Is medical insurance a major consideration for you (non US resident)

[Aus_E_Expat]

I see a lot of posts on this site where US residents are concerned about medical insurance and health care costs, even to the point where their employment choices or how long they stay in a job is based on the medical insurance an employer may provide.

I am not a US citizen or resident and while I do have private health insurance, the cost is not so significant that it would impact on my retirement considerations and I could even drop health insurance at a later stage and just rely on the government system.

For other non US citizens or residents, how big a consideration is medical insurance?

 

[FIREd]

Even if I moved back to my European country of origin, medical insurance and health care costs would not be trivial. I would have to pay for basic (public) health insurance and for supplemental (private) health insurance. Dental and vision are not well covered and could add significantly to the cost. Overall, It could be upward of $10K per year.

 

[retirementguy1]

One good answer is to retire in a low tax bracket. In life, make money, keep expenses low, save a LOT of money, retire early. Then get an ACA subsidy. Done.

 

[pb4uski]

Health insurance is ~6.5% of our total living expenses (including our mortgage) and ~8.5% of our total living expenses (excluding our mortgage). And I think our health insurance costs are low compared to others.

Deductibles and co-pays would be on top of these health insurance costs and would add another 3-4% or so but they vary significantly from year to year.

 

[6miths]

Not too much of an issue in Canada. Don't think it enters into retirement planning in a major way. Vision and dental are not covered by the national plan but are not prohibitively expensive. Drugs are not covered until 65 I think but costs are quite reasonable unless one is getting into something very exotic. Major concern for Canadians with respect to health care is most likely if they are traveling to the United States. Definitely a bad idea to cross the border without good supplemental coverage.

 

[pb4uski]

Not too much of an issue in Canada. .....

From another thread, the cost is stealthy as it is embedded in taxes you pay: Health care in Canada is not free, think tank says, claiming average family will pay $11K this year | CTV News

 

[Spudd]

I'm Canadian, and if I retire before official retirement age I'll lose my health care supplemental insurance provided by my company (if I hang in till 55 then I'll get to keep it). However, it only provides me with $1000/year to spend on "alternative" treatments such as massage, physiotherapy, chiropracty, etc, and $200 every 2 years for vision. So for the health care part I can figure on OOP costs of $1100/year above what I pay now (supposing I were to max out the benefits).

The question mark is on dental. My current dental insurance covers 80%, and we both have pretty healthy teeth so haven't incurred any huge expenses. But as we age presumably this will become more expensive. Not sure how much to budget for this.

 

[Meadbh]

I am Canadian also. My basic health care is paid for in my income taxes and a provincial health care premium. Vision care is covered. Dental care is not covered. Here is a link to the coverage list for the province that I live in.

MSP - Medical and Health Care Benefits

I also have a personal health plan through my corporation, which covers any expenses that I incur related to a prescription by a licenced health care professional. This can include glasses, medications, hearing aids, massage therapy, physiotherapy, etc. I pay these expenses from personal funds and submit the receipts to the insurance company with a corporate cheque to cover the expenses plus a premium. I then receive a refund of 100% of qualified expenses. The corporation also pays for a travel health insurance policy for me. The resulting corporate expenses are tax deductible.

So I am not worried about the cost of my personal healthcare.

 

[Safeparachute]

What are the thoughts on having Long term health insurance?

 

[Meadbh]

What are the thoughts on having Long term health insurance?

Do you mean long term care insurance? If so, the Search function will help you locate several previous discussions on this subject.

 

[M Paquette]

Within the United States, having medical insurance is very important. Medical facilities typically have two sets of prices. One set of prices are the rates negotiated with insurance companies, which are what insured persons will pay as part of their 'out of pocket' or deductible costs. The other set of prices, the 'chargemaster' rates, are what a person with no insurance will pay.

The 'chargemaster' rates are set to address what the hospital industry refers to as the "Saudi sheikh problem".

“You don’t really want to change your charges if you have a Saudi sheikh come in with a suitcase full of cash who’s going to pay full charges."
-- Dr. Warren Browner, CEO of California Pacific Medical Center

http://www.nytimes.com/2013/12/03/h...ngle-stitch-tops-500.html?pagewanted=all&_r=0

Medical care, in particular hospitalization, can be extremely expensive for the uninsured visiting the United States.

 

[6miths]

From another thread, the cost is stealthy as it is embedded in taxes you pay: Health care in Canada is not free, think tank says, claiming average family will pay $11K this year | CTV News

Yes as I said, not too much of an issue... money well spent and look at the source: 'conservative think tank Fraser Institute'. Thinks that American health care system rocks. For our family of six, given what we pay in taxes (which also pay for one or two other things I think), I would say it's a great bargain for broad coverage that will never be taken away and provides excellent care.

 

[6miths]

From another thread, the cost is stealthy as it is embedded in taxes you pay: Health care in Canada is not free, think tank says, claiming average family will pay $11K this year | CTV News

Oh my, in reading the article I see that CTV was cherry picking the findings as in the body of the text it said that even this study from a right-wing think tank found, 'According to the study, Canadian families will pay on average between $3,592 to $11,786 for public health insurance in 2014'. I love the media (and 'think tanks' with political agendas. These numbers seem a little more in keeping with our family's reality. At any rate, a bargain even on the high end of this scale.

 

[calmloki]

We have an embarrassment of annual income, but even with that burden my medical insurance will go down by $400/month when I turn 65 thanks to Medicare. Six months later SO will have her insurance costs drop a similar amount. $800*12 = a nice nontaxable raise.

 

[LOL!]

Generally in the USA, folks with jobs of moderate income will have employer-provided health insurance. They would pay part of the premiums out of their paychecks, but the employer would pay most of the premiums, so that the actual cost of the health insurance would be hidden like it is in Australia.

If one is older, then one qualifies for government health care. This is not often known by foreigners that the US Government is one of the largest healthcare providers in the US.

The problem arises for those without jobs or in low paying jobs AND who are not old enough to qualify for government healthcare. That's where the Affordable Care Act has stepped in. We see now on this forum how folks are trying to drive their income low enough to qualify for some of the government subsidies provided by the ACA. Perhaps that is an unintended consequence.

I think there is quite a lot of politics involved with this, but in general, health care is good and affordable in the USA. You wouldn't know it though if you only read media reports about it. I think journalists must work for employers that don't pay well and don't provide health insurance for them. Actually, many journalists are free-lancers nowadays, so that also tints the articles they write.

Anyways for me, I've had health insurance all my life except perhaps when I didn't know I didn't have health insurance (maybe between ages 23 and 26 as a student). I had to buy health insurance when I worked overseas in Europe and the cost was about 25% of my annual salary. Do you know how much it would cost a US ex-pat to have health insurance in Austria or Australia?

So medical insurance is not a big deal for many in the US including me.

 

[kramer]

One (non-obvious) issue for my Canadian friends who spend part of the year abroad is that they can't spend *too* long abroad or they lose all health coverage for a period of time (including coverage when they return to Canada). For most of Canada the allowed annual time period abroad is 6 months although I know it is 7 months allowed in Ontario.

I have a good friend from Ontario and he counts his days every year and is out of the country exactly 7 months even though he would like to be abroad a bit longer than that.

I have learned all sorts of things about Canada since I retired. That is because Canadians travel abroad so much and I have made many Canadian friends even though I didn't know that many while living in the USA.

 

[Surfdaddy]

I am nearing ready to RE at 58 and it is a huge issue. Until the ACA if you had certain conditions you would not be able to buy insurance at ANY cost. That at least is a huge improvement. Still, the costs can be prohibitive if retiring early (before 65). I still have kids in college and at our ages our HC costs were in the neighborhood of $20K/year premiums for a family of 4, with a $5k/year deductible pp/$10K per family. So budgeting almost $30K per year is a huge consideration. I don't really see how anybody can retire before 65 without a ton of money or some other plan provided by an employer.

IMHO the US system is a disaster and we have been fed Kool-Aid about how great the US is. I've traveled a lot internationally and seen other countries. DW and I were on a vacation and met a young German couple - they were taking 2 weeks at a resort where we were taking 1 week. Of course they get mandated 6weeks/yr vacation since that's the law in Germany. They also don't have to worry about being bankrupted by HC costs. They also pay 1/2 the price or less per capita in their society to insure for HC, and their average life expectancy is longer than ours. Frankly, I find the US embarrassing and somewhat apalling. Meanwhile dysfunctional Congress fights because the party is more important than the people. And I won't even get into the pervasive surveillance since we can't go deeply into politics...

 

[eta2020]

Even if I moved back to my European country of origin, medical insurance and health care costs would not be trivial. I would have to pay for basic (public) health insurance and for supplemental (private) health insurance. Dental and vision are not well covered and could add significantly to the cost. Overall, It could be upward of $10K per year.

Same for me. Moving back to EU in most cases will result in higher overall taxes. This is especially if I manage my income stream in such way as to qualify for subsidies in US.

None the less I may move back because I enjoy life in Europe.

 

[fh2000]

I am 58 and looking to RE around January/February of 2015 (this has been a moving target one quarter at a time so far). DW is almost 53 and plans to do the same. We are dual citizens (US and one small Asian country).

My plan is to snowbird between US and home country. We purchased a 2nd home there for our retirement, though our kids are still in college here and likely will stay in US after graduation.

We plan to do Cobra first and then purchase Bronze HSA plan thru ACA for US portion. We are also keeping our National Health Insurance with our home country. They allow us to "suspend" so we do not pay the premium while out of the country. We just need to visit her at least once in every 2 years to re-activate HI.

Our HI in US will function as our disaster insurance. If we have any dental work or chronic issue, we will just buy a ticket and go back home for care. I budget $20K for overall healthcare, and $20K for travel. If a given year we spend more on healthcare, we will reduce travel; vice versa.

During the later years, when our kids establish their own lives, we may stay home longer and longer. We do not purchase Long Term Care insurance here in US. We plan to stay in home country in their long term care facility, which is about 1/3 of the cost there comparing to US standard.

We will try to make the best of the 2 systems.

 

[rodi]

Within the United States, having medical insurance is very important. Medical facilities typically have two sets of prices. One set of prices are the rates negotiated with insurance companies, which are what insured persons will pay as part of their 'out of pocket' or deductible costs. The other set of prices, the 'chargemaster' rates, are what a person with no insurance will pay.

The 'chargemaster' rates are set to address what the hospital industry refers to as the "Saudi sheikh problem".

“You don’t really want to change your charges if you have a Saudi sheikh come in with a suitcase full of cash who’s going to pay full charges."
-- Dr. Warren Browner, CEO of California Pacific Medical Center

http://www.nytimes.com/2013/12/03/h...ngle-stitch-tops-500.html?pagewanted=all&_r=0

Medical care, in particular hospitalization, can be extremely expensive for the uninsured visiting the United States.

The negotiated rates can vary widely among different insurance providers as well. My division at megacorp was sold to a smaller company while my older son was in braces, and the younger son was about to start braces - the same orthodontist. Same amount of time in braces. Less work being done on younger son's mouth (no lower braces for first 8 months.) We paid almost DOUBLE for younger son because the new insurance company with the new megacorp did not negotiate as well. We were grandfathered into the old max lifetime allowance for orthodontics... so it wasn't a max coverage issue. Just a negotiated rate issue.

I had a long discussion with the billing office of the orthodontist... the clerk let it slip that they "loved" my new insurance company. Um, yeah - I bet they do. Closer to the full rate, and so my 20% was also greater.

 

[ShokWaveRider]

I am 60 retired and it is a HUGE issue for me and DW. She has to work because of the potential cost of our combined healthcare. I wish she could quit working but the $3k+ pm we would have to pay till I am 65 is unrealistic. We would earn too much even from passive income to qualify for descent ACA subsidies for the equivalent level of care we get now form DW's job.

Both of us are Canadian too but we do not want to go back to the cold. . We both stop functioning below 75*F.

 

[BTravlin]

I'm 56 and DW is 51. We are US citizens who permanently reside in Mexico. Just renewed our annual health insurance policy at $3,628 for both of us so that is very affordable. Deductibles are quite reasonable and our limited exposure to the health care providers here has been very good so far. The policy also covers us for up to $250k in medical expenses incurred while traveling outside of Mexico. Dental and vision coverage cost extra. We both also just had our semi-annual dental checkup and cleaning for a total of $78. Decent health care at an affordable price is one of the factors we considered when opting to move out of the U.S. and to Mexico.

 

[kcowan]

One (non-obvious) issue for my Canadian friends who spend part of the year abroad is that they can't spend *too* long abroad or they lose all health coverage for a period of time (including coverage when they return to Canada). For most of Canada the allowed annual time period abroad is 6 months although I know it is 7 months allowed in Ontario...

Yes our snowbird coverage is $1500 extra for a couple spending 212 days that BC allows. And dental, drugs and eye-wear are all additional. For a retiree, US Medicare looks pretty good. Especially using Part B and evacuation insurance.

I'm 56 and DW is 51. We are US citizens who permanently reside in Mexico. Just renewed our annual health insurance policy at $3,628 for both of us so that is very affordable. Deductibles are quite reasonable and our limited exposure to the health care providers here has been very good so far. The policy also covers us for up to $250k in medical expenses incurred while traveling outside of Mexico. Dental and vision coverage cost extra. We both also just had our semi-annual dental checkup and cleaning for a total of $78. Decent health care at an affordable price is one of the factors we considered when opting to move out of the U.S. and to Mexico.

Yes the local coverage would be great if we qualified.

 

[ivinsfan]

The cost and system of health care in different countries is really an interesting subject.

Within my own family we had a very interesting apples to apples example this past year.

My DH had a long term heart valve issue which was being watched. He ended up needing bypass surgery to have the valve repaired. This was done withing 2 weeks of some new symptoms starting. After surgery and while on the constant monitoring in the CCU, they found some potential issue with his heart rhythm, has has always been very fit except for the valve problem. He went NPO and early the next morning a cardio rhythm doc came to see him. After taking a family history in which several Uncles, his Dad and one of his Aunts all died from sudden heart attacks ( this was about 25 years ago a presumed to be the result of blocked arteries) the doc said this could be a genetic rhythm issue I think we'll just put in a pacer/defib for safety and your peace of mind. You might never need it, because right now it's not that big of a problem, but better to be on the safe side. Within an hour he was getting his new device.

I have a first cousin in England 54 and dealing with a few issues with her heart. She had a pacer in 3-4 years. Suddenly had such bad angina she went to the ER thinking it was a heart attack. They told her she needed her pacer replaced and put in hospital to watch her. She mentioned to the docs her regular doctor had been telling her for over a year that her pacer battery was getting to the end of its charge. They sent her home with meds for pain, told her not to go to work and they would call her with a replacement date. They called her back in 12 DAYS and schedule her surgery 15 DAYS after that. She told them she was having bad angina attacks 3 or 4 times a week. They gave her a different med on the phone. Then they told her, oh well maybe you do have blockage and we'll just do the artery test when you get your pacer in case you need a stent. My poor cousin spent the next 2 weeks in pain and extremely worried that something major might go wrong while she was sitting at home waiting.

Our health care system is far from perfect, but from my own experience it seems to be a case of people thinking the grass is greener on the other side of the fence. My cousin has worked her entire adult life and paid a pretty penny into the British health care system.