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Old 01-12-2010, 07:52   #46
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Just to add to this:

If you are stateside and working a job right now, consider putting money into an HSA. I've been loading mine up for a while, and it can be used for most health care costs (notably not insurance premiums) until 65, and after 65 can be used for anything (sort of like an IRA).

We pay for our deductibles out of pocket (rather than via the HSA funds), so we now have ~10K or so sitting in that HSA fund, which again can only be touched for health care expenses.

That makes carrying an international plan with a 2k-5k deductible a non issue.
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Old 01-12-2010, 07:59   #47
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I wasn't aware that HSA plans can be used to pay for medical care outside the USA.
- - But in any case International Medical Insurance generally involve coverages excluding the USA and are reasonably priced. You can also get plans that include limited time coverage inside the USA but that $1500/yr becomes "per quarter" or less.
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Old 01-12-2010, 08:14   #48
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I wasn't aware that HSA plans can be used to pay for medical care outside the USA.
- - But in any case International Medical Insurance generally involve coverages excluding the USA and are reasonably priced. You can also get plans that include limited time coverage inside the USA but that $1500/yr becomes "per quarter" or less.
Yep, it's a "qualified expense". Sadly, I work for an insurance and finance company currently, so I'm more up to speed on some of this than I'd like to be.

U.S. Treasury - HSA Frequently Asked Questions

Some mitigating factors however include the fact that:

- You only have your HSA debit card and checks, neither of which might be accepted so you need to have other funds available to pay at the time of service. It all depends on whether they take cards and/or whether they take foreign checks (drawn on the HSA account), the latter of which is extremely unlikely.

- Almost guaranteed that the expense will be challenged by the HSA bank as an unqualified expense (and thus reported to the IRS as such, and potentially freezing your card), so you'll need to fax/mail all of the receipts and related paperwork from your visit. The more you can fax them the better.

It's worth a call to your HSA account manager. Depending on who you get on the call they may or may not have any experience with international stuff, but you can at least get the procedure down for what fax#/email/address to send documents to to justify expenses.

If you get that, you should be able to use your HSA debit for any truly qualified medical expense, fax the paperwork back to your HSA bank in anticipation of a challenge, keep your copies, and off you go.
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Old 01-12-2010, 08:47   #49
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- Almost guaranteed that the expense will be challenged by the HSA bank as an unqualified expense (and thus reported to the IRS as such, and potentially freezing your card), so you'll need to fax/mail all of the receipts and related paperwork from your visit. The more you can fax them the better.
Are you sure about this RH? I wasn't aware there was any policing by the custodian of the account. They certainly don't charge enough to cover any administrative work of that nature. I've used my HSA debit card for lots of things (all qualified expenses of course ) and there is no way the bank knows what I've used it for. All they know is the name of the vendor. I also have checks for the account and can use them to reimburse myself if the vendor doesn't take the debit card. Maybe I'm missing something or just been lucky, but I thought the system was self-policing subject to IRS audit only.
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Old 01-12-2010, 09:29   #50
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Are you sure about this RH? I wasn't aware there was any policing by the custodian of the account. They certainly don't charge enough to cover any administrative work of that nature. I've used my HSA debit card for lots of things (all qualified expenses of course ) and there is no way the bank knows what I've used it for. All they know is the name of the vendor. I also have checks for the account and can use them to reimburse myself if the vendor doesn't take the debit card. Maybe I'm missing something or just been lucky, but I thought the system was self-policing subject to IRS audit only.
I think you might have better luck than me, but it's also been at least two years since I last used my HSA funds (we've been fortunate enough to be able to keep the pretax money in there, and just pay out of pocket for our deductibles). On two separate items though (the only two times I used that card) I got challenge letters in the mail, and had to provide receipts.

If I remember correctly, it's from the SIC of the merchant running the card, ala this stuff: CF SIC Code List The custodian should be doing some level of basic auditing (like making sure the card isn't run from a strip club), otherwise there's nothing stopping people from hiding ~5K in income every year.

I'm willing to bet it's all up to the bank as to how much effort they want to put into it, but whenever I see the IRS is involved in anything, I get very careful about my paperwork.
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Old 01-12-2010, 09:33   #51
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I'm willing to bet it's all up to the bank as to how much effort they want to put into it, but whenever I see the IRS is involved in anything, I get very careful about my paperwork.
This makes sense to me, and I agree ... be careful with the paperwork! Thanks.
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Old 01-12-2010, 10:05   #52
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Whether you travel back to the USA for treatment really has to do most with what the medical problem is. If it is a common problem that is also common to the local population, the local medical care system will suffice just fine. But you need to spend some time in these "other" countries to really see what they consider "adequate/normal" health-care and health-care facilities. It can be a real eye-opener.
I suppose I will have to decide at the time if it is worth spending $5000 for an airline ticket and the expense of grounding the boat for whatever the problem is.

Quote:
- - That leads into the situation of only having the medical problem treated locally in the clinics. As I mentioned, most countries have virtually free medical care for their citizens as all are considered "equal." However, in all the countries there are citizens who think/believe they are "more equal" and thusly, the second tier private medical care system has evolved. This tier has very superior (to the local clinics/hospitals) medical service and costs money. This is where I mentioned the International Medical Insurance comes into play.
How expensive is this tier?

Quote:
- - And basically in the USA at age 65 all "private/company" medical coverage terminates and you transfer into Medicare.
I'm going to have to question this. In my previous life as a claims agent for my work insurance, I saw no evidence of major medical terminating. On the contrary, it remained in place as a supplement to Medicare, who paid first. Insurance paid what Medicare wouldn't. If this was the case, my concern here would be moot, by the time I got back to the states after age 65, I would be on Medicare and not concerned with whether my company insurance had lapsed.

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Depending upon your finances you pay for that privilege and then have to fork up significantly more money to buy the "supplemental coverages." Failure to do so - I believe - forfeits your ability to get into Medicare later in life.
What?? Pay for what privelege? Don't we all pay for Medicare in our payroll deductions? What supp coverages?

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But what about your spouse/life-partner? Are you comfortable telling her she will just have to die because you will not maintain a "place-holder" that includes her? (This supposes the spouse/life partner is also of your nationality and was in the past eligible or had medical coverage.)
Yeah, mine has no coverage now and is not eligible for employee coverage. She'll probably enjoy the upgrade to 3rd world medical care.
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Old 01-12-2010, 11:26   #53
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Madwind,
You have raised many issues and questions. If you chose to return to the US for treatment you should also factor in the cost of your deductable with all the other expenses and compare what it would cost to just pay for the treatment in another country.
Medicare, I'm on it and this has been my experience: I started receiving Social Security shortly after turning 62. When I turned 65, I was eligable for Medicare type A, no charge. I optied for Type B which covers doctor fees and requires a deduction from the Social Sercurity monthly payment. Type C would cover drugs and cost more, Type D covers more and cost more. The most you can expect from Medicare is 80% of your bill, and there's a ton of stuff that's not covered, and many places will not accept Medicare payments. Bottom line is that after paying into the program all my life, it cost almost $200 a month for health coverage. This is subject to change during the next Congress, but lets not go there.
AARP approved supplemental, is nothing more than additional insurance with a private company , that pays a kickback to AARP, and cost me $155 a month. There is a window from Nov. thru Dec. (which is changing) where you can change coverage. There are about 4 companies that offer supplemental insurance and today I'm going to meet with an advisior to find out if I can get more coverage for less money.
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Old 01-12-2010, 13:52   #54
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Madwind,
You have raised many issues and questions. If you chose to return to the US for treatment you should also factor in the cost of your deductable with all the other expenses and compare what it would cost to just pay for the treatment in another country.
Yes, I was considering that as well. I think I'd have to have a pretty nasty disease that was going to incapacitate me for life to make returning for treatment worth it. So the big question is, in that condition, do I want to pay $30,000 in premiums for the privilege of wasting away in a hospital while my finances are drained? I think I'd rather just die on my boat.

Quote:
Medicare, I'm on it and this has been my experience: I started receiving Social Security shortly after turning 62. When I turned 65, I was eligable for Medicare type A, no charge. I optied for Type B which covers doctor fees and requires a deduction from the Social Sercurity monthly payment. Type C would cover drugs and cost more, Type D covers more and cost more. The most you can expect from Medicare is 80% of your bill, and there's a ton of stuff that's not covered, and many places will not accept Medicare payments. Bottom line is that after paying into the program all my life, it cost almost $200 a month for health coverage.
Don't know what all that means as I have paid into the Social Security system, but because I am a local government employee, I am not entitled to receive the benefits I have paid for. Your government has decided that I do not have a need for what I paid for because of the employer I chose to work for. They don't seem to see the need to refund my money though, do they?

When I worked as a claims rep, I saw people on Part A get 100% claims payment with their company insurance supplementing what MC wouldn't pay. You don't pay extra for Part A. That's what Medicare Part A says anyway. I suppose if part B covers you around the globe, it might be worth paying $200 a month for the EXTRA coverage. But that leaves a ten year gap from my retirement age of 55 til I have the option for it.
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Old 01-12-2010, 21:11   #55
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Very interested in this topic!
We were working on outfitting the boat, polishing our sailing skills and preparing to sail away in a couple of years. New company came in and eliminated my job! I have now joined millions of others out of work. I still have not received my Cobra packet but have heard that the cost will not be pleasant. Insurance quotes are ugly. At 57 and 61 we got a quote today on a HSA for over $13,000 in premiums with a $4,200 deductable. Thats not an option we can afford. International coverage is looking like the only option we can afford. Other than IMIS does anyone have a provider to reccomend? I have been researching options and have had alot of responses from providers that I don't believe are legimate companies. This economy has really provided a fertile enviorment for scams!
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Old 01-12-2010, 21:25   #56
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At 57 and 61 we got a quote today on a HSA for over $13,000 in premiums with a $4,200 deductable.
Deby
As a Canadian, I was not going to chip in on this thread, but I can't believe the horrible situation you guys in the States have on healthcare.

You get into philosophical discussions that don't help your outcome or healthcare costs as a percentage of GDP (your costs are about 5% higher in GDP terms). And before anyone thinks I am a flaming socialist, I have correctly been accused of being right of Attila the Hun

We pay nothing, and can't be bounced for pre-existing conditions. Five years ago I had a serious condition that required 3.5 months of hospitalization. I had instant access to a world renowned specialist in my condition. By instant, I mean the day after I entered emergency. And yes, our taxes pay for it, but our taxes are now lower than in the States.

I know in the States I could not have afforded the care, and that I would have been cut off from any further insurance.

I am 59, now diabetic, but otherwise very healthy. I can't imagine what I would need to pay when I see $13,000 with a $4,200 deductible.

No wonder my snowbird friends have just evacuation travel insurance.

One thought, although you would not be covered by our healthcare, it MAY be cheaper for you to have evacuation insurance to a Canadian center. I suspect it may be cheaper than going back to the States for a needed procedure.
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Old 01-12-2010, 21:48   #57
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In europe, where there is a private health insurance market, ( not all countries) its possible to get overseas medical coverage , including the US and most include medical repatriation ( our health system actually pays to send citizens to the US for treatment from time to time!). However the cover is usually limited to three months, so its needs a bit of trickery to keep it in place. ( they dont have any real way of determining what time you spent out of your own country anyway).

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Old 02-12-2010, 05:10   #58
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Madwand - I would suggest you do some very serious research into Medicare. You will be shocked and angry at what you actually get and how much you must pay. It took me almost 6 months of going over and over the "fine print" and brochures and many, many advisors on what to get and how to do it. You have to put together a "package" of additional insurance that surrounds Medicare and fills in gaps

Madwand
I'm going to have to question this. In my previous life as a claims agent for my work insurance, I saw no evidence of major medical terminating. On the contrary, it remained in place as a supplement to Medicare, who paid first. Insurance paid what Medicare wouldn't.


That is termination of your major medical coverage and you are being sent to Medicare - no choice. My company did the same and everybody I know with excellent medical coverage while working or where in the "gap" between retirement and age 65 were terminated from company medical plans at age 65.
- - Here's the hook - we were offered a "supplemental" to Medicare at very high prices. Supplementals cost money and there are numerous versions and many companies offering them. This is where the research comes in. Some of these "supplementals" are near scams and some are authentic and the costs are usually quite lower than your company's offered conversion to a "supplemental." So you have to do some serious shopping around.
- - The primary supplemental fills up the payments from Medicare's 80% to 100% - there are many versions of this to weed through to find the one best for your own circumstances.
- - Then there is the "drug coverage" which if you don't have it and live in the USA with a medical condition can bankrupt you. AARP did some articles on the monthly costs of "retired" folks with medical conditions - mostly contrived by Doctors - that were on average costing the retired couple from $5K to $12K per year for the pills. That is, if they can't afford to drive to Canada or Mexico to buy their drugs.

What?? Pay for what privelege? Don't we all pay for Medicare in our payroll deductions? What supp coverages?

- - Again some serious research and a large bottle of aspirin/Advil. JohnA covers the Medicare and Supplemental quite well - but in my case my monthly medical insurance under my company before I retired cost me about $40/month - now that I am under Medicare and have purchased the necessary Supplementals to fill the gap between what Medicare will pay and what the Hospital/Doctor/drug store will charge - I now pay about $250/month, every month. Oh! no privileges involved, since the only choice is Medicare or nothing - or move out of the USA.

$30K in premiums - 20 years - Age?

- - You must be younger than 45 years old to pay that amount of money. I presume most, or at least a significant majority of cruisers and serious wannabe cruisers are about to be retired around age 55 to 65. So the "place-holder" premiums apply to the younger cruisers who are probably on a "sabbatical" cruise of a year or two or three before returning to the work place. Here is where the "place holder" premiums are important both in medical but also in automobile/vehicle insurance. As I mentioned, once you "drop out" getting back in can easily exceed the cost of "place holder" premiums.

- - -
avb3 - Doesn't most parts of Canada now have a requirement that you must be in country up to 6 mos/year? I see that in other threads on the subject quite often.
- - To Canadians CF members - can you pay a "premium" to Canada's health system to stay covered if you stay out of Canada longer than the required "in country" requirement?
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Old 02-12-2010, 05:20   #59
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At 57 and 61 we got a quote today on a HSA for over $13,000 in premiums with a $4,200 deductable.
Deby

Where did you get the quote?

I have run e-healthinsurance.com many times and received much lower quotes than that (me 57, she 54). BUT, I haven't actually applied, so I may not qualify. I won't know till I actually do apply. Not time yet.
What state are you in?
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Old 02-12-2010, 06:23   #60
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I also ran e-healthinsurance and received responses from carriers I have never heard of that wanted my bank account information to apply. BCBS sent me info and an application but they have not responded to a couple of questions i sent them. The quote i received was from a local broker but it is running close to what I have been finding everywhere. When going through the application it looks like we will have dificulty qualifing. Although We would not have met the 4200 deductable last year in med bills.
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