ACA and the idea of expatriation as an alternative

[Khufu]

health insurance in Thailand

I don't know about Malaysia, but here in Thailand health insurance that is available to expats typically does not cover pre-existing conditions and is generally not available at all to a foreigner older than 65. On the other hand the treatment costs are so low that self-insuring is a viable option.

I understand that crime is increasing in Malaysia these days.

 

[donheff]

In general, it sure appears that 90% of everyone on this forum appears to be very against expatriation. Since there are over eight million Americans living in over 150 nations arund the globe, many of which are by choice, I gather the following as reasons:
a) people are way too close minded to ever consider expatriation (a shame)
b) people have family in the USA and therefore would never consider expatriation (a better reason)
c) people believe everything we are told about the entire planet longing to live in the USA because we are the greatest nation on Earth (even though statistically speaking, we rank quite low somewhere in virtually everything considered relevant to quality of life like education, crime, healthcare costs, technology advances, etc).

If there is anyone willing to consider otherwise, let me chime in.

There are lots of reasons for people all over the world to expatriate and lots on this board do. Many people expatriate to the US, usually to make money. Many expatriate from the US, often to stretch a pension or savings. But, regardless where you live most people don't expatriate and are not interested in doing so. Family, friends, culture, church... There are hundreds of reasons people prefer to stay where they are and the vast majority do. As to your conjecture that the ACA is adding to the advantages for Americans to expatriate it seems to me you have it backwards which was why everyone said "no" on the previous thread. It doesn't matter whether you think the ACA sucks or not, or even if you believe it will screw up the debt long term. From an individual early retiree perspective it provides HI guarantees that were simply not available before. And it certainly shows no signs of skyrocketing the individual HI market costs for pre-Medicare ER seekers.

 

[Texas Proud]

To the OP,

You brought up the connection between the ACA and expatriation, so when people are commenting about it..... well, it is because of you...


As to would people expatriate BECAUSE of the ACA.... I say "NO"....


If you have income in the $40K range (like you are throwing out), you probably will have an insurance plan that is subsidized.... and the cost of health insurance is not going to be that big a deal....

If you make enough that you do not get subsidy, then you have enough money to live in America..... moving out is a decision you can make for other reasons that are valid, but the ACA is not one of them IMO...

 

[haha]

I believe the OP has made it clear that he and his wife are not really happy in Walnut Creek. Who knows why he came up with the ACA hook, but in reality it seems that he plans to live outside US for reasons other than purely economic, and clearly the current health insurance situation in America, like Don said above, is better from the sub-65 yo retiree's POV than what he might have faced before.

Crediting what he said, he is leaving because he wants to, not for purely or perhaps even mostly financial reasons.

 

[daylatedollarshort]

I believe the OP has made it clear that he and his wife are not really happy in Walnut Creek. Who knows why he came up with the ACA hook, but in reality it seems that he plans to live outside US for reasons other than purely economic, and clearly the current health insurance situation in America, like Don said above, is better from the sub-65 yo retiree's POV than what he might have faced before.

Crediting what he said, he is leaving because he wants to, not for purely or perhaps even mostly financial reasons.

The OP will have $588K in home equity when he wants to retire based on what he posted. That would buy what I would consider a nice, mortgage free house even in the Bay Area. The median home sales prices in Contra Costa and Alameda county are less than that -

California Home Prices and CA Heat Map - Trulia Real Estate Search - Trulia.com

A $40K income, HSA bronze plan for two 50 year olds at Kaiser would cost $17 a month, plus co-pays and deductibles.

So $40K left for food, health co-pays and deductibles, property tax, etc. For fun get a library card for the free events and attraction passes and a reciprocal art museum pass for $125 a year and hike in the Redwoods, walk around Fishermans's Wharf, have a picnic at Golden Gate Park, go to free star gazing at all the planetariums on the weekends, have days at the beach and visit just about all the museums for free or minimal cost between the two pass cards. Buy an Entertainment book at Costco for $25 and eat out for half price all year. Shop at farmer's markets and ethnic markets for inexpensive produce grown close by in the Central Valley.

Not a bad life in my book.

rodiy2k, leave if you want, but don't stick it on the ACA or even the Bay Area cost of living if you have enough to live mortgage free. Home prices are more, but if you have that covered, retirees can live well on modest budgets.

 

[nun]

Be careful with your terminology. The strict meaning of expatriation for a US citizen is actually renouncing US citizenship.

This thread is about becoming a US expatriate without giving up US citizenship.

 

[nun]

If you are of Medicare age remember that there is a 10% increase in your medicare premiums for every year that you defer. So if you move overseas you should think carefully about keeping them up if you ever plan on returning to the US or of course if you intend to return to the US for healthcare.

 

[Khufu]

Be careful with your terminology. The strict meaning of expatriation for a US citizen is actually renouncing US citizenship.

This thread is about becoming a US expatriate without giving up US citizenship.

Not true. That is the meaning only in the context of citizenship. In other contexts "to expat" may mean to work abroad or simply to move abroad whether working or retired. I never encountered the meaning of expatting as renouncing citizenship until the recent changes in US law imposing a financial penalty for the first time for renouncing citizenship. My guess is that journalists simply appropriated the word for the then current discussion without regard to correct usage.

 

[nun]

Not true. That is the meaning only in the context of citizenship. In other contexts "to expat" may mean to work abroad or simply to move abroad whether working or retired. I never encountered the meaning of expatting as renouncing citizenship until the recent changes in US law imposing a financial penalty for the first time for renouncing citizenship. My guess is that journalists simply appropriated the word for the then current discussion without regard to correct usage.

Expatriation has a range of meanings. One is leaving your native land, another is renouncing allegiance to you native land. The IRS uses the latter meaning, so a US citizen can become a foreign resident, but the IRS does not consider that expatriation if you are still a US citizen. Once you have filed the necessary state department forms to renounce US citizenship you the file an IRS Expatriation form 8854.

The different meanings of expatriation are generally not an issue as the most common usage is moving overseas, but that makes it all the more important to use it correctly when talking about anything connected with finances, ACA, taxes etc.

 

[kramer]

If you are of Medicare age remember that there is a 10% increase in your medicare premiums for every year that you defer. So if you move overseas you should think carefully about keeping them up if you ever plan on returning to the US or of course if you intend to return to the US for healthcare.

This is a big decision for each expat to make. One can maintain regular medicare coverage (Part A) at no charge, but the penalty is for the Part B premium to which nun is referring. Surprisingly, there appears to be no penalty for forgoing Part D payments.

almost all who choose Part A also sign up for the U.S. Medicare program's optional Part B Supplementary Medical Insurance, which covers outpatient medical services at acute care hospitals (including emergency-room visits), observed-status services at acute care hospitals even if confined to the hospital overnight or longer, surgical center procedures, doctor services (including most doctor services performed during the admitted hospital/SNF stays covered under Part A as well as office visits), a limited number of usually office/clinic-administered drugs, and some durable medical equipment.

The 2014 monthly Part B premium is $104.90. There is a $147 annual deductible.

For someone based in Asia, it might be most convenient to set up their Medicare services in Guam. However, the Guam population is only about 180,000, so I would presume their facilities might be limited. Also, friends have told me it is surprisingly expensive to stay there.

It is not clear to me how much one would have to pay in charges for a major hospitalization event if one had Part A but not Part B coverage. It would probably be messy. And any non-negotiated charges (e.g., cash price is sticker price) could make it prohibitively expensive.

 

[nun]

This is a big decision for each expat to make. One can maintain regular medicare coverage (Part A) at no charge, but the penalty is for the Part B premium to which nun is referring. Surprisingly, there appears to be no penalty for forgoing Part D payments.



The 2014 monthly Part B premium is $104.90. There is a $147 annual deductible.

For someone based in Asia, it might be most convenient to set up their Medicare services in Guam. However, the Guam population is only about 180,000, so I would presume their facilities might be limited. Also, friends have told me it is surprisingly expensive to stay there.

It is not clear to me how much one would have to pay in charges for a major hospitalization event if one had Part A but not Part B coverage. It would probably be messy. And any non-negotiated charges (e.g., cash price is sticker price) could make it prohibitively expensive.

Also without Part C and Part D or a Medigap policy the out of pocket costs could mount up quickly.

 

[daylatedollarshort]

It is not clear to me how much one would have to pay in charges for a major hospitalization event if one had Part A but not Part B coverage. It would probably be messy. And any non-negotiated charges (e.g., cash price is sticker price) could make it prohibitively expensive.

I have a relative, born in Europe, worked for years in the U.S., then moved back to Europe for retirement. He came to the U.S. for a visit after age 65 and needed major surgery while he was here.

He was never a U.S. citizen, and I do not believe he kept up any kind of Medicare payments from overseas, but he did buy travel health insurance before his visit. I know in the hospital here they checked into Medicare and told him he qualified because of all the years he worked in the U.S. I believe between Medicare and the travel insurance he had all his bills covered, but he did need the travel insurance as Medicare did not cover all the hospital costs.

 

[LinCella]

I live in the Bay Area, make a good living for what I do, but I could never buy a house here and not even going farther out to the East Bay or Contra Costa. The prices are ridiculous for an area that is now just chock a block with freeways, people everywhere, no space in between towns. My only hope is to move away. I'm fine with that, I grew up here and I'm sick of the development. A housing development taking pace on the old racetrack is building two story homes without any space and placed right next to your neighbor for $800k to start...this is insane

 

[Khufu]

I have a relative, born in Europe, worked for years in the U.S., then moved back to Europe for retirement. He came to the U.S. for a visit after age 65 and needed major surgery while he was here.

He was never a U.S. citizen, and I do not believe he kept up any kind of Medicare payments from overseas, but he did buy travel health insurance before his visit. I know in the hospital here they checked into Medicare and told him he qualified because of all the years he worked in the U.S. I believe between Medicare and the travel insurance he had all his bills covered, but he did need the travel insurance as Medicare did not cover all the hospital costs.

Where did he buy the travel health insurance? As far as I know it is not available to those over 65.

 

[daylatedollarshort]

Where did he buy the travel health insurance? As far as I know it is not available to those over 65.

If you Google over 65 travel insurance, there are many companies selling the coverage, but most are not based in the U.S. but some cover U.S. visits for residents of other countries.

 

[Alan]

Where did he buy the travel health insurance? As far as I know it is not available to those over 65.

We have had plenty of over 65 visitors from the UK who have had travel health insurance. We talked to a relative age 84 a couple of years ago and he told us that his international traveling days were over because travel health insurance was too expensive - still available but too expensive for him.

 

[daylatedollarshort]

We have had plenty of over 65 visitors from the UK who have had travel health insurance. We talked to a relative age 84 a couple of years ago and he told us that his international traveling days were over because travel health insurance was too expensive - still available but too expensive for him.

That would be another good reason to have a passport from an EU country in retirement. Can't you get an EU health travel card for other EU countries then with no age restrictions on health care?

 

[Alan]

That would be another good reason to have a passport from an EU country in retirement. Can't you get an EU health travel card for other EU countries then with no age restrictions on health care?

I believe so, but I don't know the details. It is not just a matter of a having a passport, which I have, you have to also be a resident tax payer as well. (The USA is almost unique in taxing its citizens regardless of where they reside).

 

[nun]

That would be another good reason to have a passport from an EU country in retirement. Can't you get an EU health travel card for other EU countries then with no age restrictions on health care?

There is a reciprocal agreement between EU countries for health insurance. If you are covered under the NHS you can get a free European Heath Insurance Card

Cover your healthcare abroad - The NHS in England - NHS Choices

However, having a UK passport does not entitle you to NHS coverage, you have to be resident in the UK to be covered under the NHS.

 

[ShokWaveRider]

If it fails we can go back to Canada where we can always stay with relatives and get free healthcare while deciding what to do next

We are both Canadian, living in Florida. The problem with going back is it is so cold in winters.

Where in Mala"z"ia were you planning to settle? Is the weather not brutal year round?

For us the key areas of consideration are in order: 1a) Availability of affordable SOCIALIZED healthcare; 1b) Weather; 2) Housing costs.

I think Weather and healthcare can be interchanged.

 

[kramer]

That would be another good reason to have a passport from an EU country in retirement. Can't you get an EU health travel card for other EU countries then with no age restrictions on health care?

On my last trip to the US I was able to buy travel insurance even though I am a US citizen. I am a resident in the Philippines but my citizenship is US only.

I know a lot of people who have done this, had successful medical claims, etc. (mainly US expats living in Mexico who visit the US) However, I do recall that some travel insurances seem to exclude US citizens for insurance for visits to the US.

I just looked it up, I used World Nomads