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Old 03-13-2017, 08:13 AM   #41
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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.
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Old 03-13-2017, 08:14 AM   #42
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Originally Posted by EastWest Gal View Post
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.
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Old 03-13-2017, 08:21 AM   #43
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.... 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.).
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Old 03-13-2017, 08:53 AM   #44
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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.
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Old 03-13-2017, 09:00 AM   #45
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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.
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Old 03-13-2017, 09:35 AM   #46
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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
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Old 03-13-2017, 09:35 AM   #47
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Panama is also another country worth looking at.
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Old 03-13-2017, 09:46 AM   #48
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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.
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Old 03-13-2017, 09:50 AM   #49
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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.
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Old 03-13-2017, 09:53 AM   #50
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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.
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Old 03-13-2017, 09:59 AM   #51
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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.
I checked on Kaiser, they have catastrophic plans, it would cost my kid $178 vs $268 Silver plan. Almost half off the silver premium.
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Old 03-13-2017, 10:34 AM   #52
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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
Can you provide some sort of link to that info? The only thing I can find is you are exempt from the penalty if the lowest cost bronze plan is more than 8.13% of your income....nowhere can I find that a catastrophic plan is available to you if you're over 30. None of the hardship exemptions show this in regards to who over 30 is eligible for a catastrophic option.
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Old 03-13-2017, 10:38 AM   #53
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If you are exempt from the penalty due to affordability then you are eligible to buy catastrophic coverage even if you are over 30.

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Who can buy a Catastrophic plan

Only the following people are eligible:
  • People under 30
  • People of any age with a hardship exemption or affordability exemption (based on Marketplace or job-based insurance being unaffordable)
https://www.healthcare.gov/choose-a-...ns-categories/
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Old 03-13-2017, 10:53 AM   #54
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OP, What is the basis for you acquiring residency in Mexico? I would look at which countries would let me establish residency and then where in that country they have IJC accredited hospitals. Then look into international healthcare plans that give you access to these hospitals as well as limited access in the USA.

A friend of mine (63) has International insurance and it runs about $200/mth. Max 6 mos. in the USA, I believe.

His prior policy ran about $400 a month but was cancelled under ACA. He works around the world as a consultant in the oil industry and big companies require him to have an international policy.

Two years ago a friend who lives here and in Houston spent 6 mos in an intensive care ward here (Peru) as most of his major organs failed. Ran up a bill of $340,000 which was eventually covered by BCBS Texas. After they paid, they said they did not recall selling a policy with international coverage for years and how did he get it.
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Old 03-13-2017, 01:12 PM   #55
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OP, What is the basis for you acquiring residency in Mexico? I would look at which countries would let me establish residency and then where in that country they have IJC accredited hospitals. Then look into international healthcare plans that give you access to these hospitals as well as limited access in the USA.
Look into San Javier hospital in Guadalajara.
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Old 03-13-2017, 10:01 PM   #56
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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.

Right how DH and I have an average Silver Plan through the ACA costing us $22,740/year, no subsidies. For kicks, letís say the new plan goes into effect in 2019. We will both be eligible for Medicare in 2024. Assume our premium jumps to 5x the minimum premium in 2019 and there is no premium decrease. Assume a 5% inflation rate per year, including next year. Assume we get ACA insurance next year but the program phases out starting in 2019. 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. There is no political will to reign in costs, and market forces won't work when costs are hidden behind insurance companies. Between us we have had less than 10 visits for anything other than routine health maintenance over the past 17 years. My husband is on a statin and Iím not on any meds, losing weight to my ideal weight in about a year. No big family history risk. We donít smoke and we barely drink.

Here is the idea: In early 2019, buy a home in Mexico, either San Miguel de Allende or by Lake Chapala. Obtain a temporary visa, good up to four years (through 2023). DH moves exactly 4 years before his 65th birthday in January, I do the same in September. Move there, obtain Mexican health insurance. Also purchase Global Health Insurance for travel anywhereóthis is for catastrophic problems. Snowbird back and forth, spending just over 6 months in Mexico, and the rest at home. At the end of that time, sell the Mexican home. Or if we like it better there...you get the idea.

Basically, we would use the money thrown away on these exorbitant health care premiums to buy a house, use Mexican residency to get health insurance and make us eligible for global health insurance which includes the U.S. for a fraction of the cost. We get an extra house which will appreciate over time. It seems to make sense to invest that money in real estate rather than throwing it at an insurance company.

What do you all think?
I agree with the suggestion to rent/lease in Mexico rather than buy - at least for the first couple of years - but first, you should look at some other states. I have a Gold plan in CA that costs about $700/mo. without subsidies and I my rates went down $.01 this year. No doubt, some states will do much better than others in keeping costs down. With a Democratic super-majority in California [also the world's 6th largest economy] I don't expect our health care costs to change a lot from where they are today.
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Old 03-13-2017, 10:32 PM   #57
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For several years now I've been thinking that the amount of money I needed to reserve for healthcare in the US could buy me another home in Canada. So that option is available and would have some benefits (closer to both our families). But life is very comfortable here in CA.
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Old 03-13-2017, 10:50 PM   #58
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... 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.
Indeed survival rates for cancer vary greatly between different stages. The earlier it is detected, the far better the chance.

Then, I also recall reading that the determination of the cancer stage is not as precise as one would think.
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Old 03-13-2017, 11:01 PM   #59
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For several years now I've been thinking that the amount of money I needed to reserve for healthcare in the US could buy me another home in Canada. So that option is available and would have some benefits (closer to both our families). But life is very comfortable here in CA.
Not as cold, eh?
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Old 03-13-2017, 11:42 PM   #60
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Panama is also another country worth looking at.
I'm looking into this. I like the idea of them using the Dollar, quality of HC, scuba diving, and the fact they are gun friendly.

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OP, What is the basis for you acquiring residency in Mexico? I would look at which countries would let me establish residency and then where in that country they have IJC accredited hospitals. Then look into international healthcare plans that give you access to these hospitals as well as limited access in the USA.

A friend of mine (63) has International insurance and it runs about $200/mth. Max 6 mos. in the USA, I believe.

His prior policy ran about $400 a month but was cancelled under ACA. He works around the world as a consultant in the oil industry and big companies require him to have an international policy.
I wonder if this would work for me with a lake home in MN (haven't acquired as of yet nor have I retired) that I would live in for 182 days or less per year and the rest in a place like Panama.
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