back and forth from mexico

[teekaymn]

I know that a lot of people who RE enjoy the low cost health care/health insurance that countries like Mexico have to offer, but what do folks do for health concerns when you travel back to the U.S. of A. to see the kids over the holidays or spend a summer? Assuming one is too young for Medicare, and isn't fortunate enough to have an employer that offers a health care policy in retirement, what are the options to make that bridge to Medicare? Private policies are so dang expensive, and I'm assuming a "traveler's" policy doesn't apply to one who is still has an American permanent address. Will PPACA have any clarifying effect on options for RE'ers, or just muddy the water even more?

[kramer]

Here is a thread on this that I posted on in the Boglehead's forum:

Bogleheads • View topic - Need Health Insurance Reccomendations, for travel

In that thread, I listed some companies currently offering short-term travel policies to USA Citizens traveling to the USA. Typically, pre-existing conditions are not covered by these insurances and they are for defined time intervals.

If you are still a part-time resident of the USA then yes I believe that you will be required by PPACA to maintain full-time health insurance in the USA. Travel insurances are not a substitute for certified PPACA coverages. This could be a significant financial burden on many part-time expatriates. Their medical expenses could go up instead of down because they would be paying for USA health insurance they don't fully utilize plus paying for health care in the their other country.

It is conceivable that some insurances in the exchanges for the state where you are a part-time resident would cover this situation but I seriously doubt it.

[rodi]

Here in San Diego I have friends who commute across the border to Mexico for health care and dental care. There are clinics that are targeted towards Americans.

I hadn't heard about this until I read the following thread on a San Diego economics blog.
OT: Health Care in Mexico vs. U.S. (related to "Father is visiting and hospitalized...") | Piggington's Econo-Almanac | San Diego Housing Market News and Analysis

[teekaymn]

Thanks for your initial responses, kramer and rodi. I think DW and I will be comfortable with covering any health care needs if we were to live in Mexico for half the year, but my larger question is what we do if, while we're visiting the kids back in Minnesota over the summer, we need emergency treatment or a hospital stay in the U.S. Are there affordable policies that cover an pre-Medicare American expat who returns to the U.S. for periodic visits?

[teekaymn]

And thank you both for the links -- I'll be reading them in-depth later today.

[kevink]

We've been living in Mexico full-time for nearly three years and are many years away from Medicare or Medicaid eligibility. We have a U.S. mailing address but our home address for tax filings, etc. is in Mexico. When we visit the U.S. we most often buy a policy from World Nomads (.com) and choose Mexico as our home country.

There are plenty of private insurance policies here in Mexico that cover you worldwide (including the U.S.) and rates are much cheaper than U.S. policies, but again Mexico needs to be you declared home. Here in Mexico we self-insure, but it would be insane to set foot in the U.S without coverage given the stratospheric costs of an E.R. visit, etc.

Given the excellent care here, the ease of seeing specialists and costs at about 10% of U.S. prices I once asked an insurance agent in Colorado if we could buy a "reverse Medi Vac" policy if we lived in the U.S. that would fly us to Mexico in an emergency. Needless to say, the silence on the other end of the line was deafening.

[teekaymn]

Quote:

Given the excellent care here, the ease of seeing specialists and costs at about 10% of U.S. prices I once asked an insurance agent in Colorado if we could buy a "reverse Medi Vac" policy if we lived in the U.S. that would fly us to Mexico in an emergency. Needless to say, the silence on the other end of the line was deafening.

Wow. I can hear that agent's "gulp" from here.

In order to claim Mexico as "home", though, wouldn't I need to reside there a minimum of 330 days, or some such number?

[kramer]

I agree with Kevin, there is no way you can set foot in the USA without financial (oops, I meant health) insurance.

Unfortunately, the way that I understand that PPACA is structured, it is all or nothing regarding residency. Which means a part-time USA resident must "anchor" their health insurance coverage in the USA and not abroad. A policy written by a Mexican insurer will definitely not qualify. In fact, I don't even think real First World international policies like BUPA will qualify. But this is only informed speculation on my part, I don't think anyone really knows for sure at this point.

Also, some short term medical policies, like that offered by Assurant Health (one of the options in my list that has been available up until now), may no longer exist circa 2014 (again, I am not sure, but at the very least the market for these policies will be drastically reduced and these policies cannot qualify for PPACA certification). In that case, you would only be left with options like World Nomads that Kevin mentioned (and they have a good reputation among Mexican expats). So the health insurance options for true expats who want temporary USA coverage will possibly be reduced.

Regarding residency, I would take a close look at the Bona-Fide Residence test which would allow you to spend more than 30 days per year in the USA. But it is more for long term expats, you don't even qualify until you have spent a full tax year residing abroad (you can amend back taxes, however):

Foreign Earned Income Exclusion - Bona Fide Residence Test

I would welcome other informed opinions on what I have stated here. I am not an expert.

[teekaymn]

Quote:

Originally Posted by kevink When we visit the U.S. we most often buy a policy from World Nomads (.com) and choose Mexico as our home country.

Thanks Kevin -- can you provide any ballpark numbers on typical costs for a World Nomads policy to cover a visit (or visits) back to the States?

[kramer]

Data from 2012:

World Nomads priced at about $170 per month for a late 50s woman. If I recall, it did not seem so age sensitive in pricing like other insurances. Mexico resident. After you are stabilized, you go back to Mexico.

Assurant Health 5 weeks for 46 year old male about $210. $3000 deductible, max $5000 out-of-pocket, Filipino resident. You can get care until the time runs out, not necessarily shipped back to Philippines after you are stabilized.

Neither covers pre-existing conditions.

[teekaymn]

Quote:

Originally Posted by kramer I agree with Kevin, there is no way you can set foot in the USA without financial (oops, I meant health) insurance. Unfortunately, the way that I understand that PPACA is structured, it is all or nothing regarding residency. Which means a part-time USA resident must "anchor" their health insurance coverage in the USA and not abroad. A policy written by a Mexican insurer will definitely not qualify. In fact, I don't even think real First World international policies like BUPA will qualify. But this is only informed speculation on my part, I don't think anyone really knows for sure at this point. Also, some short term medical policies, like that offered by Assurant Health (one of the options in my list that has been available up until now), may no longer exist circa 2014 (again, I am not sure, but at the very least the market for these policies will be drastically reduced and these policies cannot qualify for PPACA certification). In that case, you would only be left with options like World Nomads that Kevin mentioned (and they have a good reputation among Mexican expats). So the health insurance options for true expats who want temporary USA coverage will possibly be reduced. Regarding residency, I would take a close look at the Bona-Fide Residence test which would allow you to spend more than 30 days per year in the USA. But it is more for long term expats, you don't even qualify until you have spent a full tax year residing abroad (you can amend back taxes, however): Foreign Earned Income Exclusion - Bona Fide Residence Test I would welcome other informed opinions on what I have stated here. I am not an expert.

Thanks very much, kramer. Based on the limited amount of reading I've done to this point, I've come to pretty much the same conclusion: "It's too early to tell."

DW and I are still about 5 years from making any kind of move, so hopefully the picture will be made more clear by then. For now I'm just trying to put projected numbers into a budget spreadsheet.

[teekaymn]

Quote:

Originally Posted by kramer Data from 2012: World Nomads priced at about $170 per month for a late 50s woman. If I recall, it did not seem so age sensitive in pricing like other insurances. Mexico resident. After you are stabilized, you go back to Mexico. Assurant Health 5 weeks for 46 year old male about $210. $3000 deductible, max $5000 out-of-pocket, Filipino resident. You can get care until the time runs out, not necessarily shipped back to Philippines after you are stabilized. Neither covers pre-existing conditions.

This is really helpful, Kramer -- thanks! I'll be doing some rooting around on World Nomads web site.

[kevink]

Thanks Kramer for adding your invaluable perspective to this discussion. I hope the Kaderlis will chime in at some point with their views about this, since they've been doing the low-cost perpetual traveler thing for so many years and are very savvy about health care and insurance.

Clearly there are a ton of unknowns - and unintended consequences - of PPACA that we'll have to wait and see about. One thing that's really underlined for me is the importance of keeping taxable income as low as possible - low enough to be eligible for Medicaid or at the very least for heavily subsidized rates on the exchanges. Like many others we know who live down here we consider ourselves health care and insurance "refugees." Ironically one of the unintended consequences of PPACA is that by providing us with access to catastophic care via Medicaid it would make it possible for us to live on our Mexico budget in the U.S. while traveling to Mexico for routine care, dental work, etc.