US Health Care Bill and Cruising

[Stevens 47]

I have not started this thread to have a debate or express opinions of the recent Health Care Bill passed into law.

My question is has any person on this forum studied or has knowledge of how the bill will affect cruisers that fall into this category.

1 Not working with no taxable income.

2 Out of the USA territorial waters.

3 If you are required to purchase insurance, how will that policy be effective in another country.

I suppose this question will be similar to others living abroad and earning income in their non USA country. I do know that technically one is supposed to pay USA income tax on that income.

Jack

[Ram]

the insurance is good on US soil only, like just about any other health insurance you might have now-so you will need to go home to use it-my understanding is you have no income/assits its free-

[BambooSailor]

As far as I know, there is very little about health care in that bill, it mostly deals with health insurance, two very different industries...

[Pblais]

My question is has any person on this forum studied or has knowledge of how the bill will affect cruisers that fall into this category.

It is more about acquiring insurance than anything else. Income guidelines and state based pools. Nothing about cross state pools. Insurance is still basically state regulated and attempts to do that failed early. Subsidies for some low income based groups.

A great deal of this won't go into effect until after most current cruisers are done cruising. With the recent increases in premiums over the next few months I wouldn't expect much short term savings.

[GordMay]

What’s in the health care reform bill? Almost no one knows, because It's 1,017 pages long, and written in an alien form of bureaucratic Amenglish.

If anyone has the time and interest, they can inform themselves here
➥ Affordable Health Care for America: Reconciliation Bill | EdLabor Journal | Committee on Education and Labor

Good luck!

[Stevens 47]

Here is an example. I have rental house's in Florida. It has been my intention to live of the rental income while cruising. I live in California and the boat will be home ported in CA. I currently do not have health insurance. In 2014 if I am cruising in New Zealand, would I be required to purchase insurance in the USA. Seems like I would then I would have to travel back to the USA/State of issuance to use the policy??

[djmarchand]

Stevens 47:

As others have noted most of your questions are unknowable now. Not until regulations are formulated, insurance pools established, rules published and maybe even lots of court challenges later, will we know.

Having said that, as an uninsured cruiser, nothing will happen to mandate coverage until 2014. If you want to buy US insurance now, you can and if you don't have a preexisting condition, you can buy it as always with a few extra benefits like lack of recession. If you don't have insurance, you can buy it in the new risk pool and will probably qualify for a federal subsidy if you have no income.

But all of that supposes that you want to buy US insurance which will have little benefit abroad. Such insurance will probably only cover true emergency care until you can return to the US for longer term care, a major operation or treatment, etc. I know this doesn't make much sense because foreign care is almost certainly cheaper than US care, but that is the way it is.

If you want to buy coverage for care outside the US while cruising the new healthcare bill has no affect on you. I am sure that there will be exclusions to the US mandate for people like you who do not live in the US.

David

[Boracay]

If I understand American health care insurance it's really expensive. We're talking $10k and up p.a. or more, right?
I'm only aware of health care costs in a few countries but to summarize what I am aware of:-

* Australia (where I live) can be expensive. I only have basic Medicare and pay any extra as needed. It's never been a lot of money, normally I discuss costs with the Doctor and work something out (mostly they Bulk Bill so it's free). Some don't mind cash!
Dental has no insurance here and Aussie dentists are expensive. They're good though (never had a real problem with their work).
* I assume New Zealand to be similar to Australia.
* I had malaria in New Guinea. We knew the Aussie doctor at the local hospital and they were right onto it. No worries. I feel rather guilty but I think I paid $20 for everything.
* I had an ear infection on Koh Lanta in Thailand. Had to get a local PMV (special hire, expensive) on rough roads right across the island to the only hospital feeling miserable, had to wait hours, got a sympathetic english speaking local doctor who knew exactly what it was and got patched right up. From the reactions of the Thai driver I knew they were seriously ripping me off. $50 I think it cost. I might have had to wait while they got the good doctor.
* Recent anecdotal evidence suggests that prices for dental work in Thailand (or that part of the world anyway) are putting smiles on the faces of Cruisers.
* Been in the Philippines a lot and seen their health care system. The doctors on Siquijor are especially interesting. No plans to get sick there.

So I guess it all comes down to risk. That $10k p.a. or whatever is going to buy a heap of medical work in most lesser developed countries, and it's going to be in cash right there and then if you don't rely on insurance. But I have the luxury of a Government backed scheme that will look after me if I can get home.

Me going to America? Now that would be expensive...

[goboatingnow]

I'm in Ireland and we generally need health insurance. To my knowledge no healthcare insurance covers you out of your country All it covers is emergency healthcare s
and then if you want more you are going home. I don't beleive it is possible to insure yourself abroad like at home.

Dave

[bloodhunter]

As to U.S. income taxes. There is an exclusion but it is on EARNED income only. Interest, dividents, rental income does not qualify. Further to qualify for the earned income exclusion (section 911 of the tax code) you m,ust pass the bona fide resident test. That means at a minimum you have to establish a permanent residence abroad and you have to be abroad for at least one full tax year. Also your country of residence and the U.S. must have reciprocal tax treaties with provisions allowing the exclusions. Then there are other rules and regulations depending on individual circumstances (sigh)

[Hud3]

Originally Posted by goboatingnow

I'm in Ireland and we generally need health insurance. To my knowledge no healthcare insurance covers you out of your country All it covers is emergency healthcare and then if you want more you are going home. I don't beleive it is possible to insure yourself abroad like at home.

Dave

That may be true with some or most policies, but the health care insurance offered to retirees from my former company in the U.S. works just fine down here on Nevis, or anywhere else in the world. I have to pay a bit more in co-payments because the doctors and hospital are "out of network", but all I do is submit the claim with receipts, and a check comes back in the mail.

On the other hand, having reached age 65 in January, my wife and I signed up for Medicare, as required by law. We're now paying monthly premiums for the Medicare that are four times what we pay for my company health insurance, and Medicare doesn't cover us at all outside the U.S.

[osirissail]

Actually HUD3 - when you sign up for Medicare you also need to sign up for a Supplemental Plan and a Drug Plan. All three are necessary to complete the transition to the "Medicare" world. My transition from employer provided medical to Medicare ended up costing me 10 times more that I was paying.
- - There is a Supplemental Medicare Plan known at Option "F" that does include limited overseas medical care - basically a sort of "Travel Medical Insurance" coverage.
- - But for US citizens/residents cruising outside with potential medical exposure you need to purchase the International Medical Plans available from multiple sources. These cover your medical needs in other countries and also satisfy the "Visa" medical insurance requirements such as the French have.
- - The justification for having and paying for the Medicare coverage was recently demonstrated by a good cruising friend's wife who got breast cancer which was treated here in Grenada - but, they did not get it all. They were running "naked" without any USA medical insurance and were faced with choosing between death or heading back to the USA for more advanced medical procedures. It ended up in a nightmare of costs and complications involving trying to find a medical provider inside the USA that did not require medical insurance coverage. They sold their boat, stripped their savings to zero but it was too little, to late. So for those in an "ex-pat" style life you need to "really" make a decision to accept the "final consequence" should you decide to drop or not sign up for Medicare. That's a tough call when its not you but your life partner (spouse) who is involved.

[David M]

I think Gordon nailed it. Even the people who voted for it don't truly know what they voted for. I don't think its an answerable question.

[Stevens 47]

Originally Posted by David M

I think Gordon nailed it. Even the people who voted for it don't truly know what they voted for. I don't think its an answerable question.

It will be answered, though maybe not this year. Who knows maybe there is a person out there who has nothing better to do than read that law all 1000+ pages and knows the answer. I think I will have some idea when 2014 comes around. Jack

[roverhi]

I thought there was over 2,000 pages and then the reconciliation bill and the bill modifying that.


There are insurance policies that will pay for transporting you back to a country of origin. Gets you back home where you might have additional network support, somewhat familiar health care procedures or at least a doctor who speaks your language. If what I hear is true, you don't need to carry insurance once the care part, not the tax part, goes into effect (2014??). You just have to pay a fine that is initially less than a boat unit and you are covered.