Interesting idea to beat crazy health care premiums

[Fedup]

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.

 

[Joylush]

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.

 

[pb4uski]

If you are exempt from the penalty due to affordability then you are eligible to buy catastrophic coverage even if you are over 30.

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-plan/plans-categories/

 

[NYEXPAT]

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.

 

[NYEXPAT]

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.

 

[Starsky]

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, let’s 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 I’m not on any meds, losing weight to my ideal weight in about a year. No big family history risk. We don’t 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 anywhere—this 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.

 

[photoguy]

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.

 

[NW-Bound]

... 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.

 

[NW-Bound]

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?

 

[Johanson]

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.

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.

 

[Meadbh]

Speaking of survival rates, there is a new study out today that shows diffferent survival rates for cystic fibrosis in Canada and the US. The news story identifies some possible contributory factors.

Cystic fibrosis patients in Canada living more than a decade longer than those in U.S.: study | CTV News

 

[NW-Bound]

Perhaps the US system treats patients with acute conditions better than those with chronic illnesses.

But speaking of Canada and the reputation for long wait times, I just saw this article: Canada's healthcare wait times in 2016 longest-ever recorded: Fraser Institute report | CTV News.

In Ontario, the best province, the GP-to-specialist wait time is 7.2 weeks, and specialist-to-treatment is 8.4 weeks. The worst province is New Brunswick with 21.5 and 17.4 respectively. That is awful.

Earlier, I said I was quite happy with the treatment of a serious life-threatening illness. With my pre-ACA plan in 2013, I could go to any specialist myself without waiting for referral from the GP, so I skipped the GP. Saw this specialist in 4 days.

The diagnosis was positive when the result came back the next day. After calming down, I found myself another specialist, whom I saw in 2 days, who immediately referred me to a surgeon whom I happened to choose already. They turned out to be friends. I saw the surgeon the very next morning. They coordinated the treatment, and referred me to another specialist yet, whom I saw 2 weeks after the positive diagnosis.

The course of treatment started with a surgery in a hospital less than 4 weeks after I thought something was wrong with me. As mentioned earlier, it involved 2 minor surgeries, 2 major ones, and numerous CAT scans, tests and procedures that lasted 2 years.

I don't think any place could do any better than that, unless I were a billionaire. It cost me $20K in deductible over 2 years (not including follow-ups), and my insurance a bit less than $200K.

So, as I mentioned in the earlier post, other than the cost, everything was great. Hospital rooms were nice and clean. I had my own room for both major surgeries. One hospital had an awfully nice menu I could order from, but I recovered so well that just as they allowed me to have solid food, they kicked me out before I could try one interesting dish (forgot what it was). Well, maybe it would not be really that good, but I felt I needed some real food to ease the surgery pain.

 

[Meadbh]

NW-Bound, I'm glad you received such prompt and excellent treatment. What would the situation have been had you been uninsured?

 

[NW-Bound]

My friend has a nephew with the same illness before I did. I do not know the severity, and all the details. The young guy applied for the state indigent assistance program, got the treatment and surgery, and was still alive when I talked with my friend about my disease. My friend was consoling me that it would be OK when telling me about his nephew.

I did not ask, and my friend probably would not know, about the wait time to get approval for that assistance. Where did the nephew get the treatment and surgeries, I do not know, and my friend most likely would not either.

 

[NW-Bound]

I realize I did not really answer your question about my own situation.

I would not be eligible for indigent assistance. And I have always had insurance. So, I did not find out what I would have to do.

I guess I would try to negotiate with the providers, and if they gave me the same $200K bill, I would have to take it as I valued my life.

 

[TreeHugger]

Right how DH and I have an average Silver Plan through the ACA costing us $22,740/year, no subsidies. For kicks, let’s 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.

What do you all think?

1) This is not a worst case scenario. CBO expects Insurance rates will initially rise by 15-20 percent.

2) Do not buy real estate outside of the US.

3) Consider Non-Habitual Residency in Portugal (Tax Heaven). Portugal is safer, with better infrastructure and friendly people.

4) Consider moving to Hawaii or Massachusetts. US States with best healtcare laws/affordability.

 

[EastWest Gal]

Not a terrible idea, worth looking into.

PS, if you are serious, start learning Spanish now. I'm sure more folks in Mexico speak English well, than in the US folks speak Spanish, but it will be a handy skill to have especially if you end up in hospital for any period.

The places listed are large expat communities. I also have a second cousin in Los Cabos, we don't know each other well but after my aunt's funeral in February, cousin's blood has grown thick. And I speak some already. I know a bit of the medical terminology from work.

I'm only partly serious. But that part could grow. It's hard to believe this is happening. But our premiums are also unbelievable.

 

[EastWest Gal]

1) This is not a worst case scenario. CBO expects Insurance rates will initially rise by 15-20 percent.

2) Do not buy real estate outside of the US.

3) Consider Non-Habitual Residency in Portugal (Tax Heaven). Portugal is safer, with better infrastructure and friendly people.

4) Consider moving to Hawaii or Massachusetts. US States with best healtcare laws/affordability.

Doc Severinson moved to San Miguel de Allende in 2006. That area is safe and retiree friendly, apparently with good medical care. But your ideas are decent too.

I've looked into Portugal and I didn't think about Hawaii or Massachusetts. And California is considering their own health care legislation. Moving to California would be moving home.

 

[photoguy]

Not as cold, eh?

Well the cold is certainly a factor, and I didn't like needing an ice scrapper for my glasses when I came back home (moisture would condense and then freeze on them). But there's lots of other things to like about the US & San Diego area -- no mosquitos when camping for one thing. I've gotten more mosquito bites in one trip to Algonquin park than I have in my entire time in the US (~20 years).

 

[fh2000]

Current law has residence test:

"Americans who are NOT residents of the USA, do NOT have to participate if you meet the requirements of being a resident of another country (or if you are outside the USA for 330 days or more per year). "
https://yucalandia.com/living-in-yu...res-effects-on-american-expats-living-abroad/

Does the new proposal include something similar?

 

[Pilot2013]

IDK, how about instead of abandoning family and friends where you have spent 95% of your life, just make a plan that includes HI costs as part of your ER planning? But then that wouldn't make a statement....

 

[daylatedollarshort]

IDK, how about instead of abandoning family and friends where you have spent 95% of your life, just make a plan that includes HI costs as part of your ER planning? But then that wouldn't make a statement....

That could be $50K a year or more with deductibles. Some might rather spend that money on a villa in Spain, make new friends and have extra money to travel and pay to have friends and family visit. Many of us have already moved away from the towns we grew up in so there's no family around. Some posters here or their spouses aren't from the U.S. anyway. The U.S. is a big place. We'd actually be closer to family if we moved to Mexico than if we stayed put.

Some of our friends have already moved away in retirement to lower cost of living areas, even before the ACA repeal popped up. From what I've read LTC costs are also significantly less than $100K a year in every country outside the U.S. There are many compelling reasons to consider a move for some of us.

 

[kcowan]

My son lives in Ontario. He was diagnosed with testicular cancer in April 2016. He was admitted to the operation in May and began radiation treatment in June. I think the wait times are because everyone goes to the hospital because it is free. But at least they do triage on life-threatening diseases.

 

[Pilot2013]

That could be $50K a year or more with deductibles. Some might rather spend that money on a villa in Spain, make new friends and have extra money to travel and pay to have friends and family visit. Many of us have already moved away from the towns we grew up in so there's no family around. The U.S. is a big place. We'd actually be closer to family if we moved to Mexico than if we stayed put. Some of our friends have already moved away in retirement to lower cost of living areas, even before the ACA repeal popped up. From what I've read LTC costs are also significantly less than $100K a year in every country outside the U.S.

Each person has to make their own decision about how much it means, or how important it is for them to ER, and what they are willing to give up. Maybe I will get to the point that I will leave the State, Country that I call home so that I don't have to work a few more years. I just haven't gotten there yet....

yet.

 

[Hyperborea]

3) Consider Non-Habitual Residency in Portugal (Tax Heaven). Portugal is safer, with better infrastructure and friendly people.

Do you have any first or second hand experience with this? I have been considering this as a way to have a base to explore Europe from.