Medical Insurance & Costs

[rescher]

Originally Posted by cll2

Is anyone aware of any really good resources for researching this issue? Specifically all the options and issues around worldwide insurance availability compiled in one place? Or even an independent company\service that helps match up people to their insurance needs? Seems like with so much confusion, and apparently lots of need, someone would be making a few bucks by helping people figure this issue out.

This is exactly the type of service I could use. We're a family of six in Ontario Canada and we're planning on cruising for five or six years. I spoke to International Medical Group, Travel Insurance, Travel Health Insurance, International Travel Insurance – IMG Insurance, today, but feel I would be better served using a broker to help me comparison shop and dissect the fine print. Prices for our family range from $2,200 per year for a Silver plan with a $10,000 deductible to $37,000 for the Platinum plan with a $100 deductible. Platinum with the $10,000 deductible is $16,700.

[MaxwellIns]

I could not agree more. Figuring out the multiple facets of Health Insurance for Cruisers can be extremely confusing.

The implementation of the Affordable Care Act in the US has only further compounded the problem by requiring US citizen to purchase "minimum value" coverage to avoid paying the annual penalty.

When assessing cruising health insurance options for my friends and family, the primary factor with regard to price is the cruising ground itself. Domestic US coverage that meets the PPACA "minimum value" requirement is going to be extremely expensive. Carriers are required to offer coverage without life time maximums that significantly increase the cost of coverage.

I have found a two pronged approached to be the most beneficial when it comes to international cruising health insurance. I recommend HSA compatible ACA compliant products, combined with fixed indemnity / evacuation international medical.

[colemj]

Originally Posted by MaxwellIns

the primary factor with regard to price is the cursing ground itself.

You can say that again - I have been cursing every time I see our bill…

Mark

[SV THIRD DAY]

Originally Posted by zboss

What's next, ObamaSalary?

Well now that you asked.....YES.
But of course "if you like you Salary.....you can keep it"...for now anyway...

[belizesailor]

Originally Posted by chuckr

We are Americans and been out of the USA for the 5 years or so and I am 69 and admiral is 67. We do not carry any insurance. We get our medical locally and have good results. ...

For the first time in my life I am without health insurance...by choice. Until recently I carried a very affordable (~$240/month) policy here in Guatemala. My normal annual healthcare costs are substantially less than the cost of this policy and I have several friends who've had major medical services here and all have spent less than $10K. So when the policy came up for renewal, I cancelled it. Given the affordability of healthcare in Central America It seemed like a waste of money to me to insure against affordable expenses.

[SV THIRD DAY]

Originally Posted by BandB

You hear the comments of how little medicare pays doctors. Well, they pay no worse than most other insurers with negotiated rates and in some cases they actually pay better. As to hospitals for instance, most HMO's pay less than medicare and PPO's pay about the same.

Having a wife and brother seeing patients for a living, I had to laugh when I heard someone say that Medicare could pay better than private insurance, but I didn't have any info in front of me, then Sha.Zam....I read this story how the low medical reimbursements of Medicare/Obamacare are forcing Hospitals to close and thought...yep...just what my eyes have personally been seeing. People can chose to live in a bubble of their own making, but when facts pop that bubble the crash can hurt.

Obamacare blamed for killing hospitals

[BandB]

Originally Posted by SV THIRD DAY

Having a wife and brother seeing patients for a living, I had to laugh when I heard someone say that Medicare could pay better than private insurance, but I didn't have any info in front of me, then Sha.Zam....I read this story how the low medical reimbursements of Medicare/Obamacare are forcing Hospitals to close and thought...yep...just what my eyes have personally been seeing. People can chose to live in a bubble of their own making, but when facts pop that bubble the crash can hurt.

Obamacare blamed for killing hospitals

I am not in some bubble, thank you. The insurers have followed suit and in some cases where they've negotiated deals they are paying doctors less. I've seen the specific numbers. This is only the largest insurers but BCBS, Aetna, and Cigna do so. In some of their HMO's for doctors to participate they pay roughly 85% of the medicare amount. I've reviewed large amounts of specific payments and compared them. I'm not claiming medicare doesn't pay too little in some cases, but I am claiming they are not the only ones. Unfortunately when you hear the words "cost containment" that often means pay doctors and hospitals less rather than figure out better solutions.

Your wife and brother may not participate in some of the lowest paying plans but those plans do insure a tremendous number of people, especially large employee groups.

[SV THIRD DAY]

Originally Posted by BandB

Your wife and brother may not participate in some of the lowest paying plans but those plans do insure a tremendous number of people, especially large employee groups.

For now that is...not for long...Medicare rates will equalize the higher paying plans down to McDoctor wages, been watching it happen for years, but my eyes could be wrong....

But that's semantics, what about the Real Issue here?

So what do we tell all those folks who have had their access to a Hospital cut/gone/evaporate away due to this "change we can believe in" fiasco? Feeding them the line "if you like your hospital you can keep it" has already been tried, so maybe the truth of Rationing would work better? Na...forget that...I'll just go back to Mexico for my health care and the folks still believing in the Hope and Change can keep the mess they created.

This is how/why the ACA/Obamacare relates to Cruisers...you will get FAR better care outside of the USA for far less a price. So if you are out of the USA for the specified period of time, you are free from the clutches of Obamacare...now there's another reason to get out while the gett'ins good.

[BandB]

Originally Posted by SV THIRD DAY

But that's semantics, what about the Real Issue here?

So what do we tell all those folks who have had their access to a Hospital cut/gone/evaporate away due to this "change we can believe in" fiasco? Feeding them the line "if you like your hospital you can keep it" has already been tried, so maybe the truth of Rationing would work better? Na...forget that...I'll just go back to Mexico for my health care and the folks still believing in the Hope and Change can keep the mess they created.

The real issue is the cost of health care in the US. And it's not one administration. It's been that way for a long time. It was rising at double figure rates too over all administrations of the last 20 years.

And the problem is that no major Western country has figured out a solution. US is highest but all have health care issues. Countries like Mexico, the Philippines and India are less expensive for many reasons, the biggest being wages and salaries and malpractice insurance. Medical tourism may continue to grow. I don't have the solution. I have things I'd like to see changed but it's a very complex situation.

Now "why" doesn't really matter for this question. The fact is you feel comfortable with health care in Mexico for far less than it would cost in the US. That is certainly an option for cruisers.

[chuckr]

Just a bit on the cost - In Tunisia an MRI cost me a bit over $200USD and it was scheduled in a day. We have Canadian and British friends who said they could get it for free but would have to wait months to get one and they all pay for a private MRI and doctor rather than wait for months to get one.

I just also found out that i tore the tendons in my shoulder and need surgery and i will not come back to the USA, even with Medicare part A and B, as first I have to find a Doctor who will take me, then schedule the surgery and the recovery. And what would be my portion of the bill?

Tomorrow I will meet with the Doctor again and probably have surgery later this week. His estimated cost is about $2k USD but that is to determined depending what he finds when he sees inside the shoulder.

The admiral had hand surgery in Colombia for a total of $2kUSD and pt for $25usd per session and as good any where in the world. I had !/2 a nose replaced in Trinidad and again it was very inexpensive and world class.

More on the cost as this develops.

[Cottontop]

A friend of ours college age daughter was in a car wreck while traveling in Spain. Serious injuries, although not life threatening. The hospital the ambulance took her to would not admit her until she came up with cash for the expected cost of treatment. The credit cards she had were not enough. Her gold-plated US insurance was irrelevant. Her parents had to scramble to get money wired.

The Spanish hospital never heard of US insurance companies or those elsewhere, and has no relationships with them or any way to recover from them. Nor can if recover from a foreign tourist who leaves the country after treatment. And in many countries, hospitals are not required to admit. (But I know of another case, again in Spain, where a foreign illegal resident was admitted and treated and not charged anything.)

This "pay in advance" requirement, regardless of insurance, can obviously be a big problem. And I'm not picking on Spain. I've since talked to knowledgable people who assure me this can be a problem in much of the world.

At work, our foreign travelers are covered by an outfit named iSOS (iSOS has competitors). ISOS and its competitors have relationships with hospitals and doctors around the world, and they will show up with cash if required. They also pay to evacuate. My last trip, I bought trip insurance from an outfit (not iSOS) that sent me a list of the doctors and hospitals they had a relationship with in the country I was visiting.

I wish I had never learned about this, it has made my traveling life more complicated (and expensive).

[Group9]

I think most of us can agree.
1. health costs and health insurance in the US could use some improvement.
2. the ACA, has made it much worse.
3. When you are out of the US, 1 and 2 don't matter nearly as much.
4. Not many people want to have major surgery in a third world country.

[Paul L]

Originally Posted by Group9

I think most of us can agree.
1. health costs and health insurance in the US could use some improvement.
2. the ACA, has made it much worse.
3. When you are out of the US, 1 and 2 don't matter nearly as much.
4. Not many people want to have major surgery in a third world country.

Not sure how you come up with "most if us agree". I sure don't.
On #1: The US has the least efficient health system in the industrialized world. We spend more per person than any industrialized country (as well as the high spending as a portion of GDP). We do not cover all like most industrialized countries do and we do not get better outcomes. "Use some improvement" is a monumental understatement.
On #2: Insuring that when you get laid off or otherwise leave a job, you can still purchase quality health insurance without pre-existing conditions restrictions is a major improvement. As cruisers, our health insurance costs went down considerably when we got an ACA policy. And so far the annual increases are trivial as compared to the annual percentage increases when we had insurance before.
On #3. I really disagree with this. We have insurance to protect our assets. I don't want to go bankrupt and leave my spouse with nothing just because I get a terrible long-term disease. That's why we have health insurance -- it is not to pre-pay for day-to-day medical costs. (the number cause of personal bankruptcies in the US is medical care related costs)
On #4: I guess this depends on what your definition of third-world is. We have dealt with excellent surgeons in Panama, for example.

[Group9]

Originally Posted by Paul L

Not sure how you come up with "most if us agree". I sure don't.
On #1: The US has the least efficient health system in the industrialized world. We spend more per person than any industrialized country (as well as the high spending as a portion of GDP). We do not cover all like most industrialized countries do and we do not get better outcomes. "Use some improvement" is a monumental understatement.
On #2: Insuring that when you get laid off or otherwise leave a job, you can still purchase quality health insurance without pre-existing conditions restrictions is a major improvement. As cruisers, our health insurance costs went down considerably when we got an ACA policy. And so far the annual increases are trivial as compared to the annual percentage increases when we had insurance before.
On #3. I really disagree with this. We have insurance to protect our assets. I don't want to go bankrupt and leave my spouse with nothing just because I get a terrible long-term disease. That's why we have health insurance -- it is not to pre-pay for day-to-day medical costs. (the number cause of personal bankruptcies in the US is medical care related costs)
On #4: I guess this depends on what your definition of third-world is. We have dealt with excellent surgeons in Panama, for example.

I'm glad you are one of the people who benefited from the ACA. But, I'm sorry so many people had to lose the insurance they had and liked to make that happen for you.

[Dennis.G]

Originally Posted by Group9

I think most of us can agree.
1. health costs and health insurance in the US could use some improvement.
2. the ACA, has made it much worse.
3. When you are out of the US, 1 and 2 don't matter nearly as much.
4. Not many people want to have major surgery in a third world country.

Not sure that I agree completely.

1. Understatement of the day. The health insurance system in USA is an embarrassment. Almost half of bankruptcies in USA are due to medical costs - not a great way to fund health care.
2. WRONG! Although ACA may not fix everything, it has moved the USA forward with many more people getting health coverage, and many others getting better coverage than they had. Without the ACA our family would be completely screwed regarding health insurance. USA health care costs still increasing at 3%/yr over last four years, so while increasing at slower rate than before, still not under control.
3. Only if you plan never to return to USA in case of illness or debilitating injury.
4. Agree. But lots of countries can provide modern health care at a level equal to or better than USA.