I lived in Taiwan and used the National Health Care system extensively. It was quite good and convenient for routine health care. I never needed to do anything major like surgery, though. It is not easy to become a resident of Taiwan. If you did manage to do so, you would need to pay into the healthcare system for a period of time before you would be covered.
Best Overseas Healthcare Options
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I lived in Taiwan and used the National Health Care system extensively. It was quite good and convenient for routine health care. I never needed to do anything major like surgery, though. It is not easy to become a resident of Taiwan. If you did manage to do so, you would need to pay into the healthcare system for a period of time before you would be covered.
explanade
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How expensive are the policies?
My only interest in getting a visa or trying to get citizenship in the EU is to access the health care system, so that I wouldn't have to fly back to the US for health care.
But I recall reading somewhere that if you get a long-term visa, you may become liable for taxes on income earned in the US, even without having all the benefits of citizenship.
Of course you're already liable for US taxes.
So what do Americans who buy property in the EU do? They fly back or purchase private health insurance?
My sense is that private health insurance isn't anywhere near as comprehensive as it is in the US, because in most countries, all citizens get basic care. Private insurance is complementary rather than comprehensive so it gives you things like private hospital rooms and other side benefits.
Retired Expat
Full time employment: Posting here.
Health care Uruguay
As an expat in Uruguay I would say this. There is no or not much of a Nationalized system. The government hospitals mostly treat the poor. There are lots of private hospitals and all offer a Mutualista program where you join that hospital and pay a monthly fee. Usually quite reasonable but only if you qualify.... under age 65, no chronic conditions, not overweight. You are only covered for that location so no help if traveling.
That being said, there are lots of options for quality health care Or health coverage here that cost much less than what one would pay in The US... for simple stuff or a consult it costs $3....
As an expat in Uruguay I would say this. There is no or not much of a Nationalized system. The government hospitals mostly treat the poor. There are lots of private hospitals and all offer a Mutualista program where you join that hospital and pay a monthly fee. Usually quite reasonable but only if you qualify.... under age 65, no chronic conditions, not overweight. You are only covered for that location so no help if traveling.
That being said, there are lots of options for quality health care Or health coverage here that cost much less than what one would pay in The US... for simple stuff or a consult it costs $3....
Puravida1
Dryer sheet aficionado
The cost of the policies vary widely from a few hundred Euros to perhaps 1500 or so for one person. The cheapest policies only cover public hospitals in Malta. The most expensive cover international locations, private hospitals and have allowances for medicine, glasses and prescriptions. There is everything in between so a large variety of policies. Also the things that were in the US pre obamacare are there: exclusions for pre-existing conditions and they do not have to renew your policy.
You cannot get insurance unless you are a resident so that means spending most of the year in Malta.
In the EU, most countries will tax you on your world wide income, so income from your US investments can be taxed by your EU country. You can usually subtract the amount you paid in the US so you dont get taxed twice. So for example if France says you owe 4 and the USA says you owe 3 on some US income, you pay 3 to the US and 1 to France. There are only a couple of countries that have a remittance based system that only tax your local income. Malta is one of these. You cannot avoid US federal taxes no matter where you live.
There is no uniformity across Europe around public/private care. Some countries like the UK are mostly public, while others like the Netherlands are all private. The Netherlands also has a requirement that everyone buy insurance or pay a fine.
In defense of the US system, there is more money to be made in medicine in the US than in other countries and as such you can nearly always buy your way into any medical procedure or medicine available. In other countries many medicines are not approved for use since their cost is not deemed good value at a national level. For example the Shingrix shingles vaccine is still not available in the EU. You still want to travel back to the US for those things.
You cannot get insurance unless you are a resident so that means spending most of the year in Malta.
In the EU, most countries will tax you on your world wide income, so income from your US investments can be taxed by your EU country. You can usually subtract the amount you paid in the US so you dont get taxed twice. So for example if France says you owe 4 and the USA says you owe 3 on some US income, you pay 3 to the US and 1 to France. There are only a couple of countries that have a remittance based system that only tax your local income. Malta is one of these. You cannot avoid US federal taxes no matter where you live.
There is no uniformity across Europe around public/private care. Some countries like the UK are mostly public, while others like the Netherlands are all private. The Netherlands also has a requirement that everyone buy insurance or pay a fine.
In defense of the US system, there is more money to be made in medicine in the US than in other countries and as such you can nearly always buy your way into any medical procedure or medicine available. In other countries many medicines are not approved for use since their cost is not deemed good value at a national level. For example the Shingrix shingles vaccine is still not available in the EU. You still want to travel back to the US for those things.
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That will be per year I think.
Our private insurance in England for myself and my wife costs £99/mo and it covers health, vision and dental.
explanade
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So as long as you have a residency visa, you can purchase these policies if you're not eligible for the national health care systems in EU countries?
What are copays, deductibles and lifetime limits like on these kinds of policies?
What are copays, deductibles and lifetime limits like on these kinds of policies?
I can only say what our policy covers.
5 free video GP consultations per person per year.
No Copays
£500 Deductible
£50 Deductible per person per year for dental, 100% coverage beyond that
£200 per person per year towards cost of prescription glasses or contact lenses
No lifetime limits that I am aware of. Earlier this year my SIL had open heart surgery through her private insurance. A few years earlier she had her breast cancer treated under her policy, lumpectomy followed by radiation therapy.
10 days ago I booked a video appointment for the next day. Before the appointment I was able to write up my symptoms and upload photos I took of my swollen knee. The GP talked with me for about 10 minutes and told me he was sending me a referral letter to an orthopedic specialist. That letter arrived by email within 30 minutes. I called my insurance company and after 10 minutes they set up a claim for me and authorized 2 appointments plus whatever scans were needed.
I then looked up orthopedic surgeons at my local private hospital and saved copies of their bios. On calling the hospital they said there were 3 available with appointments this week and gave me their names. I chose one and saw him 2 days later. After he examined me he said he expected that it was soft tissue damage and gave me a letter to take down to the imaging department for an MRI, and I got an appointment for later that day. He called me a week later to discuss the findings. Badly torn ligament which he could fix with arthroscopic day surgery. I called my insurance company and they have authorized the surgery.
As with previous experience the processing of the claim is very speedy, and I can track it all online. His appointments cost £250 (in person) and £130 (telephone call after MRI). MRI cost £480. I am on the hook for £500 and insurance has already paid the rest, and will pay full cost of surgery.
My wife had an eye test on Monday and ordered and paid for new glasses. In this case I simply went online after scanning the prescription and receipt for the glasses, which cost £238. We will get £200 refunded direct into our bank. Dentist claims are handled the same way, all online, pay dentist by credit card and get paid by insurance company directly into bank before credit card payment is due.
Being a UK citizen is irrelevant, all permanent residents have access to the NHS and to private health insurance.
This particular policy is a supplemental policy to the NHS, but that is my choice to keep costs down. Two years ago I had heart ablation using the NHS because the care was fast and excellent.
If you have pre-existing conditions before taking out insurance then these will be excluded, but you can always go private and pay as you go. There are loads of insurance companies to choose from, plenty of competition.
Prices are advertised at the hospitals, insurance not required. For example, a straight forward total knee replacement will cost around £10k, but a guaranteed price will be given after consultation to determine a treatment plan.
https://www.nuffieldhealth.com/hospitals/self-pay
Puravida1
Dryer sheet aficionado
Yes per year. Most people in Europe buy their insurance that way as its not very expensive.
Puravida1
Dryer sheet aficionado
UK will be different as the public system there really dominates the healthcare.
But in Malta and many other countries there is a private system too with private hospitals and doctors. EU (not UK) citizens who are resident in Malta and are retired and not working are not paying into the public system through payroll taxes and do not have free access to the public healthcare system. A condition of their residency is that they carry at least basic insurance that pays for access to the public system. Most EU countries have something similar but the UK is different.
Private insurance might have a 1000 euro deductable called an 'excess' and an annual limit of up to about a million euro. It is hard to spend a million euro in a european hospital. They dont often have lifetime maximums because they can decline to let you renew the policy after a year. It can be hard to get a policy as a new customer if you are over about 70.
The way to think of this is that it is not really an Either/Or decision. If you were unfortunate enough to exceed the maximum in a year, you could always set up a company and pay yourself a small salary with taxes to get instant access to the public system which has 'no limits'.
Also something to consider in these days of advanced gene therapy treatments is that the EU is not really self sufficient in these new technologies. Even in places like Switzerland or Germany, gene therapy will involve sending tissues to the US for treatment before sending the processed tissue back to the EU where the patient is. Fundraisers to pay to send children for cancer treatment in the USA are common across Europe. Sometimes the European public system wont pay for this treatment and then the European does without. In the USA, Americans would be able to access this treatment via their insurance or Medicare. There is no free lunch here.
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