ACA costs for early retiree/cruiser

[svadagio]

I see this subject here a lot and will post this.
I have been out here in the Caribbean 13 years. Yea I know others have been longer.
I have to have "spots" removed from my skin regular. My wife has a medical condition requiring constant medication.
I have had these spots removed in a number of country s. In Roatan a lady dermatologist removed about 7 for $65.00 using liquid nitrogen. One of my favorite ways. In Cartagena a very nice gentleman remove 5 using the most modern and least painless method to date. A laser with a tv camera and special lights mounted in a hand held device. $60.00 In the Rio Dulcie a lady doctor removed 1 with acid. My least favorite for $10.00. In Martinique a lady doctor removed 1 with nitrogen for $20.00.
In St Thomas USVI I had one removed for $470.00. I payed $152.00 thanks to medicare. The doctor used an electric device to cut around it then grabbed it and tore it off my face. He is not my favorite one.

My wifes meds cost $30.00 to $60.00 per month in the US 13 years ago. The test etc. to get the prescription for just 3 months worth is about $200.00. Out here it cost from $6.00 to $15.00 per month and no test required. We do get her checked every so often. In Guatemala city at the teaching hospital run by a major US university it cost $18.00 total and they emailed us the results.

What is my point. If you are coming out here and do not have some sort of serious medical condition do not worry so much. I have had better care out here in some places than in the states. The teaching hospitals are great and are now running "medical travel" deals for people living in the states who can not aford what they need in the states. Many of the doctors out here are trained in the states or Columbia which has good medical schools. They take more time with you so may get a better diagnoses. As always talk to the other cruisers and you can find a good doctor most places within a reasonable distance.

One last thing. Getting care in the states is not always the best. We have a friend who fell off a dock in Fl and cut herself bad. It was infected bad due to the pollution in the marina. The Fl doctor gave her meds that did nothing. The Bahamas doc the same. Finally the doc in Luperon DR cured it right up. He sees this all the time and knows what to do.

Bob

[colemj]

Originally Posted by sailorboy1

Yes traveling outside maybe makes an ACA plan almost worthless. But for $31/mo may be worth having for a major problem and returning back

It depends on the specific plan. Our ACA covers us outside the US. We don't use it much because care is generally so cheap outside the US - but, like you note, it makes sense to have it anyhow if you will be spending any time in the US or plan to return to the US if you take seriously ill.

Otherwise, you won't stand a chance financially.

Mark

[belizesailor]

Originally Posted by colemj

It depends on the specific plan. Our ACA covers us outside the US. We don't use it much because care is generally so cheap outside the US - but, like you note, it makes sense to have it anyhow if you will be spending any time in the US or plan to return to the US if you take seriously ill.

Otherwise, you won't stand a chance financially.

Mark

I think the plan relative to returning to the USA is an important point. I maintained health insurance until a few years ago to cover me just in case I decided to return to the USA for a serious illness. I dropped it after excellent experiences (both mine and others) with Guatemalan healthcare. Now, I would prefer to stay here for care even for serious illness and know that even serious illness here wont bankrupt me...unlike the States.

[Alchemist 66]

Originally Posted by HBWT

Regarding ACA subsidies, if you are out of the country for more than 275 consecutive calendar days per year, you can forgo State Mandated Health Insurance and penalties.

I thought it was 330 cumulative days in a year, not 275 consecutive.

From the IRS website:
"You meet the physical presence test if you are physically present in a foreign country or countries 330 full days during a period of 12 consecutive months. The 330 qualifying days do not have to be consecutive. The physical presence test applies to both U.S. citizens and resident aliens."

I wonder if being "physically present" imposes a complication to cruisers during long passages. If you are at sea, and in international waters for a month, does that leave you only 5 days of the year to not be "physically present" in a foreign country?

[colemj]

Originally Posted by belizesailor

I think the plan relative to returning to the USA is an important point. I maintained health insurance until a few years ago to cover me just in case I decided to return to the USA for a serious illness. I dropped it after excellent experiences (both mine and others) with Guatemalan healthcare. Now, I would prefer to stay here for care even for serious illness and know that even serious illness here wont bankrupt me...unlike the States.

I agree that all healthcare we have received outside the US has been excellent (however, we haven't needed much). I didn't mean to imply that one needs to return to the US for serious health issues. I meant that if one planned to return in that case - because of family support, getting affairs in order, etc - it made sense to keep a plan active.

Mark

[belizesailor]

Originally Posted by colemj

I agree that all healthcare we have received outside the US has been excellent (however, we haven't needed much). I didn't mean to imply that one needs to return to the US for serious health issues. I meant that if one planned to return in that case - because of family support, getting affairs in order, etc - it made sense to keep a plan active.

Mark

I didn't take it that you did. Just that if you did for whatever reason then that is a consideration.

[jjk308]

As a long time civil servant I have had experience with the process that can produce results as screwed up as the ACA, which is an extreme case.

First, the people who wrote the ACA were in a sort of bubble of their own making. The healthcare insurance problem ruled their life. They brought with them definite biases towards massive government social and economic restructuring and then just bounced their ideas off each other. The only outsiders they really listened to were those who agreed with their preexisting biases. The only insiders they listened to were their political masters whose concerns were limited to getting it through Congress.

Then when it went to Congress it was at the center of a political maelstrom the likes of which is rarely seen. The Democrats only chance of getting it through was to dig in their heels, hold onto their core votes and insist it be passed as presented with as few changes as possible. And as fast as possible before anyone figured out all the implications.

So the result is a nutty system that has hurt most of those who had secure and stable health insurance, and whose increase in coverage is mostly due - 90% - to expanded Medicaid in some of the states.

The expected Supreme Court ruling is due to the process described above, of a portion of the ACA remaining from a time wihen the drafters expected to easily coerce the states into running their own insurance marketplaces. The reasons the state managed market requirement wasn't in place in the regulations right from the start is probably that the Obama administration was afraid of the repercussions of more state mandates that would fail in court like the Medicaid expansion and also foresaw the initial failure of the Federal marketplace.