Author Topic: FIRE without the ACA - options abroad?  (Read 14632 times)

jim555

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Re: FIRE without the ACA - options abroad?
« Reply #50 on: November 15, 2016, 02:37:06 PM »
FIRE just got a whole lot harder.  Can't wait for the death spiral.

geekette

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Re: FIRE without the ACA - options abroad?
« Reply #51 on: November 15, 2016, 02:45:08 PM »
I'm starting to think those who say "I'll never retire" are on the right track.  What's the point of saving if you can't retire and get medical insurance?  Just spend it all!

Threshkin

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Re: FIRE without the ACA - options abroad?
« Reply #52 on: November 15, 2016, 02:47:56 PM »


For the record, the most recent comprehensive ACA alternative proposed by Republicans includes a ban against denying coverage based on preexisting conditions and a guarantee that you get the regular market rate even if you are very sick provided you maintain continuous coverage.  Note that this simply expands the same rights already afforded to people who get insurance through an employer to those on the individual market.

https://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf

Just because the ACA may go away doesn't necessarily mean we're going back to the old system.  It will be replaced with something new, and many of the more popular features of the current market are highly likely to carry over.  New ones like portability across state lines may also be added, which could actually be a net plus for many early retirees.

If they do manage to maintain the good stuff (no denial based on pre-existing conditions), but get rid of the "bad" stuff (penalty for not buying health insurance), the market heads toward a death spiral.  Healthy people opt out (since no penalty) so the risk pool is made up of older people and those with preexisting conditions.  This causes the insurance companies to raise premiums, which forces out more healthy people, which raises premiums higher (or causes the insurers to just drop out of the market).

This is my understanding as well.  Trump has said he likes (at least) two components of ACA.  The coverage for preexisting conditions clause and the adult children clause.  He also said he is opposed to the mandate.  Of course if the mandate is eliminated and the other two items are retained, insurance expenses will increase even more since the insurers will have even fewer young healthy adults buying insurance and helping to defray the higher costs of other people.

I was FIRE Nov 01 this year and wound up going with COBRA coverage because it is cheaper than the least expensive ACA Bronze plan before subsidies.  I will not qualify for subsidies until 2018 if they still exist by then.

urbanista

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Re: FIRE without the ACA - options abroad?
« Reply #53 on: November 17, 2016, 02:44:47 PM »
In Australia, I pay $190 per month (Australian dollars) for a health insurance for a couple of relatives ( 60 y.o.). My relatives are foreigners, i.e. they have no permanent residency and come on a tourist long term stay visas. On this plan they get 100% of everything that local Medicare would cover, with $500 deductible per year. Pre-existing conditions are not covered for 12 months, then they are covered. It is called "overseas visitors" insurance. My relatives had multiple stays for the full year each time.

Medicare covers 100% of hospital procedures and some doctor appointments (limit $500 per calendar year). Ambulance is covered too.

I think it is an excellent deal. Considering that Australian health care is good quality, the cost is dirt cheap.



whiskeyjack

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Re: FIRE without the ACA - options abroad?
« Reply #54 on: November 17, 2016, 09:54:15 PM »
In Australia, I pay $190 per month (Australian dollars) for a health insurance for a couple of relatives ( 60 y.o.). My relatives are foreigners, i.e. they have no permanent residency and come on a tourist long term stay visas. On this plan they get 100% of everything that local Medicare would cover, with $500 deductible per year. Pre-existing conditions are not covered for 12 months, then they are covered. It is called "overseas visitors" insurance. My relatives had multiple stays for the full year each time.

Medicare covers 100% of hospital procedures and some doctor appointments (limit $500 per calendar year). Ambulance is covered too.

I think it is an excellent deal. Considering that Australian health care is good quality, the cost is dirt cheap.

This is great info!   Is the overseas visitors insurance through a private insurance company?    I'd written off Australia because the permanent resident status was too hard to get, but it sounds like the tourist visa would be easier.   Off to research.

gerardc

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Re: FIRE without the ACA - options abroad?
« Reply #55 on: November 18, 2016, 11:07:14 PM »
If they do manage to maintain the good stuff (no denial based on pre-existing conditions), but get rid of the "bad" stuff (penalty for not buying health insurance), the market heads toward a death spiral.  Healthy people opt out (since no penalty) so the risk pool is made up of older people and those with preexisting conditions.  This causes the insurance companies to raise premiums, which forces out more healthy people, which raises premiums higher (or causes the insurers to just drop out of the market).

Not necessarily:

I'm not convinced anymore that the mandate is necessary for the pre-existing conditions ban to function correctly.

Think about it. You still need to sign up for insurance in an enrollment window. So, the strategy of waiting to get cancer to sign up doesn't really work, because you have to wait up to a year uninsured in the meantime, and 1 year of health expenses can absolutely wreck you financially. So, a sensible person will still stay insured even without a mandate. They may jump on a catastrophic plan though, and switch to a Platinum plan once they get a chronic condition. However, that's still the case even with a mandate -- you can cruise on a high-deductible plan until you need coverage for consistent expenses. So, removing the mandate won't change much IMO.

Mandate or not, it seems only the HDP will stay at competitive prices, since only chronically ill folks would buy the comprehensive plans. But that's not what happens in pratice because of the subsidies, and because many rich people are very risk adverse.


To those who want to get cheap insurance abroad if the ACA is repealed: is there a risk that US insurance would be difficult to get in the future should you get back to the US, due to not having maintained continuous coverage?

urbanista

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Re: FIRE without the ACA - options abroad?
« Reply #56 on: November 21, 2016, 11:33:59 PM »
In Australia, I pay $190 per month (Australian dollars) for a health insurance for a couple of relatives ( 60 y.o.). My relatives are foreigners, i.e. they have no permanent residency and come on a tourist long term stay visas. On this plan they get 100% of everything that local Medicare would cover, with $500 deductible per year. Pre-existing conditions are not covered for 12 months, then they are covered. It is called "overseas visitors" insurance. My relatives had multiple stays for the full year each time.

Medicare covers 100% of hospital procedures and some doctor appointments (limit $500 per calendar year). Ambulance is covered too.

I think it is an excellent deal. Considering that Australian health care is good quality, the cost is dirt cheap.

This is great info!   Is the overseas visitors insurance through a private insurance company?    I'd written off Australia because the permanent resident status was too hard to get, but it sounds like the tourist visa would be easier.   Off to research.

Yes, it is private health insurance companies. All major insurance companies offer this type of cover. If you increase premiums to $200 per person per month, you can even get dental and other extras covered. Not sure about medications, those are covered in hospitals but there will be a limit for out of hospital medications.

I would still budget for at least $1000-2000 per year per person for out of pocket costs. But you are absolutely covered for catastrophic accidents, and after 12 months, for preexisting conditions too.

Cassie

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Re: FIRE without the ACA - options abroad?
« Reply #57 on: November 24, 2016, 02:47:17 PM »
WE really need to fix our healthcare in this country. If most countries with $ can provide it so can we. WE are lucky that we have retiree insurance through our past employer that is unlikely to go away because it is with the state. At one point we thought about going with the ACA but the state said if you leave we don't have to let you back in.  Ours is  expensive at 10k/year for 2 people but it is decent insurance.  New employees will not get coverage when they retire.

whiskeyjack

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Re: FIRE without the ACA - options abroad?
« Reply #58 on: November 24, 2016, 08:58:06 PM »
Quote from: gerardc link=topic=64169.msg1310518#msg1310518

To those who want to get cheap insurance abroad if the ACA is repealed: is there a risk that US insurance would be difficult to get in the future should you get back to the US, due to not having maintained continuous coverage?

The worst-case scenario, if the ACA is repealed, is that we wouldn't be able to get coverage in the US at all because of pre-existing conditions, or if a serious illness developed we'd be dropped from coverage at the end of the period, or that the cost of care would exceed the maximum that the insurance would pay.  Or that we could buy coverage, but it would be prohibitively expensive.   All of those things happened in pre-ACA days.

So there's a risk US insurance will be difficult to get whether or not we leave the US.

« Last Edit: November 25, 2016, 03:34:12 PM by whiskeyjack »

Playing with Fire UK

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Re: FIRE without the ACA - options abroad?
« Reply #59 on: November 25, 2016, 02:01:04 AM »
You probably won't be eligible for NHS care if you are travelling in the UK, regardless of which passports you hold. If you are bleeding profusely or having a heart attack our hospitals will always treat you. But if you land in the UK with an intention to settle here long term, you are eligible from the first day (proving it may be more difficult). If you were visiting the UK holding a UK passport, you may well be given treatment without questions being asked (how are you at accents?) but you wouldn't be eligible.
From my research NHS is based on being "ordinarily resident" for free coverage.  They might want to see a lease agreement, council tax bill, passport and other evidence that you are a resident and not a mere visitor.

Yes, my point is that while you can be 'ordinarily resident' the first day you arrive in the UK, it is more difficult to prove that you intend to stay long term without a scan deep into your brain or some truth serum.

I have never been asked to prove that I'm residing in the UK, or to show my passport. Which may be because I sound British, or because I've responded to letter sent to my UK address, neither of which are particularly difficult to mislead someone about.

Update, I spoke too soon: https://www.theguardian.com/society/2016/nov/21/hospitals-may-require-patients-to-show-passports-for-nhs-treatment

The fact that having a UK passport does not in itself qualify anyone for NHS care seems to have been ignored entirely. The proof of address is more important but still not the same as being OR.

Yay Brexit and nationalism and racism.  /s

jim555

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Re: FIRE without the ACA - options abroad?
« Reply #60 on: November 25, 2016, 06:46:44 AM »
I noticed that a UK landlords must now verify that tenants have to prove they are lawfully present by showing a passport or other documents or face a fine of up to £3,000.

Yay Brexit and nationalism and racism.  /s

Gin1984

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Re: FIRE without the ACA - options abroad?
« Reply #61 on: November 25, 2016, 06:54:46 AM »
I'm curious about UK citizenship. I was born there pre-1983

You can stop right there. You're eligible for UK citizenship.

In any case I currently use the VA healthcare system for my medical care and not an ACA plan so not impacted like most people here. Although I expect changes to the VA as well.

I'm curious. As a Canadian, I don't know how much ACA costs, but is it really that much that there are people willing to leave the US, take on all the costs of resettling, uprooting their lives, being away from friends and family, living in a foreign country with different customs and procedures, dealing with FATCA reporting, etc. What are the numbers we are talking about? $2K a year? $20K a year?
Prior to the ACA, I was ineligible for ANY health insurance because I locked a muscle is college.  It is not about how much the ACA plans cost but that republicans want to remove the ACA which means many people will be without any health insurance unless you work for a large employer.

usoverseas

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Re: FIRE without the ACA - options abroad?
« Reply #62 on: November 25, 2016, 07:28:24 AM »
Following...we are currently working overseas and have Cigna Worldwide with a local country supplement. We are planning on looking into extending this when we FIRE next year.