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Old 30-09-2013, 09:46   #61
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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So to bring this back onto a purely cruising-related point -- U.S. cruisers who are on extended cruises to Europe will be pleasantly surprised about the cost of health care services, even if you are uninsured and paying supposedly top whack.

While I agree and I disagree. the UK is one of the places where the "underlying" costs are quite reasonable.

when I was blue lighted to a hospital some years ago in Germany , I was kept in for a night for observation/treatmenmt , ie painkillers ( gaulstones) . Cost me €660. had to have a that in cash/credit and reclaim it.

though mind you I suppose €600 a night isn't bad for a major tech hospital stay. ( after that I discovered the EHIC )

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Old 30-09-2013, 09:49   #62
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

The elephant in the room with the exchange rates for the various plans are the deductibles and co-pays.

It appears that the way they got the monthly rates down was to raise the deductibles and co-pays to really unbelievable levels (think around $4500).

That means that if I had bought one of those policies for the last five years of my life, it would have paid exactly "zero" of my medical expenses, while I was having to pay for the coverage.

I don't think young, relatively healthy, people, are going to be too excited when they find that out.
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Old 30-09-2013, 10:18   #63
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

I'm throwing out a hypothetical question, maybe someone more familiar with the new laws can bring some light.

Since no insurance would mean a fine AND the fine is small, AND you cannot be denied coverage for an existing condition (among other reasons) by the exchanges. Is it possible to pay the annual fines then apply to the exchange, year(s) later if you find yourself in need serious medical care? As in "now I'm sick and want coverage". This seems too simple, and probably is. Some help here please.
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Old 30-09-2013, 10:36   #64
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Originally Posted by Group9 View Post
The elephant in the room with the exchange rates for the various plans are the deductibles and co-pays.

It appears that the way they got the monthly rates down was to raise the deductibles and co-pays to really unbelievable levels (think around $4500).

That means that if I had bought one of those policies for the last five years of my life, it would have paid exactly "zero" of my medical expenses, while I was having to pay for the coverage.

I don't think young, relatively healthy, people, are going to be too excited when they find that out.
It appears most silver plans will have deductibles in the 2000 - 3000 range then 20% co-insurance. The max annual out-of-pocket will be at most $6,350 for any plan.

Gold and platinum plans will have lower deductibles and co-insurance. Carriers are required to have silver and gold to enter the exchanges. Bronze and Platinum are optional offerings.
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Old 30-09-2013, 11:27   #65
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Originally Posted by goboatingnow View Post
When I meet US folk with medical insurances costing 10k plus. How the hell do they meet that bill don't mind the underlying medical costs.

I was in bupa(UK) and bupa ( Ireland ) and thought the 2k a year I paid outrageous. And in Ireland at the time you got 40% back in tax rebates !!

How does someone on 35k dollars afford 8k !!!!!

Sorry for a little thread drift

Dave
That sounds cheap compared to the $36,000/or $100 per day my wife and I pay.... like I pointed out in an earlier post before it was scrubbed for being too political. But, to answer your question: We can't afford the premiums (tax), nobody can.
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Old 30-09-2013, 11:37   #66
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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When we take off cruising, our income will be zero aside from interest on our qualifying investments(assuming they show a return). This will be below $16k/yr.

So voluntarily leaving our jobs and going cruising allows us to get medicare benefits? I do not think that is correct. Don't we have to be over 65?
I can't speak for your investments, but if you plan on using the interest from them for cruising, that interest will probably be $16k or more, unless you are in the $500/month club. This is income per your tax return (adjusted gross income on the 1040 is what they use to determine it).

If you are below that, you qualify for Medicaid. You are correct that you don't qualify for Medicare until older, but that is a different program than Medicaid.

I am not qualified in any way to advise on this and my answers could be completely wrong - I am just passing on what I have been learning as I go through the same complicated process as you are.

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Old 30-09-2013, 11:43   #67
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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The elephant in the room with the exchange rates for the various plans are the deductibles and co-pays.

It appears that the way they got the monthly rates down was to raise the deductibles and co-pays to really unbelievable levels (think around $4500).

That means that if I had bought one of those policies for the last five years of my life, it would have paid exactly "zero" of my medical expenses, while I was having to pay for the coverage.

I don't think young, relatively healthy, people, are going to be too excited when they find that out.
We have been paying $4,000/yr for catastrophic coverage that doesn't even kick in until we have spent $10,000 out of our pockets. And that includes nothing in return.

So a $4500 deductible would be fantastic for us, and it would even cost us half as much!

Unfortunately, health insurance in the US is more about protecting your assets than getting health care. I do not mean that in a political sense at all - it is just the reality that a large health event without any insurance could wipe out everything you own - house, car, investments, etc.

We think of our current plan as asset insurance rather than health insurance.

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Old 30-09-2013, 12:24   #68
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

If I understand it correctly, most cruisers with US residency come out really well under the ACA

If your income is less than $11,000 (and are a resident of a state that expanded medicare with ACA) then insurance is free. Organize your investments to not have too much income while you are cruising (equities or other deferred instruments) and use savings to cover spending while cruising. This is probably a great strategy for someone cruising for only a couple of years.

Or have income between $11,000 to $44,000 so your insurance cost is capped at a percent of your income. For example, a 60 year old couple making $25,000 won't pay more than 4.51% of their income (e.g. $94/month). Again, you can manage your investment income to manage your health insurance cost.

Or, make as much money as you want, buy inexpensive catastrophe/travel insurance privately and also pay the "fine" ($695 a year in 2016). Then you can sign up for ACA insurance once a year during the annual enrollment period even if you have pre-existing conditions.

Note that I'm not expert but this is what it seems to say.....
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Old 30-09-2013, 12:59   #69
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Originally Posted by RainDog View Post
It appears most silver plans will have deductibles in the 2000 - 3000 range then 20% co-insurance. The max annual out-of-pocket will be at most $6,350 for any plan.

Gold and platinum plans will have lower deductibles and co-insurance. Carriers are required to have silver and gold to enter the exchanges. Bronze and Platinum are optional offerings.
Yeah, how many young healthy people are going to be excited about that?
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Old 30-09-2013, 13:00   #70
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Originally Posted by 1ercru View Post
I'm throwing out a hypothetical question, maybe someone more familiar with the new laws can bring some light.

Since no insurance would mean a fine AND the fine is small, AND you cannot be denied coverage for an existing condition (among other reasons) by the exchanges. Is it possible to pay the annual fines then apply to the exchange, year(s) later if you find yourself in need serious medical care? As in "now I'm sick and want coverage". This seems too simple, and probably is. Some help here please.
That's actually a pretty good idea, and completely okay, as far as I can see.

I'd rather do that than sign up for one of those exchange plans with the numbers I am seeing published.
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Old 30-09-2013, 13:13   #71
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Originally Posted by 1ercru View Post
I'm throwing out a hypothetical question, maybe someone more familiar with the new laws can bring some light.

Since no insurance would mean a fine AND the fine is small, AND you cannot be denied coverage for an existing condition (among other reasons) by the exchanges. Is it possible to pay the annual fines then apply to the exchange, year(s) later if you find yourself in need serious medical care? As in "now I'm sick and want coverage". This seems too simple, and probably is. Some help here please.
I think you can only sign up once a year, and you sign up for next year in the fall. So if you get sick you will have between a 2 and 14 month waiting period to sign up. By then you have probably racked up $100k in Medical bills.

If you add "Carry a catastrophic plan" before you get sick, this makes more sense. If you have no assets, then of course you have nothing to lose.
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Old 30-09-2013, 13:36   #72
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

[QUOTE=CarlF;1353254.....

Or, make as much money as you want, buy inexpensive catastrophe/travel insurance privately and also pay the "fine" ($695 a year in 2016). Then you can sign up for ACA insurance once a year during the annual enrollment period even if you have pre-existing conditions.

Note that I'm not expert but this is what it seems to say.....[/QUOTE]
Try finding inexpensive catastrophic insurance. I doubt you will find anything that is cheaper than the subsidized Exchange plans. I sure can't. The Exchange plans will reduce our insurance costs significantly. We currently carry a plan with 10,000 deductible, so I'd consider that a catastrophic plan. It costs much more than the Exchange plan, covers less and with higher out of pocket. So the Exchange plan will save us a lot while cruising.
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Old 30-09-2013, 14:42   #73
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Yeah, how many young healthy people are going to be excited about that?
I wonder if this will (farther) impact the number of "healthy young people" who go all in and cruise?

I suppose the penalty will not be too burdensome for them, but I suppose we will see.
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Old 30-09-2013, 17:17   #74
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Originally Posted by Group9 View Post
The elephant in the room with the exchange rates for the various plans are the deductibles and co-pays.

It appears that the way they got the monthly rates down was to raise the deductibles and co-pays to really unbelievable levels (think around $4500).

That means that if I had bought one of those policies for the last five years of my life, it would have paid exactly "zero" of my medical expenses, while I was having to pay for the coverage.

I don't think young, relatively healthy, people, are going to be too excited when they find that out.
But isn't that the point of variable deductibles and co-pays? If you are young and health then wouldn't you chose a plan with a high deductible and co-pays in order to lower your premiums? If you are young and healthy you won't be using the insurance much, if at all, so why pay for lower deductibles and smaller co-pays?
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Old 30-09-2013, 17:52   #75
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The passage of this law expedited our cruising plans...from 5 years down to 2. I am a nurse in US hospitals. When I did temp nursing contracts, (travel nursing) I had no insurance. We went years with no coverage, and my son was born in Costa Rica because I couldn't afford US healthcare. It just boiled down to numbers. The birth cost me about $4k there, for private medicine. I ended up with an unexpected c-section. Here those bills would have been upwards of $40K. During those years of no coverage in the US, my daughter had a UTI and a clinic visit and lab and antibiotics was over $250. For something completely simple that was diagnosed before she even went to the clinic.

I just checked the marketplace last night. (Btw I doubt many American's have the slightest clue about the process...I've mentioned it a couple of times and am getting blank stares from my fellow Americans). Anyway, for myself, a single mom with two kids in my custody, the cost was $589 per month with a $12,000 deductible. that was for bronze. To upgrade to a silver plan, it was $711 a month with a $6K deductible. Given that I pay in the 37% range for taxes, there is no way that is even possible for me. I'm spending about that much a month refitting the boat, so I'm glad I have coverage right now. In the old days, when I didn't, I just wouldn't have had coverage. I would have still paid out of pocket for any illness, hoped we stayed healthy, fixed up the boat and planned my bug out.
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