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Old 28-09-2013, 11:54   #1
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ACA/Obamacare for American Cruisers Abroad MERGED THREADS

I would really like to avoid this being political so I'm asking everyone to please avoid making snippy comments. Contribute factually and please use .gov or .edu sources.

I work in the insurance and technology space and decided to spend the morning talking to some colleagues and combing through the current rulebook as it pertains to the Patient Protection and Affordable Care Act (PPACA). I wrote most of it down in a blog post.

Rebel Heart - Eric's Blog - the affordable care act (obamacare) and cruising*sailors

I wanted to see if anyone else had a different interpretation of the law or had any additional questions. I think the actual people affected by the uniqueness of expatriation is pretty limited.

If any of the conditions are true, you don't need to do anything:
  • Covered by (nearly any) Medicaide plan
  • Covered by Medicare Part A
  • Covered by Medicare Advantage
  • Are not required by the IRS to file a tax return
  • Covered by a current individually purchased or employee sponsored group plan
  • Are not a US citizen
  • Veterans, and active duty, enrolled in VA medical services.
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Old 28-09-2013, 12:10   #2
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Re: PPACA / Obamacare impact to USA sailors

Quote:
Originally Posted by rebel heart View Post
I would really like to avoid this being political so I'm asking everyone to please avoid making snippy comments. Contribute factually and please use .gov or .edu sources.

I work in the insurance and technology space and decided to spend the morning talking to some colleagues and combing through the current rulebook as it pertains to the Patient Protection and Affordable Care Act (PPACA). I wrote most of it down in a blog post.

Rebel Heart - Eric's Blog - the affordable care act (obamacare) and cruising*sailors

I wanted to see if anyone else had a different interpretation of the law or had any additional questions. I think the actual people affected by the uniqueness of expatriation is pretty limited.

If any of the conditions are true, you don't need to do anything:
  • Covered by (nearly any) Medicaide plan
  • Covered by Medicare Part A
  • Covered by Medicare Advantage
  • Are not required by the IRS to file a tax return
  • Covered by a current individually purchased or employee sponsored group plan
  • Are not a US citizen
  • Veterans, and active duty, enrolled in VA medical services.
I dont know what Obama care is ,guess I will read your blog and find out,I havent been to a med. docs office in over 20 yrs,except once when I had a flying accident in Canada, and if that is Obama care Im all for it...
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Old 28-09-2013, 12:18   #3
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Re: PPACA / Obamacare impact to USA sailors

A friend just checked into her rate increase. Currently $290 a month, it is (according to her insurance provider) going to $970. This is not a good thing, will not say more then that since I agree that this is a good thread and want to avoid it being shut for political reasons.

Health insurance is a significant expense for many, the higher costs are going to cut into budgets significantly for some.
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Old 28-09-2013, 12:27   #4
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Re: PPACA / Obamacare impact to USA sailors

Like it or hate it, the PPCA will have a major impact in a year or two. The predicted impact varies with your politics. It will be interesting to see what really happens.

PS....how's that for non political?
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Old 28-09-2013, 12:28   #5
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Re: PPACA / Obamacare impact to USA sailors

Quote:
Originally Posted by s/v 'Faith' View Post
A friend just checked into her rate increase. Currently $290 a month, it is (according to her insurance provider) going to $970. This is not a good thing, will not say more then that since I agree that this is a good thread and want to avoid it being shut for political reasons.

Health insurance is a significant expense for many, the higher costs are going to cut into budgets significantly for some.
I've seen plan costs change because the PPACA requires plans to meet certain minimum "essential health benefits". No annual max, no lifetime max, ambulance services, and mental health are among the big ones. So for plans that didn't cover those that now have to, the costs have gone up.

For plans that did have those services, the costs have remained relatively unchanged and the proposed argument is the costs should come down because of increased competition.
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Old 28-09-2013, 12:36   #6
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Re: PPACA / Obamacare impact to USA sailors

Quote:
Originally Posted by s/v 'Faith' View Post
A friend just checked into her rate increase. Currently $290 a month, it is (according to her insurance provider) going to $970. This is not a good thing, will not say more then that since I agree that this is a good thread and want to avoid it being shut for political reasons.

Health insurance is a significant expense for many, the higher costs are going to cut into budgets significantly for some.
This sounds quite contrary to my experience but maybe some differences.

First to clarify, is your friend currently buying her own insurance or is that $290/month her share of the cost for insurance provided by her employer?

And if her insurance provider is telling her that it will cost $970/month she needs a new insurance company because I have family members that pay for less than that for private insurance.
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Old 28-09-2013, 13:14   #7
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Re: PPACA / Obamacare impact to USA sailors

Quote:
Originally Posted by s/v 'Faith' View Post
A friend just checked into her rate increase. Currently $290 a month, it is (according to her insurance provider) going to $970.
The exchanges will be running next week and you can get exact costs then.

Otherwise, cost estimates are currently available here (.gov!)
https://www.healthcare.gov/how-can-i...lth-insurance/
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Old 28-09-2013, 13:24   #8
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Re: PPACA / Obamacare impact to USA sailors

I think impact on cruisers depends on if you want insurance.

If you do, such as in our case, this will allow us to buy insurance. Before this we would not have been able to buy US insurance at any price due to pre-existing conditions. This will allow us to buy it at market rates. Basically this will allow us to go cruising with much less stress.

If you do not want insurance at all, and are required under the law, you will have to pay a small fine if you do not get it. If you are on an extremely shoe string budget, I can see how that could be a burden. Of course the fine will be really tiny if you have little income, so not really that big of a burden.

I would guess for 90%+ of cruisers, the ACA will have no impact whatsoever.
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Old 28-09-2013, 13:30   #9
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Re: PPACA / Obamacare impact to USA sailors

She is a business owner who has a policy she uses as "casualty insurance"... She has never used insurance for medical costs... Not a single claim in over 15 years of coverage.

She pays cash for care, as folks did for most of history. I will ask what company she is with, I just spoke with her yesterday about this and she was quite upset.
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Old 28-09-2013, 13:41   #10
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Re: PPACA / Obamacare impact to USA sailors

Quote:
Originally Posted by s/v 'Faith' View Post
A friend just checked into her rate increase. Currently $290 a month, it is (according to her insurance provider) going to $970. This is not a good thing, will not say more then that since I agree that this is a good thread and want to avoid it being shut for political reasons.

Health insurance is a significant expense for many, the higher costs are going to cut into budgets significantly for some.
This could only possibly be the case if she is over 30, relatively high income (no subsidy) and her current premium is for a policy no longer available do to coverage limit changes, etc.

AND even with that, it's hard to imagine the figure you're quoting.

I think that figure is a real red herring and much more likely a "friend" of your favorite AM radio host vs. a real honest example.
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Old 28-09-2013, 13:49   #11
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Re: PPACA / Obamacare impact to USA sailors

S/V Faith is not making this up, but his friend may of misunderstood the estimate. Lot of mis info out there.
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Old 29-09-2013, 07:26   #12
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ACA/Obamacare for American Cruisers Abroad

This is NOT INTENDED as a discussion on the relative Merits or Evils of "Obamacare" (Affordable Healthcare Act or ACA hereafter) or anything political. Please please please do not hijack the discussion that direction - I heartily invite the Moderating team to please cull that!!! There are plenty of places on the net we can go to whip ourselves into a partisan frenzy on the politics of this; we all need answers!

This is intended as a PRACTICAL thread/discussion for those of us that are Americans, living on boats outside the U.S., and needing to figure out how this affects us. Love it or hate it, we have to deal with it starting 10/1/13 and 1/1/14. This is a serious questions - I'm planning to cross post this on the SSCA forums too.

From my understanding so far:

- All Americans are supposed to have some sort of coverage, either employer provided, bought themselves, Gov't provided (e.g. Medicare).

- If you do not have acceptable coverage you will be subject to a penalty, from a minimal amount (~$100/person, $295/family) up to 1% of your income, whichever is greater. Extremely low income people may get the penalty waived.

- The general model for ACA programs is similar to Medicare, they are focused on healthcare delivered in the U.S., not abroad.

- Providers of ex-pat insurance plans have been given some flexibility to comply with earlier provisions of the ACA so need not be 100% compliant for 1/1/14

- If you have an established residence abroad you will be exempt from the non-compliance penalty. Guidelines for this are similar to IRS "Foreign Tax Credit" rules.

- Those that buy their own health insurance will go through www.healthcare.gov, the "Healthcare Marketplace" to pick from competing plans from your state.

____________________________________________

My concerns are as follows:

- The "Healthcare Marketplace" may or may not contain expat style plans that provide coverage outside the U.S.; I suspect they do not from what I have read.

- Floating from country to country like we cruisers are wont to do, with no fixed address, we will NOT be able to establish "Residency" in any particular country. As far as the US Government is concerned I live in Green Cove Springs, FL and travel a lot.

So if I can not buy a plan through the Marketplace that will give me any medical coverage outside the U.S., will we still be subject to the penalty even if we buy some other plan that may not be "qualified"? I'd hate to be in a situation where I buy an ex-pat plan AND get hammered with non-compliance penalties.

There's a lot of questions here on how this will affect us, does anyone have any insight of information beyond what I've learned so far?
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Old 29-09-2013, 07:37   #13
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re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

I won't comment on specifics of US healthcare
but ask yourself these questions

(a) If you are basically healthy and have no current chronic conditions, then most countries will give you free emergency healthcare. Do you need anything else

(b if you find yourself very sick, you will want medical repatriation insurance as most people want to go "home" if very ill

(c ) if you have a chronic illness or require some form of elective surgery, you will need an medical insurance that covers you aboard, Though typically these are "pay and reclaim " so there can be a big cash flow hit

(d) General medical costs like GP visits , scans and tests , drugs etc are often low cost in many countries outside the US. This factor needs to be considered.

You have to ask yourself if you need an all singing all dancing insurance cover aboard in the first place.

sorry if this is slight thread drift

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Old 29-09-2013, 07:51   #14
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re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

We keep health insurance while cruising to protect our assets if we get serioulsy sick. We are not looking for pre-paid medical care to cover all sorts of small things. These we pay for out of pocket and reasonable outside the US. If one of us gets seriously sick, then to get covered in the US we would have to spend down our assets, leaving the other partner essentially bankrupt -- something we don't want to do. We have friends who recently went through a life threatening heart issue and the bill came to $600k.
With the changes due to ACA our current high deductible individual policy would go up about 50% if we stayed with the same company. This is due in part because of greater coverage and lower deductible/out-of-pocket expenses apparently required by ACA. With our relatively low cruisers income we will be able to get a policy from the Exchange at about 50% less than what we are currently paying, with lower out-of-pocket maximums. So ACA, as I understand it, works out well for us and is a benefit to cruisers like us.
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Old 29-09-2013, 08:25   #15
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re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

I posted a link to an article I wrote about this:

Rebel Heart - Eric's Blog - the affordable care act (obamacare) and cruising*sailors


The "Healthcare Marketplace" may or may not contain expat style plans that provide coverage outside the U.S.; I suspect they do not from what I have read.

- It's doubtful they ever will but many plans, like Anthem Blue Cross, pride themselves on covering you (via reimbursements) internationally.

Floating from country to country like we cruisers are wont to do, with no fixed address, we will NOT be able to establish "Residency" in any particular country. As far as the US Government is concerned I live in Green Cove Springs, FL and travel a lot.

I don't know what the concern is there.

So if I can not buy a plan through the Marketplace that will give me any medical coverage outside the U.S., will we still be subject to the penalty even if we buy some other plan that may not be "qualified"? I'd hate to be in a situation where I buy an ex-pat plan AND get hammered with non-compliance penalties.

If you buy a plan that does not meet "minimum essential care", and are not excluded via any other mechanism, you are subject to the penalty because you did not meet the individual mandate.

There's a lot of questions here on how this will affect us, does anyone have any insight of information beyond what I've learned so far?

I wrote a lot of it up and have been talking to some of my colleagues on the benefit side of my business (the guys who work with individual medical insurance) regarding plan options that would work well.

In summary, if you're out of the country 330 days a year, thus satisfying the Physical Presence Test of the FEIA, you're not required to buy medical insurance. If you're out of the USA less than 330 days a year, you should probably consider a US based policy that covers you overseas.

The space for expat plans is getting a lot smaller and I imagine by 2015 will be of little use to most US expats who spend any considerable time stateside.
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