Author Topic: Healthcare Costs in the EU  (Read 6714 times)

Threshkin

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Healthcare Costs in the EU
« on: May 18, 2015, 11:35:25 AM »
My wife and I are on the cusp of FIRE and are exploring options for living overseas.  Health care costs are a major concern.  Here in the US the premium costs for the two of us is about $1,000/month before subsidies but not including deductibles and out-of-pocket expenses.

My wife is an EU citizen (German) and we are thinking about the possibility of retiring in the EU but we have not been able to find much information on the costs of health care. We can find information on the relative quality of healthcare but information on the fixed vs. variable cost on a country by country basis is hard to find.

Can any of our EU based mustachians help us out here?  Are there any on-line resources I can use to research our options, costs and restrictions?

Here are a few specific questions i am trying to answer:
  • Does citizenship in one EU country give access to national healthcare systems in other EU countries?
  • What are the fixed (premiums) and variable costs of health care in different EU countries?
  • Are there age based restrictions for starting healthcare coverage?  We are currently 51 and 58.
  • If you travel within the EU does your health care coverage travel with you or do to need supplemental coverage?
  • Are there any other factors we should consider?

Exflyboy

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Re: Healthcare Costs in the EU
« Reply #1 on: May 18, 2015, 12:38:40 PM »
I am a citizen of the UK so I can't be precise but when I was looking into this I came up with..

1) If we could show that we intended to live in the UK my (American) Wife and I got access to the National health Service which is free (well not really free as its paid for with taxes). All we needed to show was that we had sold our house in the US and had something like a shipping receipt for all our belongings heading to the UK. They don't want medical tourists dipping into the system and then leaving without paying.

2) Healthcare is no longer a European wide deal. In the past you could go on vacation to the Europe and carry with you a form that said the UK Government would pay for your care in mainland Europe. Sadly of course we had people retiring to Southern Europe on this deal and the UK authorities stopped this system.

Bottom line I think its much more country specific and there is no reciprocal arrangements like there used to be.

You will have to get specific info on Germany is the bottom line.

Incidently, if you are about to FIRE, you might be able to get your income down to $22k per year to get max subsidy, for my Wife and I that looks to be about $50 a month premium for a silver plan. This should be easy if you have after tax savings.. you simply sell enough of your investments to hit about $22k in capital gains.

There are plenty of other options for low coast HC.. Heck just throw a dart at a map of the world and you'll almost be guaranteed lower cost of HC!!!

How about Thailand, Panama, Belieze, Guatemala...


PeteD01

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Re: Healthcare Costs in the EU
« Reply #2 on: May 18, 2015, 02:32:38 PM »
Your best bet is to get international health insurance because it is affordable and gives you time to look around.
We (two adults) are paying only $350/month with medical evacuation coverage, global coverage and 90 days/year USA included, and 5000 Euro deductible.
Once you know where you are going to settle down, you can get into the nitty gritty of figuring out the local market.
Your wife might be eligible to reenter the "gesetzliche Krankenversicherung" in Germany if she had been a member up until the day she left Germany for a country in which public insurance is not available or where she entered public insurance/health system without a lapse.
However, she will have to apply at her old insurance company within thirty days after returning or they are allowed to reject her application.
It is complicated and you will have to do the research yourself to confirm the details.
I have that option and I am very careful about not letting it expire - I have no intention to move to Germany at this time but one never knows...



daverobev

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Re: Healthcare Costs in the EU
« Reply #3 on: May 18, 2015, 06:11:21 PM »

Exflyboy

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Re: Healthcare Costs in the EU
« Reply #4 on: May 18, 2015, 06:35:11 PM »
2) Healthcare is no longer a European wide deal.

https://en.wikipedia.org/wiki/European_Health_Insurance_Card

Note however it is based on where you are legally residing, not on your Citizenship.. I know EX pat Brits have had some issues being covered by this.

PeteD01

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Re: Healthcare Costs in the EU
« Reply #5 on: May 18, 2015, 07:04:41 PM »
2) Healthcare is no longer a European wide deal.

https://en.wikipedia.org/wiki/European_Health_Insurance_Card

Note however it is based on where you are legally residing, not on your Citizenship.. I know EX pat Brits have had some issues being covered by this.

Yes, and once you have obtained residence and insurance in one member state, you may become ineligible for public health insurance in another member state and things can get only worse from there. One needs to be extremely careful and knowledgeable before deciding on the state of residence. On the other hand, if one decides to stay with private insurance, there should not be any problems except that, in some states, it makes you ineligible for statuary health coverage indefinitely...

daverobev

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Re: Healthcare Costs in the EU
« Reply #6 on: May 20, 2015, 12:53:19 PM »
AFAIK you don't 'decide' on your state of residence, it's a factual thing - for the UK at least you tell them the number of days you were in the country, the days worked in the country, etc, etc. And then they determine your domicile, residence etc.

Not sure about other member states. But of course your coverage is based on where you reside. You can't live in France or Spain and expect the UK to cover you, that's just not fair.

PeteD01

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Re: Healthcare Costs in the EU
« Reply #7 on: May 20, 2015, 01:30:27 PM »
AFAIK you don't 'decide' on your state of residence, it's a factual thing - for the UK at least you tell them the number of days you were in the country, the days worked in the country, etc, etc. And then they determine your domicile, residence etc.

Not sure about other member states. But of course your coverage is based on where you reside. You can't live in France or Spain and expect the UK to cover you, that's just not fair.

It is entirely up to the retiree holding an EU passport where to establish residence. All you got to do is meet the requirement that your income or means of support put you above the eligibility level for welfare of the country of your choice and to prove health insurance and to stay more than 183 days per tax year.

The UK is an exception as NHS health benefits are not exportable anymore unless one is only a visitor in another EU country. For many EU countries, the public health system of the country of origin will continue to provide coverage as long as one maintains membership. Membership in one public health system (or statuary health coverage) precludes membership in the public health system of another member state.

However, moving from one public health system to another is mandatory if one works in another member state and, upon return to the country of origin, the membership in that country can be picked up again within a certain period of time or by meeting work and income requirements independent of any deadline. Some countries' citizens are automatically members of the health system while residing in the country.

In general, moving from EU country to EU country while working and paying taxes and social system contributions in the respective countries poses minimal problems. For retirees, it is much more complicated and, in some cases and some countries, virtually impossible to join a public health system/insurance.
In order not to get tangled up in complications, it is much better for a retiree coming from outside of the EU to obtain international health insurance and work from there.

Mr FrugalNL

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Re: Healthcare Costs in the EU
« Reply #8 on: May 20, 2015, 02:23:34 PM »
  • Does citizenship in one EU country give access to national healthcare systems in other EU countries?
  • What are the fixed (premiums) and variable costs of health care in different EU countries?
  • Are there age based restrictions for starting healthcare coverage?  We are currently 51 and 58.
  • If you travel within the EU does your health care coverage travel with you or do to need supplemental coverage?
  • Are there any other factors we should consider?

1. I'm not sure.
2. No-frills basic health insurance with the maximum allowed 875 deductible for two adults of your ages would cost you about 140/month in the Netherlands. Everyone living or working in the Netherlands is obliged to take out basic health insurance. Insurance companies must accept all applicants for basic health insurance. If you want additional coverage, that may be subject to conditions imposed by the insurance company. Certain types of healthcare, like consulting a general practitioner, are paid for by the insurance company even if you haven't paid the whole deductible yet. Some of the cheaper health insurance policies restrict which hospitals are covered. Info on the Dutch government's website: http://www.government.nl/issues/health-insurance
3. No.
4. Depends on your insurance policy, I think.
5. We've also got great bicycle lanes. :-) https://www.youtube.com/watch?v=ob-uVs0_eC0

Threshkin

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Re: Healthcare Costs in the EU
« Reply #9 on: May 20, 2015, 05:31:09 PM »
Thanks Everyone for the great responses.  I am learning a lot!

In our case my wife is a German citizen (naturalized) but has lived in the US for over ten years.  If we move back to the EU, we have only limited incentive to move to Germany.  Moving to the EU is not something we have decided to do, we are just investigating options and trying to learn as much as we can before we make a decision.

daverobev

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Re: Healthcare Costs in the EU
« Reply #10 on: May 21, 2015, 04:52:16 AM »
Thanks Everyone for the great responses.  I am learning a lot!

In our case my wife is a German citizen (naturalized) but has lived in the US for over ten years.  If we move back to the EU, we have only limited incentive to move to Germany.  Moving to the EU is not something we have decided to do, we are just investigating options and trying to learn as much as we can before we make a decision.

I think you would need to get a visa in the country in question if your wife was not a citizen of that country. Example, I'm British and there is a mechanism to get my wife a UK visa and eventually citizenship. But AFAIK we can't do the same thing for another EU country. She could only visit, or apply to immigrate to France (say), but me being *British* doesn't help her at all in that respect. Only once she became British would she get free movement in the EU.

Moonwaves

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Re: Healthcare Costs in the EU
« Reply #11 on: May 21, 2015, 05:27:36 AM »
If she previously paid into the German state system (not really a state system but for want of a better word - in German it'd be a "gesetzliche Krankenkasse") then I think she can be taken back into that system without penalty of any kind or without being forced to take private insurance. [edit: see that PeteD already mentioned this, sorry, missed that first time round]

There are some international private insurances which are recognised in Germany, but not many. I'd recommend losing a few hours of your life to the toytowngermany forums. Obviously, it's a Germany-based website (for English speakers) but given your connection to Germany, it's probably not a bad place to start. There are a few insurance guys who contribute a lot to the forums (users Starshollow and John G. in particular) who are extremely helpful. I don't really participate over there any more but there are wiki pages here that are useful and here's one link to a discussion on international health insurance. Seach health insurance and you'll get loads of results (use the google-powered button for best results).

With regard to the EHIC, that's really only intended as a way to get health cover for short stays in EU countries that you're not resident in. So it's handy for holidays but not meant to replace health insurance in your normal country of residence. For example, sometimes the only things covered are emergency treatment and/or pain relief to get you through your holiday and back home. I chipped a tooth once when on holiday in Germany while I was actually still living in Ireland. Went to the dentist in Germany with my E111 form (which the EHIC replaced) and all she could do was give me pain relief and a temprorary filling. Nothing else was allowed at the time - I had to wait till I was back in Ireland to get the proper work done.

I'd be inclined to say Ireland would definitely not be one of the best options to choose for you as the whole system there can be a bit ridiculous. But there are lots of discussions among some very financially savvy people on askaboutmoney.com if you wanted to inform yourself about how things work there.
« Last Edit: May 21, 2015, 06:01:43 AM by Moonwaves »

PeteD01

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Re: Healthcare Costs in the EU
« Reply #12 on: May 21, 2015, 07:29:16 AM »
Thanks Everyone for the great responses.  I am learning a lot!

In our case my wife is a German citizen (naturalized) but has lived in the US for over ten years.  If we move back to the EU, we have only limited incentive to move to Germany.  Moving to the EU is not something we have decided to do, we are just investigating options and trying to learn as much as we can before we make a decision.

I think you would need to get a visa in the country in question if your wife was not a citizen of that country. Example, I'm British and there is a mechanism to get my wife a UK visa and eventually citizenship. But AFAIK we can't do the same thing for another EU country. She could only visit, or apply to immigrate to France (say), but me being *British* doesn't help her at all in that respect. Only once she became British would she get free movement in the EU.

For the non-EU spouse of a British citizen residing in the UK, national law is applicable. You being British would make it easy for her to immigrate to France if you were a resident of France, which you could very easily become.
In general terms: immigration of a non-EU spouse of an EU citizen falls under national law if the EU citizen is a national of the EU country he or she is legally residing in.  Immigration of a non-EU spouse of an EU citizen falls under EU law if the EU citizen is a not a national of the EU country he or she is legally residing in.

EU immigration law regarding non-EU immediate family immigration is pretty straightforward and easy to deal with.

PeteD01

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Re: Healthcare Costs in the EU
« Reply #13 on: May 21, 2015, 07:45:10 AM »
It would probably be easiest by far to move to Germany for a while. From then on it should be no problem to go wherever you want in the EU.

The problem is that once one becomes a memeber of a statuary health insurance/system, it can be difficult to become a member in another EU country.
Health insurance in Germany can be very expensive and laws in Europe are designed to discourage movement to lower cost countries by keeping the retiree in the system of the country of origin. Moving to Germany first could turn out to be a major financial mistake if Germany turns out not to be the final destination.

I am not trying to give legal advice here, but suffice it to say that is is illegal anyways to obtain residency in a particular EU country for the sole purpose of obtaining social services (health care falls under these). Moving first to Germany and obtaining benefits on that basis only to eventually move to another country and maintaining the coverage could be construed as a fraudulent move. This type of fraud is a very hot topic in the EU and scrutiny is to be expected.
It is far better to acknowledge the reality that one is not sure where one is going to settle down eventually and, in the meantime, to obtain international insurance which is designed to cover precisely that situation.

WerKater

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Re: Healthcare Costs in the EU
« Reply #14 on: May 21, 2015, 09:35:12 AM »
If she previously paid into the German state system (not really a state system but for want of a better word - in German it'd be a "gesetzliche Krankenkasse") then I think she can be taken back into that system without penalty of any kind or without being forced to take private insurance. [edit: see that PeteD already mentioned this, sorry, missed that first time round]
I just looked up the law (http://www.gesetze-im-internet.de/sgb_5/__9.html) and I believe that this is correct (I am not a lawyer!). If your wife paid into the system until leaving Germany she has the right to become a voluntary member of any "Gesetzliche Krankenversicherung" upon her return. But this right would extend to you only if your monthly income is below 405.
Also note that the voluntary public insurance will cost you between 15 and 16% of your total income.
« Last Edit: May 21, 2015, 09:37:16 AM by WerKater »

daverobev

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Re: Healthcare Costs in the EU
« Reply #15 on: May 21, 2015, 09:55:08 AM »
Thanks Everyone for the great responses.  I am learning a lot!

In our case my wife is a German citizen (naturalized) but has lived in the US for over ten years.  If we move back to the EU, we have only limited incentive to move to Germany.  Moving to the EU is not something we have decided to do, we are just investigating options and trying to learn as much as we can before we make a decision.

I think you would need to get a visa in the country in question if your wife was not a citizen of that country. Example, I'm British and there is a mechanism to get my wife a UK visa and eventually citizenship. But AFAIK we can't do the same thing for another EU country. She could only visit, or apply to immigrate to France (say), but me being *British* doesn't help her at all in that respect. Only once she became British would she get free movement in the EU.

For the non-EU spouse of a British citizen residing in the UK, national law is applicable. You being British would make it easy for her to immigrate to France if you were a resident of France, which you could very easily become.
In general terms: immigration of a non-EU spouse of an EU citizen falls under national law if the EU citizen is a national of the EU country he or she is legally residing in.  Immigration of a non-EU spouse of an EU citizen falls under EU law if the EU citizen is a not a national of the EU country he or she is legally residing in.

EU immigration law regarding non-EU immediate family immigration is pretty straightforward and easy to deal with.

Ohhh.. is that right? So actually it would be easier for her/us to move to France than to move to the UK?! Do you have links/pointers - "legally residing" obviously I don't want to move for 6 months on my own to become legally resident and then have her come, could we go with her as a visitor and change status once I became resident, say?

Her family is of German origin on one side, but sadly when her mum became Canadian she lost the German side. My daughter, on the other hand, inherits Britishness from me - hurrah!

PeteD01

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Re: Healthcare Costs in the EU
« Reply #16 on: May 21, 2015, 11:12:00 AM »
Thanks Everyone for the great responses.  I am learning a lot!

In our case my wife is a German citizen (naturalized) but has lived in the US for over ten years.  If we move back to the EU, we have only limited incentive to move to Germany.  Moving to the EU is not something we have decided to do, we are just investigating options and trying to learn as much as we can before we make a decision.

I think you would need to get a visa in the country in question if your wife was not a citizen of that country. Example, I'm British and there is a mechanism to get my wife a UK visa and eventually citizenship. But AFAIK we can't do the same thing for another EU country. She could only visit, or apply to immigrate to France (say), but me being *British* doesn't help her at all in that respect. Only once she became British would she get free movement in the EU.

For the non-EU spouse of a British citizen residing in the UK, national law is applicable. You being British would make it easy for her to immigrate to France if you were a resident of France, which you could very easily become.
In general terms: immigration of a non-EU spouse of an EU citizen falls under national law if the EU citizen is a national of the EU country he or she is legally residing in.  Immigration of a non-EU spouse of an EU citizen falls under EU law if the EU citizen is a not a national of the EU country he or she is legally residing in.

EU immigration law regarding non-EU immediate family immigration is pretty straightforward and easy to deal with.

Ohhh.. is that right? So actually it would be easier for her/us to move to France than to move to the UK?! Do you have links/pointers - "legally residing" obviously I don't want to move for 6 months on my own to become legally resident and then have her come, could we go with her as a visitor and change status once I became resident, say?

Her family is of German origin on one side, but sadly when her mum became Canadian she lost the German side. My daughter, on the other hand, inherits Britishness from me - hurrah!

You would need to move and become a resident of France in order for EU law to become applicable.


http://europa.eu/youreurope/citizens/residence/worker-pensioner/non-eu-family-members/index_en.htm

daverobev

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Re: Healthcare Costs in the EU
« Reply #17 on: May 21, 2015, 11:24:19 AM »
Thanks Everyone for the great responses.  I am learning a lot!

In our case my wife is a German citizen (naturalized) but has lived in the US for over ten years.  If we move back to the EU, we have only limited incentive to move to Germany.  Moving to the EU is not something we have decided to do, we are just investigating options and trying to learn as much as we can before we make a decision.

I think you would need to get a visa in the country in question if your wife was not a citizen of that country. Example, I'm British and there is a mechanism to get my wife a UK visa and eventually citizenship. But AFAIK we can't do the same thing for another EU country. She could only visit, or apply to immigrate to France (say), but me being *British* doesn't help her at all in that respect. Only once she became British would she get free movement in the EU.

For the non-EU spouse of a British citizen residing in the UK, national law is applicable. You being British would make it easy for her to immigrate to France if you were a resident of France, which you could very easily become.
In general terms: immigration of a non-EU spouse of an EU citizen falls under national law if the EU citizen is a national of the EU country he or she is legally residing in.  Immigration of a non-EU spouse of an EU citizen falls under EU law if the EU citizen is a not a national of the EU country he or she is legally residing in.

EU immigration law regarding non-EU immediate family immigration is pretty straightforward and easy to deal with.

Ohhh.. is that right? So actually it would be easier for her/us to move to France than to move to the UK?! Do you have links/pointers - "legally residing" obviously I don't want to move for 6 months on my own to become legally resident and then have her come, could we go with her as a visitor and change status once I became resident, say?

Her family is of German origin on one side, but sadly when her mum became Canadian she lost the German side. My daughter, on the other hand, inherits Britishness from me - hurrah!

You would need to move and become a resident of France in order for EU law to become applicable.


http://europa.eu/youreurope/citizens/residence/worker-pensioner/non-eu-family-members/index_en.htm

Oh holy shit. Mediterranean, here we come...!

Paul der Krake

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Re: Healthcare Costs in the EU
« Reply #18 on: June 02, 2015, 06:54:31 PM »
This is probably not very helpful if you already found your spouse, but on the off chance that some US citizen is reading this trying to decide between a Brit, a German, and a French spouse: choose the French.

You can gain French citizenship after 5 years of marriage without ever setting foot in the country! That's an incredible deal.