Cruising and the Affordable Care Act.

[Paul L]

Originally Posted by HBWT

.... For year round cruisers, don't get health insurance in the u.s. unless you plan in being in the u.s.
...

So what policy do you recommend for this category? 2 have been proposed so far in this thread. The first was the BUPA one that seems to only cover ex-pats living in a specific place, i.e. not cruising. The 2nd was the IMG policy that Rich suggested that has some pretty onerous pre-existing conditions limits that would make it fairly unusable for typical age US cruisers.

[Lake-Effect]

Originally Posted by HBWT

I would kindly ask all Canadian cruisers to not comment on this thread as you most likely have such little knowledge of US healthcare that your comments are shortsighted and uneducated. Now that I say it, most U.S. Cruisers too!

...From someone who gets paid money to talk about the health insurance industry for both countries.

Your info re some specifics was a breath of fresh air. Thanks. More please, because comments here and elsewhere suggest that the ACA isn't well understood yet, since it's still an emotional, hot-button topic subject for many, and because some major political and industry groups have a vested interest in helping it fail.

RE non-US comments...
1- it's an international forum, and a few non-USians have an interest in health policy too
2- the thread had already devolved into an ACA-bashing fest; it was a train wreck before I jumped aboard. Bickering is what bored cruisers like to do
3- sometimes it's tough to watch a friend struggle with a problem that many of us have already come out the other side of.

But, yeah. I'll just watch.

[Paul L]

Originally Posted by SV THIRD DAY

No doubt...Fools abound even those that have never hear of a little medical procedure of having the Ovaries removed after the kids were hatched...ha ha ha ...classic indeed. What's the point...easy...the ACA mandates you MUST have Prenatal care even for a woman that HAS NO OVARIES...bingo costs go up.

Insurance is shared risk. You want a policy that is cheaper because you won't ask for the medical costs associated with a pregnancy. Your wife is astronomically unlikely to get prostate cancer too, so she should skip paying into a policy that covers that? In the non-ACA policies you mentioned, the pre-existing conditions clauses might exclude anything related to the additional risk associated with a women who has had her ovaries removed(heart, osteoporosis, etc). Then what, look for an ACA compliant policy? (nothing personal here, you brought it up).

[dwedeking2]

The problem with the ACA (in my opinion) is that it removes the ability for the consumer to make a choice on what coverage they feel is adequate for their lifestyle/environment.

Legally, if you are in not out of the country for more than 331 days of the year then you must pay either the fine to the IRS or pay the fee for healthcare within your state system and also pay for healthcare/insurance aboard for the time frame that you are out of country to compensate for what the ACA mandated policy doesn't cover.

I'll pay the tax to the irs this year, and next year be exempt from the ACA due to location.

[w32honu]

Originally Posted by sailorboy1

sad that an important topic like health care always turns into a political rant

Agreed.......

[goboatingnow]

Originally Posted by dwedeking2

The problem with the ACA (in my opinion) is that it removes the ability for the consumer to make a choice on what coverage they feel is adequate for their lifestyle/environment.

Legally, if you are in not out of the country for more than 331 days of the year then you must pay either the fine to the IRS or pay the fee for healthcare within your state system and also pay for healthcare/insurance aboard for the time frame that you are out of country to compensate for what the ACA mandated policy doesn't cover.

I'll pay the tax to the irs this year, and next year be exempt from the ACA due to location.

You presumably have the same problem with your auto insurance then !

Dave

[dwedeking2]

Yes. I'm opposed to the .gov telling you what products you need to own, what level of risk you are allowed to take.

I'm not anti insurance, but I am a better judge of what protection from risk that I need. I have insurance to cover catastrophic issues and when I owned a car I had insurance for it.

[goboatingnow]

Originally Posted by dwedeking2

Yes. I'm opposed to the .gov telling you what products you need to own, what level of risk you are allowed to take.

I'm not anti insurance, but I am a better judge of what protection from risk that I need. I have insurance to cover catastrophic issues and when I owned a car I had insurance for it.

Perhaps as another way of looking at it. You might consider that a basic level of medical care is a service that general taxation should provide, rather like schooling and say the police service. Hence ones basic Heath should not be a function of ones pocket, not should your education be a function of your daddies pocket.

Dave

[letsgetsailing3]

Originally Posted by goboatingnow

Hence ones basic Heath should not be a function of ones pocket, not should your education be a function of your daddies pocket.

Dave

Why are we abdicating health to the list of government services? Shouldn't we, by the same logic, insist that people eat and drink healthy foods, and exercise? These are arguably more important than supplying someone with pharmaceuticals.

The issue I have with ACA is that the government is insisting that people share the cost of providing health care to all individuals, but neither controlling the costs nor insisting on cost transparency.

We've identified it as a runaway train, but rather than try and fix it, we've compelled everyone to board it in hopes that that will fix it.

[HBWT]

Originally Posted by Paul L

So what policy do you recommend for this category? 2 have been proposed so far in this thread. The first was the BUPA one that seems to only cover ex-pats living in a specific place, i.e. not cruising. The 2nd was the IMG policy that Rich suggested that has some pretty onerous pre-existing conditions limits that would make it fairly unusable for typical age US cruisers.

It would depend entirely on your cruising grounds and your current health. I think blue cross and there blue global is a good product with a decent price but there are over a dozen worldwide insurers offered to U.S. Citizens. You must make sure that the worldwide insurance you are purchasing is legal to be purchased in your state. Every state has a office of insurance commissioner that approves or disapproves of ALL insurance to be sold in your state. Someone commented that they did not like the government telling you what risk you can take but the OIC in your state has been doing this since before you were born. If this product is not legal to be sold in your state the contract has no legal precedence and you therefore have no grounds to pursue any claims against the insurance carrier.

New Zealand, Australia, Caribbean, most of Europe are a few examples where this coverage cost and risk indemnity makes sense. If you are in most of central/south America, most of Asia and Africa, these cost are often so little that the transfer cost of risk is far better to pay cash then carry the insurance. Would still carry emergency travel coverage. Trust me, if you have a major illness or injury in a foreign country you will want nothing more than to be in a U.S. Hospital with U.S. Doctors. That is not a statement about any foreign treatment standards but you will want the comfort of being home.

Hope this helps and good luck.

[w32honu]

Spirit of the OP.............

Somewhere along the way my country determined that in order to have a functioning democracy it would be important to have an educated and literate society. The government vis a vis our elected officials determined the best way to achieve this was to require us to educate our children. Education then became compulsory. It is the law of the land. I have not retired yet, and I pay a boat load of taxes each year. A good portion of my taxes are dedicated to the cause of education...... among a lot of other things. The Admiral and I have no children. Yet I do not feel compelled to stand on the street corner and rant a political rant about how unfair it is that I have to pay into the system to achieve this goal. It is a worthy cause....... transfer payment or not.

Point is ....... things are how they are. ACA might not be the end all solution to healthcare issues in this country, but that is not what the post is about.

ACA is here..... probably to stay in some form or another. Sans politics its just a fact. I was just curious what the experience has been for those participating. It appears that private insurance within the ACA just might be an improvement for folks out cruising (Americans). I say that only because in retirement or in a low income mode these insurance policies provide a good basic level of protection especially when considering preexisting conditions and cost. Protections that were not there previously. Some of the other insurance policies available may work as well...... depends on the individual.

Thanks for all who have been posting. It has been educational....... no pun intended.

Keep em coming.......

[letsgetsailing3]

Originally Posted by w32honu

It appears that private insurance within the ACA just might be an improvement for folks out cruising (Americans). I say that only because in retirement or in a low income mode these insurance policies provide a good basic level of protection especially when considering preexisting conditions and cost.

If someone has pre-existing conditions, they can't be excluded, but that's for all health insurance, not just companies in the ACA exchanges.

I don't see any indication that insurance from the ACA exchanges is cheaper than other plans, or offers more coverage.

So I don't see how you arrived at your conclusion, unless you're thinking that people can get their coverage subsidized, if they report a low income. Even in that case, however, what kind of coverage to they get when away from the U.S.?

[nimblemotors]

Originally Posted by letsgetsailing3

Why are we abdicating health to the list of government services? Shouldn't we, by the same logic, insist that people eat and drink healthy foods, and exercise? These are arguably more important than supplying someone with pharmaceuticals.

The issue I have with ACA is that the government is insisting that people share the cost of providing health care to all individuals, but neither controlling the costs nor insisting on cost transparency.

We've identified it as a runaway train, but rather than try and fix it, we've compelled everyone to board it in hopes that that will fix it.

That is correct about the ACA, just take a bad problem and make it worse,
but that is all that was acceptable to actual pass as law.



I understand some employers now measure your BMI and make you pay more, and a friend has a real issue with that.

[w32honu]

In retirement or not working would probably reduce income to a level that a subsidized plan would apply.

I would consider it only as a basic back up or a catastrophic plan. It would require us to travel back to the U.S. in that case. But one might want to do that anyway.

And like I mentioned another plan might be better, one outside of the ACA exchanges........

[letsgetsailing3]

Nimble, I'd call that a pre-existing condition.