NYEXPAT
Thinks s/he gets paid by the post
Yes, no healthcare mandate!
Interesting idea to beat crazy health care premiums
- Thread starter EastWest Gal
- Start date
Yes, no healthcare mandate!
<mod hat on>
Every thread on health care reform has been closed, some because of politics, others because of too many snarky posts. Why not keep both out of this thread, eh? Most members are trying to have thoughtful discussions around a difficult topic.
<mod hat off>
Every thread on health care reform has been closed, some because of politics, others because of too many snarky posts. Why not keep both out of this thread, eh? Most members are trying to have thoughtful discussions around a difficult topic.
<mod hat off>
TreeHugger
Dryer sheet wannabe
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No I do not. I am just aware that Portugal and Malta are tax heavens in Europe.
I would consider Portugal. Malta is too small.
That tax heaven status is for 10 years. Enough to bridge FIRE date and 65.
daylatedollarshort
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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I've never been to Portugal, but we're considering checking it out because of a relatively large English speaking population and a Mediterranean climate, which we've gotten used to and are not eager to give up.
AARP has this to say, "Another inexpensive country, Portugal also entices retirees with its low cost of living and real estate. A couple can do well on just $1,700 a month in many smaller cities; in Lisbon, the capital, about $2,200 a month or more is needed. Other big draws are the usually mild climate and the country’s superior red and white wines. (The seafood is excellent, too.) The laid-back atmosphere means less stress, and the western coast, lined with beaches, offers plenty of recreational opportunities."
Living costs of $2.2K a month? Pre-ACA I think our health insurance premiums here alone (when we had dependent kids) were more than that for a high deductible and high out of pocket max policy.
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Portugal has become quite an attractive destination for Europeans trying to escape either high living costs or high taxes in their home country. And the climate is nice too. But do your research. That "laid back atmosphere" can be maddening for those who are used to or value more efficient/convenient ways of doing things.
meierlde
Thinks s/he gets paid by the post
Since there is no mandate to purchase coverage no need for an out of country exception. The end of the mandate is one of the big items. note that the IRS decided not to enforce the mandate this year also.
I am covered by my home country universal healthcare. Our plan up to now was to use it only when we visit home and buy ACA as primary.
With this new development, we may have to switch to home healthcare as primary. Buy catastrophic insurance in US (if there is one) for emergency hospital stay. For any non life threatening illness, buy a ticket and fly home.
meierlde
Thinks s/he gets paid by the post
BTW the proposal includes a 30% up charge if you aren't covered by us health insurance and start taking it later (I have not seen addressed what would happen with a part time resident)
NW-Bound
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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When something is "free", there has to be some quota or some wait time. There has to be some mechanism to keep people from running to a doctor for every sniffle or headache. That mechanism can be in the form of a higher copay, or a high deductible as in my pre-ACA PPO plan.
With that $10K deductible, I could go to any specialist I wanted, no referral needed. The specialists informed my GP as a professional courtesy, but my GP took a backseat to the treatment. Why involve my GP for more costs? The policy allowed me to do that, because I had to be really sick and worried about my health to be willing to pay that $10K. The deductible acts as the gatekeeper, not my GP.
The current ACA policy I have now says I can do the same, even though it is HMO and not PPO. Why? The deductible is now $13,100, and so the same logic applies. The insurer pays nothing until I exceed that limit. It makes things a lot easier.
I know this may not work for other people, but it does for me. Even when young, I always had money put aside for emergency such as having to buy a new car or a new roof. And a life-threatening illness is certainly worthy of spending that money.
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Hyperborea
Thinks s/he gets paid by the post
We've been a number of years ago and we enjoyed it. My wife and I are planning to take another trip next year as a more focused exploratory trip. Following that we need to spend some time elsewhere for a while.
For us, this is being considered not just staying in Portugal but as a base from which to explore the rest of Europe. I currently have EU citizenship, British, but won't be able to make the move to Portugal before the Brexit divorce is over. I may regain EU citizenship since my sub-citizenship is Scottish. However, at this point I'm not assuming that will work out. For non-EU citizens you need to get a visa for long stay before you go to Portugal. I've found the forms online and some but not much discussion of how hard the process is. This is an area that I would like to know more about.
When you arrive you need to file a bunch of paperwork for registration of your residency and get a financial number (similar to a SSN) etc. etc. You will need to provide your own health insurance. I would be interested in hearing reports of how this process all worked out.
You don't actually file for the non-habitual residency until the following year when you file your taxes. To be a non-habitual resident you need to meet one of two qualifications: 1) remain in Portugal for 183 days in a year; or 2) have a dwelling in Portugal on 31 December with the intention to hold it as your habitual residence. You get 10 years under this scheme.
The tax free status gives you a break on income earned in Portugal in a high value add occupation (doctor, engineer, lawyer, etc.) and you don't get taxed in Portugal on earnings in another country which were subject to tax in the source country. That last one is a bit confusing and I've seen interpretations that say that dividends, interest, and capital gains (amongst other things) are not taxed. However, interpretations from probably more reliable sources say that capital gains are taxed since they are not "subject to taxation in the source country" under most tax treaties. This may not matter much for Americans since they will have to pay tax to the US no matter what though this might mean that there is no extra tax on the top if the Portuguese rate is higher since they avoid that under this special status (except for capital gains).
So, since I want to use Portugal for a base to explore Europe and won't be there for the required 183 days I plan to buy a place to occupy over the 4-6 months of the winter/late fall/early spring. If a rental during that time would count as a habitual residence then that might work but I would like to be able to leave stuff in the place while I'm traveling the rest of the year. I might consider renting the place out during that time.
If the interpretation is correct that capital gains is taxable in Portugal then I will probably need to structure my non-tax deferred accounts to need no rebalancing (e.g. total world index or something like it) and to live off the dividends and supplement that with cash from CDs or similar while I am a non-habitual resident of Portugal.
True, but I sure hope not. Every doc I have in CA has a big sign in their waiting room "we do not accept Covered CA". If CA goes to single payer, I really worry how we will access quality care.
Instead of becoming a resident in a place like Portugal wouldn't it be easier to leave at 183-1 days and avoid the whole tax situation? Since you are a UK citizen you can always move back if you get a serious medical condition and it should be covered as long as you can convince them you are ordinarily resident. Just get a accident/repatriation policy.
zinger1457
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But a single payer system would include everyone correct? In that case the doctors wouldn't have a choice if they wanted to stay in business.
. No, not necessarily. Many places with single layer also allow private payments to providers. If not, they could choose to move. Lots of people would change locations to avoid a substantial pay cut.
ShokWaveRider
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
I was considering moving back to Blighty too. But DW is not a UK Citizen. New rules make it quite inconvenient to sponsor her with a Spousal Visa. I still have my Old Paper UK drivers license that runs out in 2020.
I think, I prefer Canada as I am a Canadian also so is DW.
Re California, if they adopt a single payer, doctors will have to comply or move as the majority of folk will most likely take it.
I for one would move back to CA (South Orange County) in a heartbeat if they had a single payer system. Taxes or no taxes it is well worth the peace of mind.
I think, I prefer Canada as I am a Canadian also so is DW.
Re California, if they adopt a single payer, doctors will have to comply or move as the majority of folk will most likely take it.
I for one would move back to CA (South Orange County) in a heartbeat if they had a single payer system. Taxes or no taxes it is well worth the peace of mind.
Hyperborea
Thinks s/he gets paid by the post
Well, while I have UK citizenship my wife does not and as mentioned above that gets problematic and may get more so after Brexit. There's also the Schengen 90 day limit that will make traveling more complex. Being a resident of Portugal would allow one to stay inside the Schengen zone as long as one wants. Another problem is taxation and since one must be a tax resident somewhere, I don't want to get randomly stuck with a tax residency based on where I've been traveling so I want to proactively choose one and preferably one with favourable tax laws.
Oh, as well the link to the Portuguese non-habitual resident info would probably be helpful. This is an official site from the Portuguese government tourism office.
Tax regime for non-habitual residents - Living in Portugal
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Fedup
Thinks s/he gets paid by the post
This is one reason I suggested to my kid to go with Kaiser. Kaiser has top rating from consumer report. She had her first visit for flu shot and was very pleased.
Fedup
Thinks s/he gets paid by the post
There is still a private business in UK. Doctors only have to work part time to NHS.
Alex The Great
Recycles dryer sheets
I wonder what does it mean? Covered CA offer multiple plans provided by different companies such as Blue Cross, Kaiser, etc. Do you mean all these plans are not accepted? I know some providers abandoned CoveredCA such as UHC. But there are plenty of others still in.
P.S. I did some Internet search and indeed the issue is real and it is directly related to PPO providers under CoveredCA such as Blue Cross, Athem Blue Shield. It is sad to know that HMO like Kaiser left as the only choice, given its disadvantages
http://abc7news.com/health/covered-california-patients-say-they-cant-find-a-doctor/522857/
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daylatedollarshort
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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I wonder what does it mean? Covered CA offer multiple plans provided by different companies such as Blue Cross, Kaiser, etc. Do you mean all these plans are not accepted? I know some providers abandoned CoveredCA such as UHC. But there are plenty of others still in.
P.S. I did some Internet search and indeed the issue is real and it is directly related to PPO providers under CoveredCA such as Blue Cross, Athem Blue Shield. It is sad to know that HMO like Kaiser left as the only choice, given its disadvantages
7 On Your Side: Covered California patients under Blue Shield, Anthem Blue Cross say they can't find a doctor | abc7news.com
We've not had any issues so far, though we live in an urban area. Our regular hospital, labs, doctors and urgent care are all on our Covered CA plan and the list of network doctors seems quite large. Only our eye doctor was not on our Covered CA plan, but finding another one was not a problem. There are 1.5M Covered California customers so are 51 Blue Shield and 94 Anthem complaints in the link above indicative of a huge problem? We do always confirm with the doctors / labs that they are in network and do not go solely by the provider lists, though sometimes in our experience they leave out providers that are actually in network, so it is more likely a problem with accuracy than planned deception.
If the insurance company provider lists have 9 - 13% error rates as mentioned in the article, that doesn't quite jibe with the man who said he was calling all over and no one would take Covered California. If the provider network lists are 87 - 91% accurate, then it would seem like if he made calls for appointments based on the lists, the majority of doctors he called would still be in network.
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I can tell you how it works for Ohio Medicaid. You get a list of providers "who take Medicaid." Then you start calling them and find that only 3 in 100 are taking new Medicaid patients. Surprise! So, the supplied list is 100% accurate and 97% meaningless if you are on Medicaid and looking for a doctor.
This gets to the bigger point about "being covered" WRT health insurance. "Having coverage" is sometimes very different from being able to actually get quality care. Everyone on Medicaid is "covered," but you can be sure that many aren't able to get quality treatment in a timely manner.
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+1
I know the UK is single payer but has many private hospitals and many health insurance companies.
Even back in the late '70s and '80s I used to have private health insurance provided as an employee benefit. (We moved to the US in 1987). When we returned last year I looked into the cost of private HI getting quotes from a broker, and a policy for the 2 of us (ages 61 and 62) would cost $100/month, $650 deductible each, 100% coverage after that, and it includes both optical and dental coverage, no deductibles for optical and dental. (Optical only includes new glasses/contacts if the prescription has changed, dental includes 2 check-ups/year)
NW-Bound
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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We are down to a single ACA insurer in 2017 for our metropolitan area of several millions. The GP that we have used for perhaps 15 years is not on their plan. I don't know what the problem is. So, we had to go to another doctor. No problem with choosing another doctor, and we had several to chose from.
My wife just had her first visit to discuss the mild osteoporosis treatment that she was having with the former doctor. The bill came to about $250. The former doctor charge would be about 1/2 that.
When you have to foot the entire bill for everything until you hit $10K or $13K a year, you pay more attention to your healthcare cost.
My wife just had her first visit to discuss the mild osteoporosis treatment that she was having with the former doctor. The bill came to about $250. The former doctor charge would be about 1/2 that.
When you have to foot the entire bill for everything until you hit $10K or $13K a year, you pay more attention to your healthcare cost.
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I watched a documentary the other week following St Mary's NHS trust in NW London. It also operates a private hospital adjacent to the main NHS hospital and the profits from the private hospital go to the NHS hospital.
I would look at different locations in the US before I looked outside the US. Every state is so different and every area, that if its health care your worried about, there would be plenty of options in the US.. like states that don't factor in age. Obviously the biggest issue is you would have to actually move permanently as at this point coverage outside your area is usually limited to emergency only on the individual plans.
Good luck. The amazing thing to me is just how vastly differently health care premiums/plans are. My BF just got let go from his job. His Cobra is going to be $200 less than the ACA plan he was previously on (granted no subsidy), but with the difference in what it covers in scripts, it will save us an additional $150/month, so with $350/month savings, its cheaper than the ACA plan with subsidy. somethings wrong when cobra is less than aca.
Good luck. The amazing thing to me is just how vastly differently health care premiums/plans are. My BF just got let go from his job. His Cobra is going to be $200 less than the ACA plan he was previously on (granted no subsidy), but with the difference in what it covers in scripts, it will save us an additional $150/month, so with $350/month savings, its cheaper than the ACA plan with subsidy. somethings wrong when cobra is less than aca.
