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Old 12-29-2020, 08:13 AM   #81
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most countries in Europe will also declare you resident after a few months and then tax your worldwide income including social security etc, even if you leave that money in the US.
Looking into potential tax situations before moving anywhere should be right on top of everyone's list. That goes for international and domestic (between states) moves.

I think once you're not on a tourist visa, staying anywhere longer than 6 months, you should assume you'll be taxed as a local unless you're under some special exemption program, ie. Portugal's non-habitual tax residency or Taiwan's Golden Visa - both are temporary however.
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Old 12-29-2020, 10:43 AM   #82
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I should probably post this question on a separate thread, but since so many current/former expats are responding to this thread, I’ll ask here. For those of you with pre-existing conditions who purchased expat health insurance (not travel insurance), were you successful? Were you turned down by one or more companies before finding a provider who would insure you?

While I’m hoping to stay in the US, leaving the country might be a possibility if the ability to get health insurance here ever goes away. I think my top choices would be Portugal or Spain but would consider Central or South America. But my concern is the ability to purchase health insurance when I have pre-existing conditions.
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Old 12-29-2020, 11:05 AM   #83
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I should probably post this question on a separate thread, but since so many current/former expats are responding to this thread, I’ll ask here. For those of you with pre-existing conditions who purchased expat health insurance (not travel insurance), were you successful? Were you turned down by one or more companies before finding a provider who would insure you?

While I’m hoping to stay in the US, leaving the country might be a possibility if the ability to get health insurance here ever goes away. I think my top choices would be Portugal or Spain but would consider Central or South America. But my concern is the ability to purchase health insurance when I have pre-existing conditions.
I haven't had to pull the plug yet but from my research this might be the only option for the pre-existing conditions folks:

https://www.aaro.org/health-insuranc...insurance-plan

Edit: as the follow up posts suggest, it might be cheaper to pay for routine care out of pocket but this particular insurance offers a catastrophic/hospital only option which might be all that's necessary. As a recent heart attack survivor I wouldn't be very comfortable without it.
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Old 12-29-2020, 11:05 AM   #84
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I should probably post this question on a separate thread, but since so many current/former expats are responding to this thread, I’ll ask here. For those of you with pre-existing conditions who purchased expat health insurance (not travel insurance), were you successful? Were you turned down by one or more companies before finding a provider who would insure you?

While I’m hoping to stay in the US, leaving the country might be a possibility if the ability to get health insurance here ever goes away. I think my top choices would be Portugal or Spain but would consider Central or South America. But my concern is the ability to purchase health insurance when I have pre-existing conditions.
How much does it cost to treat your pre-existing conditions?

If they're well-controlled already with drugs it might be cheaper to forgo health insurance and just pay for the medications out of pocket in another country since most impose price controls, especially on "maintenance" drugs for common, chronic conditions.

You can always sign up for Part B as an option to return to the U.S. for specialized treatment under Medicare once eligible...years ago I followed online one U.S. expat in Mexico who returned to the U.S. for an organ transplant, covered by Medicare.
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Old 12-29-2020, 11:11 AM   #85
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How much does it cost to treat your pre-existing conditions?

If they're well-controlled already with drugs it might be cheaper to forgo health insurance and just pay for the medications out of pocket in another country since most impose price controls, especially on "maintenance" drugs.

You can always sign up for Part B as an option to return to the U.S. for specialized treatment under Medicare once eligible.
Exactly. You’ll be pleasantly surprised how inexpensive it is to pay out of pocket.
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Old 12-29-2020, 05:05 PM   #86
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How much does it cost to treat your pre-existing conditions?

If they're well-controlled already with drugs it might be cheaper to forgo health insurance and just pay for the medications out of pocket in another country since most impose price controls, especially on "maintenance" drugs for common, chronic conditions.

You can always sign up for Part B as an option to return to the U.S. for specialized treatment under Medicare once eligible...years ago I followed online one U.S. expat in Mexico who returned to the U.S. for an organ transplant, covered by Medicare.
How much my pre-existing conditions cost to treat is not the issue. European countries require the expat to have health insurance as a prerequisite for applying for residency.

Can somebody with pre-existing conditions who has had to purchase expat health insurance please answer my question? Thank you.
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Old 12-29-2020, 06:23 PM   #87
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We were shocked at how little we paid for a hospital visit in Malaysia four years ago. And how quickly the MRI was organized. Half day stay in emerg. Cost was $850 CAD, $650 USD. Here is what it included.

-1/2 day at a hospital emerg for dW

-xrays of her back, consult

-MRI of her back 90 minutes after consult (radiologist called in from home)

-second physician consult

-CD of the MRI, the Xrays, complete written report for our health insurer

Everything itemized right down to the disposable paper covering on the ER trolley!

-one weeks supply of pain drugs

The next surprise....how little we paid to refill the prescription drugs and how easy it was to get a months worth prior to going on to Australia.

No wonder our out of country medical insurer reimburseed our claim so quickly without one follow up question!
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Old 12-29-2020, 06:46 PM   #88
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We were shocked at how little we paid for a hospital visit in Malaysia four years ago. And how quickly the MRI was organized. Half day stay in emerg. Cost was $850 CAD, $650 USD. Here is what it included.

-1/2 day at a hospital emerg for dW

-xrays of her back, consult

-MRI of her back 90 minutes after consult (radiologist called in from home)

-second physician consult

-CD of the MRI, the Xrays, complete written report for our health insurer

Everything itemized right down to the disposable paper covering on the ER trolley!

-one weeks supply of pain drugs

The next surprise....how little we paid to refill the prescription drugs and how easy it was to get a months worth prior to going on to Australia.

No wonder our out of country medical insurer reimburseed our claim so quickly without one follow up question!
I went to the emergency room in Chiang Mai with the fractured big toe. It was more or less the same efficiency - admission, nurse, doctor, x-rays, doctor again, painkillers, payment - the whole ordeal lasted 2-3 hrs and cost me $46. I didn't even bother submitting the claim to the insurer in US. Oh, and I only wish hospitals in US look like the one I visited.
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Old 12-29-2020, 06:47 PM   #89
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Can somebody with pre-existing conditions who has had to purchase expat health insurance please answer my question? Thank you.

My comment is not based on my personal experience but on the experience of good friends who have been retiree expats in Spain for over 4 years. When they moved there, he had a preexisting immune disorder, and they successfully obtained affordable, private health insurance. After one year of residency, they received their national health insurance cards. They have generally been pleased with the quality of care in the Spanish system.
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Old 12-29-2020, 07:44 PM   #90
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How much my pre-existing conditions cost to treat is not the issue. European countries require the expat to have health insurance as a prerequisite for applying for residency.

Can somebody with pre-existing conditions who has had to purchase expat health insurance please answer my question? Thank you.
DW (who has type-2 diabetes) and I had no trouble purchasing local health insurance through our local bank when we moved to Portugal 2 years ago. I was 63 and she was 61. The insurance plan, the same one that the bank executives use, cost a fraction of the cost of the one that I had back home, although to be fair the coverage was also less broad in terms of choice of hospitals outside Portugal. I was told that it would have been harder/more expensive if either of us had been 65 or older. We have been renewing it at close to the original cost, though, even though I am now 65.

As others have mentioned, medicines prescribed by a doctor are heavily subsidized and therefore inexpensive. Annual flu shots are free, even in pharmacies. Once we got our residence cards, we were not only able to, but required to, register with the national health service (to be able to get an “official” health examination in order to exchange our driving licenses for local ones). After that, however, we have only used private doctors and exams.
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Old 12-30-2020, 02:48 AM   #91
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How much my pre-existing conditions cost to treat is not the issue. European countries require the expat to have health insurance as a prerequisite for applying for residency.

Can somebody with pre-existing conditions who has had to purchase expat health insurance please answer my question? Thank you.
I had pre-existing conditions and I got private health insurance when I returned to the UK in 2016. It is also not mandatory to have private insurance to become a resident here, but the cost of a visa includes an annual payment to the NHS. I don’t know about other European countries, I expect the situation will vary quite a bit. When we moved back it was before the EU leave referendum so the UK was still a full member.
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Old 12-30-2020, 03:09 AM   #92
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The UK surcharge is £624 per year per person for anyone under immigration control. Citizens just move back and they are good, no charges, as long as the move is for a settled purpose and not just a visit.
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Old 12-30-2020, 04:05 AM   #93
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So when I went for private insurance in Malta I had to disclose that I had surgery for a broken leg a few years before. The insurance company wanted to exclude any medical issues related to legs as a pre-existing condition. I was able to push back on this saying that I had no real current conditions and in the end they didn't put it in. Its pretty much the same conversation that everyone with individual policies used to deal with in the USA, pre obamacare.

I have a friend with pre-existing conditions that this didnt work for though. And he set up a company with himself as a salaried employee. That allowed him to pay into the social security system and get public cover.

Also I have no guarantee that my current private insurance will be renewed each year. The insurance company can always cancel, and I might be too old to be accepted as a new customer by another company then.

Another thing to consider for people with pre-existing conditions is that the culture in most european countries is to offer out of the box treatments only. If you have cancer for example your doctor wont be on the lookout for experimental therapies etc. You will only be offered the vanilla coverage approved by the government. This is where the healthcare is very different in Europe vrs the USA. For example the Shingrix vaccine is still not available in any EU countries despite the fact that it was EU approved in 2018. We still only have the old vaccine here. So return to the USA for medical is always a possibility should you be unlucky enough to need the care that is only available in the states.
Its not quite the free lunch that people make out.
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Old 12-30-2020, 05:46 AM   #94
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Alan - Yes, and if you are retired you only need to file in the US and not at all in your host country. We are in Hungary on Permanent Residence visas and we don't even have a taxpayer ID number here. We only file in the US. America is unique in requiring expatriots to file annual taxes when living permanently abroad. However, some countries (Hungary for example) will not pay any social security pensions if you live outside the country. At least the US hasn't done that (yet). But, social security pensions here are not taxed as income at all which is different than in the US. Both my military pension and social security are taxed. Hungarians also don't file their taxes at all as it is handled in the payroll deduction directly using a fixed rate of 16% unless there are deductions which is very rare and only include private pension plans and not debt interest like in the US. However, we also have no death taxes or property taxes so for us that was a main selling point to retire here. We do have a small city tax which goes towards maintaining all the beautiful parks and flowers on all the streets. We also pay an interesting "water pressure" tax for all land which pays for sewage treatment of rain effluent so the water in Lake Balaton remains pristine. The small city tax is roughly $200 a year and the water pressure tax is similar. I don't mind paying these as it goes towards good things for our community.
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Old 12-30-2020, 06:03 AM   #95
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Alan - Yes, and if you are retired you only need to file in the US and not at all in your host country. We are in Hungary on Permanent Residence visas and we don't even have a taxpayer ID number here. We only file in the US. America is unique in requiring expatriots to file annual taxes when living permanently abroad. However, some countries (Hungary for example) will not pay any social security pensions if you live outside the country. At least the US hasn't done that (yet). But, social security pensions here are not taxed as income at all which is different than in the US. Both my military pension and social security are taxed. Hungarians also don't file their taxes at all as it is handled in the payroll deduction directly using a fixed rate of 16% unless there are deductions which is very rare and only include private pension plans and not debt interest like in the US. However, we also have no death taxes or property taxes so for us that was a main selling point to retire here. We do have a small city tax which goes towards maintaining all the beautiful parks and flowers on all the streets. We also pay an interesting "water pressure" tax for all land which pays for sewage treatment of rain effluent so the water in Lake Balaton remains pristine. The small city tax is roughly $200 a year and the water pressure tax is similar. I don't mind paying these as it goes towards good things for our community.
That sounds great. Unfortunately being retired in the UK doesn't get you out of paying taxes. I get taxed on my US private pensions in the UK and claim the tax paid as credits against my US taxes. As part of the tax treaty the US does not tax SS or the UK equivalent, but the UK does.

My son has no income from the USA so, like 90% of folks here, does not have to file a self assessment return like I do, HMRC handles all that. He does file a US return every year, excluding all his UK wages with form 2555, so doesn't pay any US tax. He also uses my copy of TurboTax so doesn't even have to pay for tax software.
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Old 12-30-2020, 06:56 PM   #96
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I went to the emergency room in Chiang Mai with the fractured big toe. It was more or less the same efficiency - admission, nurse, doctor, x-rays, doctor again, painkillers, payment - the whole ordeal lasted 2-3 hrs and cost me $46. I didn't even bother submitting the claim to the insurer in US. Oh, and I only wish hospitals in US look like the one I visited.
We later found out that this hospital, in Kuala Lumpur, that we went to was one of the top medical tourism hospitals in the area. My spouse spent her career in the health industry and a fair amount of it in hospital environments was impressed from the moment we walked into the hospital until the moment we happily cabbed back to our hotel.

A few years ago we stayed in a B&B in San Jose, Costa Rica. To our surprise it was frequented primarily by Americans who went to the nearby hospital for surgery. We met a younger lady who said that she could not afford this care at home and that the hospital was recommended to her by friends at home. We did not realize that medical tourism was such a big business.
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Old 12-30-2020, 07:44 PM   #97
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How much my pre-existing conditions cost to treat is not the issue. European countries require the expat to have health insurance as a prerequisite for applying for residency.

Can somebody with pre-existing conditions who has had to purchase expat health insurance please answer my question? Thank you.
I don't know of any Central or South American countries with such a requirement, and as you noted, those are also on your list.
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Old 12-31-2020, 12:52 AM   #98
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Alan - Sorry, I didn't know how the UK works. I had assumed within the EU there was more or less the same standards of tax reciprocation. I didn't mention FATCA and all its ramifications either which can be onerous if you earn or are receiving more than $10k a month. I never considered any of the more expensive EU countries or the ridiculous taxes in Italy and Spain. I lived 6 years in Germany (while in the military) and my German friends complain a lot as well. You can estimate how bad a countries taxes are when so many retirees move to a country. I have friends here who own apartments in Budapest and rent them out to "foreigners" who then use it as their address and rarely visit. The ones I know are from the UK and Austria but I see a very large number of retirees from the Netherlands, UK, and Germany here. As far as I know we are the only Americans. I have never encountered any others.

I will add our medical is great and cheap even though we pay cash.

ncbill - yes, except if you have cash in sufficient amounts (not too sure how much but we qualify) as an exception then you don't need to have proof of insurance. I used to get away with showing them a letter from the US Military TRICARE Overseas but after I turned 65 I refused it as I would have to pay the Medicare Part B just to retain the horrible service that TRICARE offers. Our medical expenses are less than the Part B premiums even in bad years. We can't ever use Medicare and TRICARE has large deductibles and even if they pay (which is rare) it is only 60%. So, for us medical was simply going to cash payment. We "could" register for the national health insurance and pay the premiums which run around $250 a month per person but it isn't worth it for us.
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Old 12-31-2020, 01:04 AM   #99
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They do have tailor made policies for this in most countries, designed to satisfy the immigration requirement. They just cover public hospitals in your home country and only cost about 300 dollars a year.

Its not really an American vrs abroad decision. When abroad you have the local medical care which provides the care you are most likely to need. If you get really sick you can go back to the usa and get treated there with its specialist coverage. Both options are in your plan Even countries like Switzerland rely on the usa for the most advanced treatment. You are always seeing fund raisers to send the little boy to the usa for cancer treatment or reading how the local Bishop is travelling to the mayo clinic for heart treatment.
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Old 12-31-2020, 12:54 PM   #100
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ncbill - yes, except if you have cash in sufficient amounts (not too sure how much but we qualify) as an exception then you don't need to have proof of insurance. I used to get away with showing them a letter from the US Military TRICARE Overseas but after I turned 65 I refused it as I would have to pay the Medicare Part B just to retain the horrible service that TRICARE offers. Our medical expenses are less than the Part B premiums even in bad years. We can't ever use Medicare and TRICARE has large deductibles and even if they pay (which is rare) it is only 60%. So, for us medical was simply going to cash payment. We "could" register for the national health insurance and pay the premiums which run around $250 a month per person but it isn't worth it for us.
It's not the end of the world to come back to the U.S. sign up for Part B and pay the cumulative penalty if you need a procedure only available here...as I noted before one expat in Mexico I followed came back for an organ transplant covered by Medicare.

My recently deceased relative waited nearly a decade before signing up for Part B so and even in their financially diminished circumstances it (plus Medigap Plan G & a drug plan) was still affordable...they ended up paying nothing extra beyond the sub-$200 annual deductible.

Personally were there no longer ACA plans I'd head to Mexico for an extended vacation & pay ~$35/month to buy into their national health plan as catastrophic insurance, paying out-of-pocket for minor needs.
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