ACA/Obamacare for American Cruisers Abroad MERGED THREADS

[belizesailor]

Originally Posted by svmariane

Found this ACA Subsidy Calculator | The Henry J. Kaiser Family Foundation

Hope that calculator helps somebody.

As for me, I've been a resident of Austria since 1992 and have documents to so prove. Gonna be a bear, though, if I need to get them "officially" translated into English.

Thanks for posting the calculator, good to be able to run actual numbers versus all the misinformation out there.

[belizesailor]

Originally Posted by svmariane

Found this ACA Subsidy Calculator | The Henry J. Kaiser Family Foundation

Hope that calculator helps somebody.

As for me, I've been a resident of Austria since 1992 and have documents to so prove. Gonna be a bear, though, if I need to get them "officially" translated into English.

Dont know what qualifies as proof under the IRS rules being followed, but I suspect visa records will work...after all big brother already has that info...especially from another developed country like Austria.

[Paul L]

Originally Posted by rebel heart

.....
But take a very real scenario like a US sailor who's cruising full time in Mexico and then gets diagnosed with cancer or another serious illness. Chances are they'll want to be back with their family and back with, frankly, superior medical care in a lot of arenas.

Lots and lots of possible scenarios. A couple more:
1. you are in French Polynesia, get sick and cared for, then your visa expires.
2. you do a visit back to the States and get in a car crash

Paying for basic health care out-of-pocket outside the US is reasonable and cost effective way to handle health care. Dealing with catastrophic medical issues requires insurance for most US citizens. ACA subsidized Exchanges looks like it offers some good possibilities.

[Boatguy30]

That is certainly the case. When I was a NZ resident I bought travel insurance in NZ before returning to the US.

I suggest we revisit this topic in a few months, assuming the internet is still working due to possible funding issues.

there will be much better info available then and less speculation.

[Dockhead]

Originally Posted by goboatingnow

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

Dave

Indeed.

We Americans tend to be paranoid about medical insurance because you can easily be bankrupted -- in our system -- if something happens which is not covered by insurance.

It is quite a revelation to discover that in many other countries -- including very civilized countries like the UK and France -- the same procedures which would bankrupt you in the U.S. are reasonably affordable even if you are a non-resident and thus required to pay the full price for them.

After a few decades living outside the U.S., I have declined to keep up the "all singing, all-dancing" medical insurance policy, and my action plan in case of a medical problem is simply to get treatment in Europe rather than in the U.S. I realize that this will not work for everyone, but I have enough assets that I could pay myself for solving even a very difficult medical problem (God forbid). So I am basically self-insured.

This might seem different to me also if I were older and not in such a good state of health as I am, so YMMV, as always with this sort of thing. But my point -- in support of Dave's -- is that medical systems work differently in different countries, which should be taken into account.

[rebel heart]

Originally Posted by Dockhead

Indeed.

We Americans tend to be paranoid about medical insurance because you can easily be bankrupted -- in our system -- if something happens which is not covered by insurance.

It is quite a revelation to discover that in many other countries -- including very civilized countries like the UK and France -- the same procedures which would bankrupt you in the U.S. are reasonably affordable even if you are a non-resident and thus required to pay the full price for them.

After a few decades living outside the U.S., I have declined to keep up the "all singing, all-dancing" medical insurance policy, and my action plan in case of a medical problem is simply to get treatment in Europe rather than in the U.S. I realize that this will not work for everyone, but I have enough assets that I could pay myself for solving even a very difficult medical problem (God forbid). So I am basically self-insured.

This might seem different to me also if I were older and not in such a good state of health as I am, so YMMV, as always with this sort of thing. But my point -- in support of Dave's -- is that medical systems work differently in different countries, which should be taken into account.

Zooming out a little bit, it's worth remembering that the intent of the law is to help the "average" American (whether or not people on here agree that it is helpful is a separate discussion).

So it's very much catered towards a 4-5 person family, making a combined $70K income, probably with some pre-existing conditions, in a somewhat soft employment marketplace (depending on sector).

Frankly I'm impressed that our legislatures and other public servants (the IRS in particular) has worked towards addressing the needs of a rather tiny fraction of a percent of US citizens. Expats, permanent travelers, folks qualifying for FEIE.

For the people in the latter category (like myself) I try to remember that a little bit of shoehorning is in order because this is largely for the benefit of people who don't have my profile. Those people have less options and make up a much higher percentage of the population.

If it helps us as a nation, the slight inconvenience of some additional tax forms I'm fine with.

With the FEIE and now bypassing the individual mandate, the long-term USA sailor gets treated fairly hands off by the government.

[goboatingnow]

Originally Posted by Dockhead

Indeed.

We Americans tend to be paranoid about medical insurance because you can easily be bankrupted -- in our system -- if something happens which is not covered by insurance.

It is quite a revelation to discover that in many other countries -- including very civilized countries like the UK and France -- the same procedures which would bankrupt you in the U.S. are reasonably affordable even if you are a non-resident and thus required to pay the full price for them.

After a few decades living outside the U.S., I have declined to keep up the "all singing, all-dancing" medical insurance policy, and my action plan in case of a medical problem is simply to get treatment in Europe rather than in the U.S. I realize that this will not work for everyone, but I have enough assets that I could pay myself for solving even a very difficult medical problem (God forbid). So I am basically self-insured.

This might seem different to me also if I were older and not in such a good state of health as I am, so YMMV, as always with this sort of thing. But my point -- in support of Dave's -- is that medical systems work differently in different countries, which should be taken into account.

Not to mention I presume you qualify for an EHIC card which will provide free medical care all over Europe

Very useful to have in France for example

Dave

[Dockhead]

Originally Posted by goboatingnow

Not to mention I presume you qualify for an EHIC card which will provide free medical care all over Europe

Very useful to have in France for example

Dave

I wish I did, but I don't qualify for the EHIC card

Then again, I don't pay European taxes

[Tim R.]

I used the calculator with 2 adults(47, 45) who do not smoke and an income of $1,000. The premium came out to $8,500/year.

I understand some states are cheaper. It may be wise to try and setup residency in a cheaper state before buying.

[goboatingnow]

When I meet US folk with medical insurances costing 10k plus. How the hell do they meet that bill don't mind the underlying medical costs.

I was in bupa(UK) and bupa ( Ireland ) and thought the 2k a year I paid outrageous. And in Ireland at the time you got 40% back in tax rebates !!

How does someone on 35k dollars afford 8k !!!!!

Sorry for a little thread drift

Dave

[colemj]

Originally Posted by Tim R.

I used the calculator with 2 adults(47, 45) who do not smoke and an income of $1,000. The premium came out to $8,500/year.

I understand some states are cheaper. It may be wise to try and setup residency in a cheaper state before buying.

Income of $1000 is well below poverty level and you would be covered by Medicaid, so the calculator does not show subsidies for that. If you manage to make another $15,000 next year, then you could get a good insurance plan for around $300/yr, and a lesser plan for free - quite a good deal it seems.

For us (2 adults 50, 42, no smoke, $30,000 income), the premium in FL after subsidies was $1,800/yr for the Silver plan. This is much cheaper and much better coverage terms than our current catastrophic-only health care plan.

The Bronze plan for us would only be $788/yr

Mark

[rebel heart]

Originally Posted by goboatingnow

When I meet US folk with medical insurances costing 10k plus. How the hell do they meet that bill don't mind the underlying medical costs.

I was in bupa(UK) and bupa ( Ireland ) and thought the 2k a year I paid outrageous. And in Ireland at the time you got 40% back in tax rebates !!

How does someone on 35k dollars afford 8k !!!!!

Sorry for a little thread drift

Dave

That's one of the points of ACA. If you don't make enough to afford health care the government provides rebates. Pretty substantial ones.

I plugged in some numbers in California's exchange and a four person family making 70K would pay $5k, depending.

Get Covered | Covered California™

[Dockhead]

Originally Posted by goboatingnow

When I meet US folk with medical insurances costing 10k plus. How the hell do they meet that bill don't mind the underlying medical costs.

I was in bupa(UK) and bupa ( Ireland ) and thought the 2k a year I paid outrageous. And in Ireland at the time you got 40% back in tax rebates !!

How does someone on 35k dollars afford 8k !!!!!

Sorry for a little thread drift

Dave

Americans will agree that the cost of health care in the U.S. is a fairly gigantic problem. People do not, however, agree at all on what to do about it. That general question is not for Cruisers Forum.

So to bring this back onto a purely cruising-related point -- U.S. cruisers who are on extended cruises to Europe will be pleasantly surprised about the cost of health care services, even if you are uninsured and paying supposedly top whack.

I was sailing in French and the UK waters with my 85 year old father last summer. He spoiled his warfarin tablets during our Channel crossing by spilling a glass of water into them. He needs these to prevent a stroke, and needed a new prescription in order to get more. We were in Cowes at the very end of our cruise. He was seen by a doctor within 10 minutes of our entering the Cowes Surgery, and came out with his 'scrip. The administrator apologized profusely for having to charge him the full commercial rate -- then he got the bill -- 12 pounds (!) or less than $20. He filled the 'scrip in the pharmacy downstairs -- for 1/4 of the price the same medication cost in the U.S. We were in and out in 45 minutes, and the total "full commercial" cost was less than just the co-pay he would have paid in the U.S., despite his mega expensive insurance policy there. He was kind of flabbergasted.

[scoobert]

This all sounds like a good reason to change country of residency.

[Tim R.]

Originally Posted by colemj

Income of $1000 is well below poverty level and you would be covered by Medicaid, so the calculator does not show subsidies for that. If you manage to make another $15,000 next year, then you could get a good insurance plan for around $300/yr, and a lesser plan for free - quite a good deal it seems.

For us (2 adults 50, 42, no smoke, $30,000 income), the premium in FL after subsidies was $1,800/yr for the Silver plan. This is much cheaper and much better coverage terms than our current catastrophic-only health care plan.

The Bronze plan for us would only be $788/yr

Mark

When we take off cruising, our income will be zero aside from interest on our qualifying investments(assuming they show a return). This will be below $16k/yr.

So voluntarily leaving our jobs and going cruising allows us to get medicare benefits? I do not think that is correct. Don't we have to be over 65?