Health Insurance Dilemma

T

Thomas3857

Recycles dryer sheets
Joined
Dec 18, 2020
Messages
57
Location
Memphis
Hi all - Would like to get some opinions regarding my health insurance options. My wife and I are moving to Europe at the end of the year on a digital nomad visa (I'm self-employed) for at least two years perhaps more (permanent residency a possibility). I'm comfortable with our FIRE numbers but not quite sure how to handle our health insurance options.

I currently pay $1,000 per month for a PPO with a $5000 deductible and a $7,000 max out-of-pocket limit for my wife and myself. This policy is offered through a professional membership organization. There was NO pre-existing condition obstacles as the group plan I suppose has enough members to make that a non-issue.

As a condition of my nomad visa we are required to have health insurance in the country we are moving to and I'm required to join the public system which will be free - sort of as I'm required to pay into the social security system but expect that cost to be minimal. I can buy private health insurance with a $0 deductible for two people for under $200 per month which most people do as a way to avoid delays in the public system.

My question is what do I do with my current insurance. I can either:

1. Cancel the policy when we move but if/when we return and I want to start the coverage again I won't qualify for this plan as I'll be retired and won't be eligible for the professional membership group plan. Will save me $24,000 in today dollars and likely more due to annual rate increases but I'll have to get ACA coverage upon return as we both have pre-existing conditions that will make non-ACA coverage either unavailable are prohibitively expensive.
2. Continue to pay the $1,000 premium so in the event we need to return to the US or there's a health issue that requires US-based care that option will remain open. If I do this I can also likely continue this coverage even after retirement and a return to the US as long as I maintain membership in the professional organization as they simply send renewals out each year and I won't have to reapply and go through the original qualification process again.

Considerations -

I like our current insurance as it's a PPO that gives us multiple health care provider options across the US with no pre-existing condition restrictions.
Our state's ACA options are currently extremely limited in terms of offered providers - think two urology groups, three dermatologists, etc. in a city of nearly 1 million.
Will the ACA be around in two years? If so, what does that look like? Can I manage my MAGI to qualify for subsidies?
Hate to pay $24,000 over the next two years for a product I never use. That's a real possibility.
Still have 7 years until I reach Medicaid age.
The $24,000 premiums I would continue to pay is less than 1% or our net worth.

I know it's a personal decision weighing risks/benefits but would love to hear some thoughts from others. Perhaps I'm missing something? Thanks!
 
Just buy ACA plan when you come back. You may not even move back to your current state. ACA plans change every year and by the time you come back, your state may offer good PPO/EPO type plans.
 
In your shoes, I would probably keep the insurance for now, but revisit the decision every 6 months. The $24,000 might just be the cost to live in Europe for 2 years.

If you can move back to a new state and location, that might make me go the ACA route as RetiredHappy recommended. However, if the ACA options suck now, I'm not sure why they won't in 2 years(?).
 
I would consider moving back to an area where you have better coverage. Grew up in Memphis and there are plenty of options to living there. You can always go back there when you get to Medicare age...

I'd drop the coverage while in Europe and worry about it later.
 
First - what an exciting adventure!

Now to the questions at hand.

I doubt the ACA will go away in two years .. two many people rely on it. I've been on an ACA plan for almost 10 years. Lots of people who do consulting, do gig work, it work for small employers are on exchange provided plans.

You say you aren't sure you'd qualify for premium tax credits.... Look at the $24k savings as money you can earmark towards future premiums. (Building your own premium subsidies). I made a similar argument to an older friend who is considering giving up her car. Her current car payments will buy a lot of Uber rides.
 
Thomas3857 said:
Hi all - Would like to get some opinions regarding my health insurance options. My wife and I are moving to Europe at the end of the year on a digital nomad visa (I'm self-employed) for at least two years perhaps more (permanent residency a possibility). I'm comfortable with our FIRE numbers but not quite sure how to handle our health insurance options.

I currently pay $1,000 per month for a PPO with a $5000 deductible and a $7,000 max out-of-pocket limit for my wife and myself. This policy is offered through a professional membership organization. There was NO pre-existing condition obstacles as the group plan I suppose has enough members to make that a non-issue.

As a condition of my nomad visa we are required to have health insurance in the country we are moving to and I'm required to join the public system which will be free - sort of as I'm required to pay into the social security system but expect that cost to be minimal. I can buy private health insurance with a $0 deductible for two people for under $200 per month which most people do as a way to avoid delays in the public system.

My question is what do I do with my current insurance. I can either:

1. Cancel the policy when we move but if/when we return and I want to start the coverage again I won't qualify for this plan as I'll be retired and won't be eligible for the professional membership group plan. Will save me $24,000 in today dollars and likely more due to annual rate increases but I'll have to get ACA coverage upon return as we both have pre-existing conditions that will make non-ACA coverage either unavailable are prohibitively expensive.
2. Continue to pay the $1,000 premium so in the event we need to return to the US or there's a health issue that requires US-based care that option will remain open. If I do this I can also likely continue this coverage even after retirement and a return to the US as long as I maintain membership in the professional organization as they simply send renewals out each year and I won't have to reapply and go through the original qualification process again.

Considerations -

I like our current insurance as it's a PPO that gives us multiple health care provider options across the US with no pre-existing condition restrictions.
Our state's ACA options are currently extremely limited in terms of offered providers - think two urology groups, three dermatologists, etc. in a city of nearly 1 million.
Will the ACA be around in two years? If so, what does that look like? Can I manage my MAGI to qualify for subsidies?
Hate to pay $24,000 over the next two years for a product I never use. That's a real possibility.
Still have 7 years until I reach Medicaid age.
The $24,000 premiums I would continue to pay is less than 1% or our net worth.

I know it's a personal decision weighing risks/benefits but would love to hear some thoughts from others. Perhaps I'm missing something? Thanks!
Click to expand...
Do you plan to keep your state residency during your absence and return to the same address after the time in Europe? Will you have the option of a different address?
 
MichaelB said:
Do you plan to keep your state residency during your absence and return to the same address after the time in Europe? Will you have the option of a different address?
Click to expand...
Probably because we don't have a state income tax and it's a lcol area.
 
rodi said:
First - what an exciting adventure!

Now to the questions at hand.

I doubt the ACA will go away in two years .. two many people rely on it. I've been on an ACA plan for almost 10 years. Lots of people who do consulting, do gig work, it work for small employers are on exchange provided plans.

You say you aren't sure you'd qualify for premium tax credits.... Look at the $24k savings as money you can earmark towards future premiums. (Building your own premium subsidies). I made a similar argument to an older friend who is considering giving up her car. Her current car payments will buy a lot of Uber rides.
Click to expand...
That's an interesting take. Thanks!
 
Surewhitey said:
I would consider moving back to an area where you have better coverage. Grew up in Memphis and there are plenty of options to living there. You can always go back there when you get to Medicare age...

I'd drop the coverage while in Europe and worry about it later.
Click to expand...
Not sure when you left Memphis but it's becoming a very difficult place to live mainly due to incredibly high level of crime. It's a shame because it's got a lot of positives but the crime problem is driving people away.
 
Thomas3857 said:
Probably because we don't have a state income tax and it's a lcol area.
Click to expand...
It’s not that low if you have to spend $24k to keep a health insurance plan you like.

If you can choose another place to live on your return, you have good ACA options and wouldn’t need to pay for insurance during your absence,
 
Thomas3857 said:
Not sure when you left Memphis but it's becoming a very difficult place to live mainly due to incredibly high level of crime. It's a shame because it's got a lot of positives but the crime problem is driving people away.
Click to expand...
I left in 95, but mom & sis still live in the area. Sis went south to Southaven. Wife makes comments on all the bars on the windows. I enjoyed growing up there, but getting out & exploring various places, I know there's much better.

I'm going for a visit in a couple of weeks. Gotta get some pulled pork BBQ & Pirtle's fried chicken.
 
Interesting quandary.

My first reaction would be to to keep the coverage. It's likely the premiums will be stable, even though you are wasting them for the years you'll be gone. But if you're lucky, you'd be wasting them if you stayed!! (with your high deductible). So, that's the good health scenario. But let's say you get a shocking diagnosis. I'd bet you'd move back, and probably a place you are familiar with. If you then had to get a PPACA plan, it would be likely a crummy network and you would be stuck with marginally informed local medical team that's overbooked. My bottom line is if you've got a reasonable chance of leaving inheritance, then you might be better off spending it on making the better medical care available to yourself, even if it's unlikely you'll need it.

But I'm biased because the ACA plans kept getting worse and worse for me over the years. They kept taking away things and reducing the number of providers. I'm in a pretty large metro area, and I imagine it's similar in other places. I think moving to various similar sized cities would be similar crummy access. State by state the ACA policies could be better or worse, depending on the state department of insurance and state AG...not sure. But I imagine the medical industrial complex has invaded uniformly in most places and are "driving down costs" Sure, if you have after tax money and can dial-in your MAGI, it's a bargain, but if you want to insure for optimal medical treatment, the ACA won't guarantee it. I guess if you move to a place with world class centers of excellence, those would be in network, but I can't imagine moving to Rochester MN or Houston TX or Boston MA, etc if I didn't know anyone and didn't know the culture.
 
sengsational said:
Interesting quandary.

My first reaction would be to to keep the coverage. It's likely the premiums will be stable, even though you are wasting them for the years you'll be gone. But if you're lucky, you'd be wasting them if you stayed!! (with your high deductible). So, that's the good health scenario. But let's say you get a shocking diagnosis. I'd bet you'd move back, and probably a place you are familiar with. If you then had to get a PPACA plan, it would be likely a crummy network and you would be stuck with marginally informed local medical team that's overbooked. My bottom line is if you've got a reasonable chance of leaving inheritance, then you might be better off spending it on making the better medical care available to yourself, even if it's unlikely you'll need it.

But I'm biased because the ACA plans kept getting worse and worse for me over the years. They kept taking away things and reducing the number of providers. I'm in a pretty large metro area, and I imagine it's similar in other places. I think moving to various similar sized cities would be similar crummy access. State by state the ACA policies could be better or worse, depending on the state department of insurance and state AG...not sure. But I imagine the medical industrial complex has invaded uniformly in most places and are "driving down costs" Sure, if you have after tax money and can dial-in your MAGI, it's a bargain, but if you want to insure for optimal medical treatment, the ACA won't guarantee it. I guess if you move to a place with world class centers of excellence, those would be in network, but I can't imagine moving to Rochester MN or Houston TX or Boston MA, etc if I didn't know anyone and didn't know the culture.
Click to expand...
Some good points. Thanks for the help.
 
Another vote to drop your current coverage and pick up an ACA policy on your return. If I were you I'd explore other areas in TN if you are wedded to this state. We live in the east of TN and there are lots of ACA plans over here (and no shortage of dermatologists and urologists in our area.
 
When I moved to Europe three years ago, I bought a plan through Geo Blue that covered me worldwide. I was concerned because I spent a couple of months per year in the US visiting friends and family. It was the same price as my ACA plan back in Florida, but without the high deductible and out of pocket expense. After a couple of years, when I was sure I was staying for a while, I dropped it and purchased a local plan. I get travel insurance for my trips back to the US.
 
You might want to spend some more time looking at the ACA plans in your current area. I went to Healthcare.gov in Memphis and found that there were 85 plans, including several BlueCrossBlueShield plans which most doctors accept. Do you have certain specialists in mind? Research those practices. Doctors do not frequently drop their enrollment into insurance as providers. It's a laborious process to get enrolled in a plan as a provider.

The ACA cliff returns in 2026 unless modified by Congress before then. 400% of the current FPL is currently just under $83,000. By the time you return it could be over $90,000. There are many ways to manipulate income to stay under the cliff. The method I had chosen was to sell significant equities every other year, so that I would pay the full amount alternating with a subsidized amount until Medicare, effectively cutting my premiums in half. I am living off of taxable portfolio, with equities that have been held for a very long time. That became unnecessary with the American Rescue Plan.

IMO, I'd drop the plan you have, since you will save $48K which you can use for your premiums when you return. Build up a cash reserve to keep your income low when you return.
 
Lagniappe said:
When I moved to Europe three years ago, I bought a plan through Geo Blue that covered me worldwide. I was concerned because I spent a couple of months per year in the US visiting friends and family. It was the same price as my ACA plan back in Florida, but without the high deductible and out of pocket expense. After a couple of years, when I was sure I was staying for a while, I dropped it and purchased a local plan. I get travel insurance for my trips back to the US
Click to expand...
 
So it provided coverage both in the US and Europe? Interesting. I'll check it out. Thanks
 
EastWest Gal said:
You might want to spend some more time looking at the ACA plans in your current area. I went to Healthcare.gov in Memphis and found that there were 85 plans, including several BlueCrossBlueShield plans which most doctors accept. Do you have certain specialists in mind? Research those practices. Doctors do not frequently drop their enrollment into insurance as providers. It's a laborious process to get enrolled in a plan as a provider.

The ACA cliff returns in 2026 unless modified by Congress before then. 400% of the current FPL is currently just under $83,000. By the time you return it could be over $90,000. There are many ways to manipulate income to stay under the cliff. The method I had chosen was to sell significant equities every other year, so that I would pay the full amount alternating with a subsidized amount until Medicare, effectively cutting my premiums in half. I am living off of taxable portfolio, with equities that have been held for a very long time. That became unnecessary with the American Rescue Plan.

IMO, I'd drop the plan you have, since you will save $48K which you can use for your premiums when you return. Build up a cash reserve to keep your income low when you return.
Click to expand...
The ACA plans in 2023 were very limited. It's possible more have been added in 2024. Thanks
 
Geo Blue requires that you have primary insurance in the USA before they would sell you the insurance. If you don't have primary insurance in the USA, you cannot buy Geo Blue.
 
RetiredHappy said:
Geo Blue requires that you have primary insurance in the USA before they would sell you the insurance. If you don't have primary insurance in the USA, you cannot buy Geo Blue.
Click to expand...
Geo Blue has multiple types of plans. The travel insuance requires primary insurance in the US. They also have plans for expats, and you can choose whether to include coverage in the US or not. The expat plans do not require another policy with coverage in the US.
 
We have used a FL-based Blue Cross Blue Shield "Blue Options" plan in our (16 year) retirement. It pre-dated ACA and was since offered in ACA. We chose a high-deductible option for lower premiums.

It is a PPO plan that offers US National and International coverage. Their International Coverage is via Geo Blue. We travel extensively and conduct our routine healthcare in different states in the US and countries outside the US.

Internationally, I just used it in Panamá this year by looking up In-Network providers. I had to pre-pay and then filed the claim easily online. Payment showed up promptly in my bank account.

My point being, if you find "Blue Options" as a choice in your State and want to start using ACA now, this coverage is what you can expect.
 
I have very strong opinions on this topic as a result of having been in and out of various insurance plans over the last 15 years. Unless you have minimal health care needs and your state has strong ACA plans with great doctor networks, I would strongly recommend you keep paying your current plan for the next two years if you can afford it.

What many people don't realize is that as you get older, it's possible to develop some very unusual health issues that require very specific expertise to address. And in my state, the ACA plans are horrific. The coverages are all EPO's and HMO's. The doctor networks are terrible. There is no way to go to centers of excellence, like the Cleveland Clinic, Mayo Clinic, etc. The deductibles/out of pocket max are in the $15k range. The procedure and drug coverages are completely inferior to typical company PPO plans. Even the cost isn't good because passive income can push you into income brackets with only partial premium coverage.

Right now a typical two person plan COBRA cost from a company could be around $1,500 per month. On the ACA, if you have some medical and drug needs and want a plan to cover them with affordable deductibles, it's going to be $2,500 per month for an unsubsidized plan. With passive income, your subsidy could be only $500-1000, unlesss your passive income is low. So looking at cost, doctor/provider coverage, drug coverage, procedure coverage, the ACA is not good. HUGE CAVEAT AT THE END. If you rarely go to the doctor and don't have much passive income, then the ACA is awesome.
 
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