Healthcare insurance and retirement - again!

[eta2020]

Thank you NW-Bound!

I am not trying to get into discussion why Spain has much better health care then USA, (at low cost and without deductibles) because I expect that would get blocked in minute.

I am just totally pragmatic about it.

 

[NW-Bound]

It varies from province to province.

Current funding | Healthcare Funding

The above link has the following excerpts:

Funding amounts are typically based on factors such as historical budgets, inflation and politics, and are provided irrespective of the number of patients or levels of demands on resources...

...under the impetus to meet budget targets, providers might restrict access to services or limit the number of admissions to facilities. Moreover, global budgets provide little incentive for innovation or to improve efficiency of care. Since global budgets do not provide opportunities for increased revenue if patient throughput increases, healthcare providers have no incentive to shorten patient lengths of stay or to discharge patients to lower cost healthcare settings...
​

The above Web page is an assessment by the University of British Columbia.

 

[Senator]

Thanks to the posts by eta2020, I searched the Web for info on Spain healthcare, a country suffering from economic problems, and found the following Web site that shows the country ranking by WHO (World Health Organization). It starts with the following excerpt:

Some people fancy all health care debates to be a case of Canadian Health Care vs. American. Not so. According to the World Health Organization’s ranking of the world’s health systems, neither Canada nor the USA ranks in the top 25.​

Indeed Spain is rated #7. Canada: #30. USA: #37.

See: World Health Organization’s Ranking of the World’s Health Systems | thepatientfactor.com.

I do not know how WHO grades each country, but looking at the list makes you wonder how other countries solve the problem. There's a lot of things one can learn.

If you have emergency healthcare needs here in the USA, you will be treated, no question. You do not need insurance or even need to pay. It may affect your credit rating, but you will never go to jail for not paying. I am not sure about a chronic condition, like cancer treatments.

What happens if you just show up in Spain, and need major healthcare needs one day, like cancer treatments? Maybe even without an ID or passport?

Do you get treated? Or sent somewhere else?

 

[NW-Bound]

Thank you NW-Bound!

I am not trying to get into discussion why Spain has much better health care then USA, (at low cost and without deductibles) because I expect that would get blocked in minute.

I am just totally pragmatic about it.

Being an engineer, I've just got to understand how things work, even if it's a medical public policy. Nothing to do with politics!

 

[eta2020]

If you have emergency healthcare needs here in the USA, you will be treated, no question. You do not need insurance or even need to pay. It may affect your credit rating, but you will never go to jail for not paying. I am not sure about a chronic condition, like cancer treatments.

What happens if you just show up in Spain, and need major healthcare needs one day, like cancer treatments? Maybe even without an ID or passport?

Do you get treated? Or sent somewhere else?

It does not matter. To my knowledge you get treated.

But it does not matter because I would establish residency and after 1 year get proper coverage. For initial 12 months I would buy private insurance.

BTW in USA if you don't pay you may need to declare bankruptcy. With my net worth that option is not feasible.

 

[NW-Bound]

If you have emergency healthcare needs here in the USA, you will be treated, no question. You do not need insurance or even need to pay. It may affect your credit rating, but you will never go to jail for not paying. I am not sure about a chronic condition, like cancer treatments.

What happens if you just show up in Spain, and need major healthcare needs one day, like cancer treatments? Maybe even without an ID or passport?

Do you get treated? Or sent somewhere else?

Surely, these are fair questions to ask. The Web has the answer:

The Royal Decree-Law 16/2012 was introduced on April 20, 2012. It puts into law severe cuts in the Spanish National Health System, including the following:

Refusal to give assistance to unregistered foreigners (in effect from September 1, 2012). This hasn't been applied by all the comunidades autónomas....
​

So, one has to register, and gets coverage after a period of residency.

 

[MichaelB]

If you have emergency healthcare needs here in the USA, you will be treated, no question. You do not need insurance or even need to pay. It may affect your credit rating, but you will never go to jail for not paying. I am not sure about a chronic condition, like cancer treatments.

If you ask for emergency treatment in the US, you will receive it. Then you will be billed an extraordinary amount of money, and expected to pay. If you only have a little bit of savings, it will all be taken and you can be left penniless.

My DD went to an emergency room in Spain. She gave them my address, they treated her, gave her meds and sent her on her way. Two months later I got a bill for $57, which I paid.

Chronic care is different, here and there. Just about everywhere in the world it requires access to insurance, because it involves doctors, labs and meds, and continuity.

 

[NW-Bound]

Regarding Canada health care which varies from province to province, I just saw the following info from an official Alberta Web site:

When you move to Alberta from another province or country, there may be a waiting period before you become eligible for coverage under the AHCIP.

Babies born in Alberta to a non-resident of Alberta are not considered residents of Alberta and are therefore not eligible for coverage with the Alberta Health Care Insurance Plan.​

See: Are you eligible for AHCIP? Registration requirements: Alberta Health website.

Again, it is interesting to see how different countries deal with healthcare.

I followed the blog of a Canadian RV'er who moved from Quebec to the Yukon. It took her 1 year to get coverage and a lot of paperwork. I found this surprising and posted about it before.

 

[Senator]

BTW in USA if you don't pay you may need to declare bankruptcy. With my net worth that option is not feasible.

If you ask for emergency treatment in the US, you will receive it. Then you will be billed an extraordinary amount of money, and expected to pay. If you only have a little bit of savings, it will all be taken and you can be left penniless.

I wonder how they can actually get any money. I know SSDI cannot be garnished. And 401K and IRA's are generally protected from creditors.

Can a pension be garnished? Can SS be garnished? Personal residences are protected in some states too.

While people should have healthcare insurance, based on the posts so far, it appears a backup plan is becoming necessary.

I see prospective tenants that owe money for years. They have bad credit, and it shows up on their credit report. They seem to live just as good of a life as anyone, other than things they need a goo credit score.

If you have a solid asset base, does anyone ever make you pay? Or forcibly take money out of your accounts (i.e. the IRS?) Isn't an IRA/401K/SS/Pension safe from creditors?

I have had tenants with IRS liens. Those tenants got all checks mailed/handed to them, they go to the bank/Walmart and cash them, and pay cash for everything including rent. Then, the IRS cannot even get the money as it is never in a bank account.

So, even if you owed a medical facility $100K+, could they ever get it? Maybe you could negotiate $25 a month payments? I do not think a medical facility ever knows what a person's net worth is.

Having solid healthcare would be my first option (after the VA), but I certainly would not hesitate, or even feel guilty, about showing up on the hospital doorstep for treatment if I did not have any insurance.

My FIRE lifestyle would be the last thing I cut at this point.

 

[MichaelB]

So, even if you owed a medical facility $100K+, could they ever get it? Maybe you could negotiate $25 a month payments? I do not think a medical facility ever knows what a person's net worth is.

No. Most health care providers will just sell the debt to a debt collector, who will then add their own fees and hound you forever, until it is fully paid. You ask will they do it for $100k? You must be kidding. They'll do it for $100. Even $50. This is an entire industry. Just ask anyone here who has insurance, and a normal office or lab visit mis-coded, and the insurer refuses to pay.

This is quite common, and a bit surprising that you are unaware.

 

[NW-Bound]

I was fortunate to be healthy up until 4 years ago. Never had a broken bone, no surgeries, no chronic illness.

Then, I found myself with an ailment that could mean death in a short time. I will write about it one of these days, with a chronological story of treatments. Within 3 days, I met with a specialist, got to see more specialists for further diagnostics and had a surgery schedule set up in a matter of days. I doubt that this process could be better under ANY other systems. Not unless I have concierge healthcare, or am one of those billionaires.

The problem is it costs a lot of money, and it is going to cost even more! To me, healthcare in the USA is not bad at all. It's just awfully expensive.

 

[eta2020]

I was fortunate to be healthy up until 4 years ago. Never had a broken bone, no surgeries, no chronic illness.

Then, I found myself with an ailment that could mean death in a short time. I will write about it one of these days, with a chronological story of treatments. Within 3 days, I met with a specialist, got to see more specialists for further diagnostics and had a surgery schedule set up in a matter of days. I doubt that this process could be better under ANY other systems. Not unless I have concierge healthcare, or am one of those billionaires.

The problem is it costs a lot of money, and it is going to cost even more!

That is fine. Just don't believe that it is ANY worst in places like Germany, Spain, Switzerland, Italy etc etc. and it costs a lot less money.

 

[Senator]

No. Most health care providers will just sell the debt to a debt collector, who will then add their own fees and hound you forever, until it is fully paid. You ask will they do it for $100k? You must be kidding. They'll do it for $100. Even $50. This is an entire industry. Just ask anyone here who has insurance, and a normal office or lab visit mis-coded, and the insurer refuses to pay.

This is quite common, and a bit surprising that you are unaware.

No doubt you get hounded. If they know how to contact you, hence the need for a new phone number every few months. That's another reason why I am not longer a low-income landlord, it's hard to contact your own tenants. I have had car and furniture repossessors come looking for cars a year after the tenant moved, so I know collectors are far behind most debtors. (I have seen federal marshals raid a place several years after a tenant moved, but that is another story...)

I have had judgments awarded to me. I garnished one person's wages, (and they then lost the home they were in at that time.). I know they do it for small money. I know they do it if you have a consistent source of income.

Social Security cannot be garnished except by the government. 401K and IRA are generally protected. Personal residences are generally protected.

The credit rating agencies are coming up with a standard that excludes medical bills. So I really wonder what the worse case downside of not paying a medical bill is.

 

[MichaelB]

No doubt you get hounded.
./.
So I really wonder what the worse case downside of not paying a medical bill is.

Are you serious? We are not talking about a group of people that lives on the run, in the streets, or like nomads. We are talking about people with jobs and children in schools. In the US health insurance is a per-requisite to reach a minimum level of financial stability.

Don't pay your debts or just declare bankruptcy is the recourse of last resort. It certainly isn't a strategy for the type of discussion we're having here.

 

[NW-Bound]

That is fine. Just don't believe that it is ANY worst in places like Germany, Spain, Switzerland, Italy etc etc. and it costs a lot less money.

Let me say that while I searched the Web for info on my illness, I ran across blogs of foreigners with the same affliction. And I was not impressed with the level of care some of them got.

Now, there are a lot of factors involved. Maybe my circumstances were more fortunate. I know it is just anecdotal evidence, and so one has to be careful before making generalizations.

Maybe my insurance was good (doctors and healthcare organizations work for money!). Other countries with public healthcare also have additional private supplemental insurance. If it is all good, why do people buy supplements? I do not know about these things, not actually living there and using the service.

 

[eta2020]

Let me say that while I searched the Web for info on my illness, I ran across blogs of foreigners with the same affliction. And I was not impressed with the level of care some of them got.

I would be shocked if in for example Munich Germany you would not be treated as well if not better.

Now that might not be case in Mexico or Thailand.

 

[NW-Bound]

It was a western country, with a healthcare ranking way higher than that of the US according to the WHO list I posted earlier. Who is lower than the US, according to that list? It really left me scratching my head.

As I said, I do not live there, and only read accounts of some individuals who do. Their cases may be one of the rare exceptions. Who knows?

And I do not have chronic illness, so my encounter with the healthcare system here was very intensive, but it's over now, I hope. Maybe it went smoothly for me because I was fortunate. Who knows?

 

[eta2020]

Well the quality will vastly vary between Florence and Sicily in Italy. (just to give example)

 

[Senator]

Are you serious? We are not talking about a group of people that lives on the run, in the streets, or like nomads. We are talking about people with jobs and children in schools. In the US health insurance is a per-requisite to reach a minimum level of financial stability.

Don't pay your debts or just declare bankruptcy is the recourse of last resort. It certainly isn't a strategy for the type of discussion we're having here.

I am serious. I spend a lot of time, as many of us here do, going over strategies to protect my assets and income in case of higher tax rates, creditors, etc. I try to understand and get any tax credits and subsidies available to me or my DGF.

None of us are ever going to change any healthcare policy in the USA. Even if we are the impetus of change, it may not happen for several years. We could have a health event tomorrow that requires treatment we cannot afford, or one we do not have coverage for, even with today's system. There are people that pay the ACA penalty, rather than get insurance. This type of discussion impacts them.

Having a backup plan is probably more relevant to more people than changing residence to a different country, although that is a valid backup plan for some too. Knowing what worse case is, helps people make decisions. Making a $25 a month payment plan is not too bad. Paying $100K, when the downside is only $1K, is a poor financial decision. A wealthy person can always move to somewhere and get care. The average person cannot.

I have VA healthcare, 100%. If I get taken to a non-Va facility, they are supposed to cover it, but maybe not. I never intend on paying any major hospital bill, if I ever get one, if I follow their rules and it is truly an emergency. Heart attack, stroke, compound fracture, etc.

I am self-insuring for LTC, and I am assuming it will be a one-way trip that my assets or VA insurance will cover. If I walk out their door after a miracle, I am not planning on writing any checks to any LTC facility.

I think it is helpful to understand all options.

 

[MichaelB]

Maybe my insurance was good (doctors and healthcare organizations work for money!). Other countries with public healthcare also have additional private supplemental insurance. If it is all good, why do people buy supplements? I do not know about these things, not actually living there and using the service.

I would be shocked if in for example Munich Germany you would not be treated as well if not better.

Now that might not be case in Mexico or Thailand.

The discussion is interesting. In the interest of keeping it on topic, some questions. If quality of healthcare is a priority, is there a way to compare the kind of healthcare we could expect in the US or moving? If so, then how do we estimate the real, total cost? How do we go about making this an option? Realistically, health care abroad is only an option if relocation is viable.

 

[donheff]

I have VA healthcare, 100%. If I get taken to a non-Va facility, they are supposed to cover it, but maybe not. I never intend on paying any major hospital bill, if I ever get one, if I follow their rules and it is truly an emergency. Heart attack, stroke, compound fracture, etc.

I am self-insuring for LTC, and I am assuming it will be a one-way trip that my assets or VA insurance will cover. If I walk out their door after a miracle, I am not planning on writing any checks to any LTC facility.

I think it is helpful to understand all options.

Is your portfolio all in protected accounts? Without solid coverage for catastrophic medical costs I would worry that a lot of my assets would be pulled out of my pockets by my creditors.

 

[bmcgonig]

I am serious. I spend a lot of time, as many of us here do, going over strategies to protect my assets and income in case of higher tax rates, creditors, etc. I try to understand and get any tax credits and subsidies available to me or my DGF.

None of us are ever going to change any healthcare policy in the USA. Even if we are the impetus of change, it may not happen for several years. We could have a health event tomorrow that requires treatment we cannot afford, or one we do not have coverage for, even with today's system. There are people that pay the ACA penalty, rather than get insurance. This type of discussion impacts them.

Having a backup plan is probably more relevant to more people than changing residence to a different country, although that is a valid backup plan for some too. Knowing what worse case is, helps people make decisions. Making a $25 a month payment plan is not too bad. Paying $100K, when the downside is only $1K, is a poor financial decision. A wealthy person can always move to somewhere and get care. The average person cannot.

I have VA healthcare, 100%. If I get taken to a non-Va facility, they are supposed to cover it, but maybe not. I never intend on paying any major hospital bill, if I ever get one, if I follow their rules and it is truly an emergency. Heart attack, stroke, compound fracture, etc.

I am self-insuring for LTC, and I am assuming it will be a one-way trip that my assets or VA insurance will cover. If I walk out their door after a miracle, I am not planning on writing any checks to any LTC facility.

I think it is helpful to understand all options.

This doesn't help you if you get cancer. You won't get chemotherapy in the ER. Or perhaps you need constant cardiac care after a heart attack. Your plan works for acute hospitalisation. It doesn't work for any chronic disease.

 

[eta2020]

The discussion is interesting. In the interest of keeping it on topic, some questions. If quality of healthcare is a priority, is there a way to compare the kind of healthcare we could expect in the US or moving? If so, then how do we estimate the real, total cost? How do we go about making this an option? Realistically, health care abroad is only an option if relocation is viable.

If you have nice fat net worth relocation to most EU countries is viable without EU passport.

But one would be then exposed to higher income taxes so it is not a free ride.

 

[Senator]

Is your portfolio all in protected accounts? Without solid coverage for catastrophic medical costs I would worry that a lot of my assets would be pulled out of my pockets by my creditors.

Much of it in RE, quite a but in pension, 401K and IRAs. I am just not sure if any can actually be pulled out of an after-tax account, even with a judgement.

If I was socked with a major bill, I would probably attempt to work out a payment plan, with minimal payments.

This doesn't help you if you get cancer. You won't get chemotherapy in the ER. Or perhaps you need constant cardiac care after a heart attack. Your plan works for acute hospitalization. It doesn't work for any chronic disease.

I have the VA for those things if I have the mental capacity, and time, to know to get to the VA. A chronic disease or chemotherapy would be handled 100% by the VA no question.

A stroke might leave me incapacitated, and the VA emergency here is not prepared to handle that type of emergency anyway. A similar thing with a heart attack, where seconds count.

That is another reason why I am focusing on keeping healthy. Working out and watching my diet a bit more. Keeping healthy is the #1 way to avoid healthcare expenses.

 

[MBSC]

Now I understood it's "Medicaid" patients that docs are declining to see not "Medicare" ......do you have hard evidence of this....

A Medicare participating physician does not have to see original Medicare enrollees. If the provider chooses to see one, then the provider must follow the participation agreement.

From The Villages Health in Florida.

If you are an existing patient with The Villages Health and are currently enrolled in original Medicare or Medicare with a traditional Medicare Supplemental policy, you can remain a patient with TVH through December 31, 2016. As of January 1, 2017, we will only be accepting patients with the Medicare Advantage plans listed above.

Reference: Accepted Insurance by The Villages Health