems in the world and that it is far superior to the system in the US - even for doctors in recent years. The US system doesn't serve the countries population well and is bloated with countless middlemen collecting their golden crumbs and driving costs to unsustainable levels. (Mods can cut out the last sentence or two if they are found to be offensive).

Waiting times are usually about 90 days but have been reduced in some provinces in recent years. While waiting one can get private insurance and even if uninsured costs would look like a bargain.
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Canada tracks wait times for procedures, etc. The US does not track wait times, so it's hard to say whether Canada is better or worse in that regard.
 
AllDone said:
Canada tracks wait times for procedures, etc. The US does not track wait times, so it's hard to say whether Canada is better or worse in that regard.
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I find it hard to imagine that Canada is better than the US in terms of wait times. We've always gotten in to see a specialist right away (a week or less) and never had to wait for imaging.

I know this is just anecdotal...

Edit: Globe and Mail is reporting wait times at 20 year high -- on avg 20weeks but could be as high as 40 in maritimes. http://www.theglobeandmail.com/news...20-year-high-in-canada-study/article33001028/
 
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There are quotas and wait times but these are for elective procedures or preventive analysis. If you have a life-threatening disease, there is ready access to equipment.

But you might wait two years for a hip/knee transplant. 2-3 weeks for a heart valve transplant. I am OK with their prioritizing.

My fellow retirees from Megacorp US are finding their HSAs being eaten up by copays and that they will be into user pay before they die.
 
Health care has to be somehow rationed. I'd rather have it rationed based on wait times than on affordability, as it is in the US.
 
People will over-use something that is "free" like medical care.

Here in the US, I wanted an MRI, just because I wanted it to see how my back was that was bothering me.
So I had it done and paid for it, then I did nothing about my back for 10 yrs. Really a waste, but I paid for it and could afford it.

In Canada, since it's all "free" (meaning no payment as already in tax system), can you imagine how many folks would be lining up for an MRI look at every little twinge.

I worked with a Canadian, who had an ear ache, so he went to the Kansas hospital emergency, they examined him and gave him drops, and a $1,500 bill. He was surprised as in Canada it would be $0 back then. He had gone to the emergency as that is what he would do in Canada, even though it was really an abuse of the system.
 
I'm a US/UK dual citizen and I've considered returning to the UK and would then have access to the NHS just by being a UK resident. However, I'm lucky that I get Massachusetts State retiree health insurance that costs $95/month and has a $300 deductible and $4000 annual out of pocket max. so I worry less about health insurance than many ERers.
 
kcowan said:
But you might wait two years for a hip/knee [-]transplant[/-] replacement. 2-3 weeks for a heart valve transplant. I am OK with their prioritizing.
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FIFY
 
Sunset said:
People will over-use something that is "free" like medical care.

Here in the US, I wanted an MRI, just because I wanted it to see how my back was that was bothering me.
So I had it done and paid for it, then I did nothing about my back for 10 yrs. Really a waste, but I paid for it and could afford it.

In Canada, since it's all "free" (meaning no payment as already in tax system), can you imagine how many folks would be lining up for an MRI look at every little twinge.

I worked with a Canadian, who had an ear ache, so he went to the Kansas hospital emergency, they examined him and gave him drops, and a $1,500 bill. He was surprised as in Canada it would be $0 back then. He had gone to the emergency as that is what he would do in Canada, even though it was really an abuse of the system.
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You make a good point so in systems like Canada's and the UK the initial doctor's visit is very important. People do go to the doctor and many things are caught and treated when they are minor saving money. Also things like MRIs have to be okayed by a doctor and they have no financial incentive for ordering such a test.
 
Sunset said:
People will over-use something that is "free" like medical care.

In Canada, since it's all "free" (meaning no payment as already in tax system), can you imagine how many folks would be lining up for an MRI look at every little twinge.
Click to expand...

That's why we have doctors. To help make evidence informed decisions that help patients, not to deliver useless care. May I ask, what was the evidence that your MRI was really a need, as opposed to a want?

Below are data on MRI use.

"In 2011–2012, the Canadian rate for MRI exams was 49 per 1,000 people. In Organisation for Economic Co-operation and Development (OECD) countries, the rate for MRI exams varied from highs of 98 (United States) and 95 (Germany) to lows of 7 (Chile) and 18 (Israel)."

So the US uses exactly twice the number of MRIs per capita compared with Canada. There is no evidence that USians are any healthier as a result. Israelis are probably healthier than all of us.

https://www.cihi.ca/en/types-of-care/specialized-services/medical-imaging

Sunset said:
I worked with a Canadian, who had an ear ache, so he went to the Kansas hospital emergency, they examined him and gave him drops, and a $1,500 bill. He was surprised as in Canada it would be $0 back then. He had gone to the emergency as that is what he would do in Canada, even though it was really an abuse of the system.
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I agree, and that's who many ERs will divert such non-emergency patients to a clinic on site.
 
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Basic question here. In Canada (Ontario specifically) can you book an appointment directly with a specialist? or do you need to see a GP first and get a referral?
 
Well depending on what insurance you have in the US you cannot book directly with a specialist unless you plan to pay for it. I know I cannot and have to go through my GP. I'm a Canadian living in the US (Not dual) and would like to move back but DW doesn't (she's 'mercian) because of taxes and temperature :p. I think the taxes are not going to be that much different now that we are not working and currently HC cost me ~11K a year for the 2 of us as we do not yet qualify for an ACA discount and likely those appear like they are going to vanish shortly. What goes in it's place may even sway DW to move...

though there is that temperature and frozen precipitation thing to overcome. If we moved BC would be the only place she would go though I would be happy to go to Montreal or Ottawa. So the thread is very interesting to me.
 
nuke_diver said:
Well depending on what insurance you have in the US you cannot book directly with a specialist unless you plan to pay for it. I know I cannot and have to go through my GP. I'm a Canadian living in the US (Not dual) and would like to move back but DW doesn't (she's 'mercian) because of taxes and temperature :p. I think the taxes are not going to be that much different now that we are not working and currently HC cost me ~11K a year for the 2 of us as we do not yet qualify for an ACA discount and likely those appear like they are going to vanish shortly. What goes in it's place may even sway DW to move...

though there is that temperature and frozen precipitation thing to overcome. If we moved BC would be the only place she would go though I would be happy to go to Montreal or Ottawa. So the thread is very interesting to me.
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Just paid my BC health insurance premium for the year. $900 CDN. While some provinces do not have a health insurance premium, income taxes are relatively low in BC.

http://www2.gov.bc.ca/gov/content/health/health-drug-coverage/msp/bc-residents/premiums

http://www.taxtips.ca/taxrates/bc.htm
 
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nuke_diver said:
Well depending on what insurance you have in the US you cannot book directly with a specialist unless you plan to pay for it.
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I have no had a great deal of need for specialists but I have seen a few. It has been my experience, to the point of concluding that it is either law or medical ethics of some kind that specialists never see anybody who is not referred from a GP. I have always thrown greenbacks around but "Dr So-and-so only see patients who are referred by another doctor."

Now of course if Warren Buffett who lives down the street here wanted to see a doctor I'm sure he could get one. But my experience specialists don't do "Walk in" traffic. You have to have a sponsor, so to speak
 
razztazz said:
I have no had a great deal of need for specialists but I have seen a few. It has been my experience, to the point of concluding that it is either law or medical ethics of some kind that specialists never see anybody who is not referred from a GP. I have always thrown greenbacks around but "Dr So-and-so only see patients who are referred by another doctor."

Now of course if Warren Buffett who lives down the street here wanted to see a doctor I'm sure he could get one. But my experience specialists don't do "Walk in" traffic. You have to have a sponsor, so to speak
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There is actually a good reason for this. Patients often self diagnose incorrectly. People who take up the specialists' time for a problem that isn't in their area of expertise (a) are more likely to be misdiagnosed (because, for example, an Orthopedic surgeon unconsciously frames everything as a bone problem), (b) waste time making their way to the correct specialist (the pain you thought was a stomach ulcer may be coming from your kidney) and (c) make waiting lists longer for other patients. There is definitely an important role for a general practitioner who can look at the whole picture, is well qualified to treat many common problems, and can triage the patient appropriately.
 
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Meadbh said:
There is actually a good reason for this. Patients often self diagnose incorrectly. People who take up the specialists' time for a problem that isn't in their area of expertise (a) are more likely to be misdiagnosed (because, for example, an Orthopedic surgeon unconsciously frames everything as a bone problem), (b) waste time making their way to the correct specialist (the pain you thought was a stomach ulcer may be coming from your kidney) and (c) make waiting lists longer for other patients. There is definitely an important role for a general practitioner who can look at the whole picture, is well qualified to treat many common problems, and can triage the patient appropriately.
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I can dig that and it does seem almost logical that a cardiologist doesn't open his door for just people looking for heart tests because the first thing the dr is going to do is act like GP to see if there is an indication.

In my case tho I had been repeatedly misdiagnosed/maldiagnosed by doctors who rendered no information but took a lot of money from me and the insurance. I wanted some "Off the books" information to verify/discredit what I was being told. Mostly I didn't need the specialist's opinion as much as I wanted the test/data and sometimes there's the gatekeeper

As it turned out my diagnoses were correct in the first place.
 
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