Early retirement and health care for boaters

[robert sailor]

Depending on where your cruising it's not all bad news. As long as your not cruising in the USA then most medical expenses can simply be paid for out of your cruising kitty because the costs in most other countries is very low compared to the USA.
We cruised the Med for a couple of years and i needed to have the services of medical specialists a couple of times and my costs were dirt cheap and the Dr.s were first rate. While the USA does have the most expensive health care in the world it doesn't have the best health-care.

[robert sailor]

Originally Posted by taxwizz

I live in Canada, and here health care is FREE.
I think that the USA is the only country in the First World that does not provide free public health care to help cure people.

But you have a great military.

Yes it's free but it's not free as it comes out of our taxes and our taxes are higher than the United States to cover this...there is never a free lunch. That said because our health care system is a not for profit single user pay system our costs are much lower than our American neighbors to the south.

[Brentolsen]

Originally Posted by taxwizz

I live in Canada, and here health care is FREE.
I think that the USA is the only country in the First World that does not provide free public health care to help cure people.

But you have a great military.

Not going to get into a political discussion...but we are the only country with a lot of "great" things...

[leandroflaherty]

US healthcare is deplorable. Prices are out of this world because Big Pharma, Big Insurance, Big Sugar (Diabetes and Obesity is a huge burden on the system).. all those big fat pigs lobby and are protected by corrupt government policy. Its not a single payer vs private insurance issue, its an issue that there is no proper incentives. The market is not free and agile, so competition is missing and they can rape us. Its disgusting. Things like restricting the entry of generic meds, restrictions on cross state insurance, restrictions on foreign doctors practicing medicine here, etc, etc.. it a racket. Obama care while "well intentioned" was a slap on our faces by forcing us to participate on a broken system. Its a disgrace what is going on.. and higher taxes is no the solution. Gutting the corruption and setting up proper markets is, including the option for groups to create "single payer" pools to negotiate.

What is the result of all this? People dying, people getting ripped off by paying x10 more than they should and those with any brain cells looking for ways to "cheat" the system by aspiring for poverty level wages so the goverment can subsidize the price at the expense of every other working smuck, while the big Corp CEOs, shareholders and Lobbys profit.

Ok, I am off my pedestal now..

[Brentolsen]

Originally Posted by leandroflaherty

US healthcare is deplorable. Prices are out of this world because Big Pharma, Big Insurance, Big Sugar (Diabetes and Obesity is a huge burden on the system).. all those big fat pigs lobby and are protected by corrupt government policy. Its not a single payer vs private insurance issue, its an issue that there is no proper incentives. The market is not free and agile, so competition is missing and they can rape us. Its disgusting. Things like restricting the entry of generic meds, restrictions on cross state insurance, restrictions on foreign doctors practicing medicine here, etc, etc.. it a racket. Obama care while "well intentioned" was a slap on our faces by forcing us to participate on a broken system. Its a disgrace what is going on.. and higher taxes is no the solution. Gutting the corruption and setting up proper markets is, including the option for groups to create "single payer" pools to negotiate.

What is the result of all this? People dying, people getting ripped off by paying x10 more than they should and those with any brain cells looking for ways to "cheat" the system by aspiring for poverty level wages so the goverment can subsidize the price at the expense of every other working smuck, while the big Corp CEOs, shareholders and Lobbys profit.

Ok, I am off my pedestal now..

I think owning a boat keeps you active...I have quite a few friends in their late 70's and 80's in great shape...a

[sailorboy1]

I told you the answer in post #2. I spent years figuring this out. If you make too much ch to get an ACA subsidy then you either need to reduce your income in a way the program measures it, or go out into the general market place and paid. And the ACA qualification don’t care how much money you have or your total assets, all it cares is the number on your tax return that is considered as your income.

It will cover major medical problems with various deductibles (cost me about $500 last year for a full cardio stress work up) and for your general physicals you need to have your residence in a place you can travel to easy or pass through once a year. For me my residence is in Jacksonville and I pass by it twice a year and/or visit and schedule physicals during that time.

[Augi]

Check with Alliance International insurance for expats. Cigna has a similar product.

I am 61 and the plan I got via Alliance cost $230 per month. It has 20K deductable, 0% copay, $3MM max annually, is for inpatient only and is good anywhere in the World. Anything under $20K annually you pay out of pocket except you get $400 paid for annually for physical exam, and typical tests your doctor might order like for blood work, etc. for your age when you go for a physical.

Everywhere except the USA you can go to any provider or hospital. Alliance will pay them direct if the provider agrees. In the USA you work directly with Olympus Managed Healthcare. If I had excluded the USA it would have cost $212 a month.

You can play around with the annual deductable, copay %, and annual max out of pocket to suit you. I just wanted to be covered for the big hit. I am healthy and Guatemala Medical costs and prescriptions are dirt cheap. I actually prefer the care I get in Guatemala compared to the USA or anywhere else. The only issue is does Guatemala have the procedures, etc needed for your illness that has cropped up.


The thing you need to check carefully is how it works if you are constantly moving from country to country. They may not cover you if you are always moving. There are restrictions about this and how much you travel away from your country of domicile. We spend at least 1/2 the year in Guatemala. So that counts as our country of domicile and the medical costs of your home country effect what the premium is. The $20K deductable/0% copay works for me because Guatemala has very good health care for most things at a fraction of the cost in the USA. The annual maximum for my plan is $3MM.

Cigna offered similar coverage for about the same price except their annual max was $1MM and they did not include the $400 a year for physical and related tests. If you get the wrong thing and have to go to the States $1MM is not enough.

[Brentolsen]

Originally Posted by Augi

Check with Alliance International insurance for expats. Cigna has a similar product.

I am 61 and the plan I got via Alliance cost $230 per month. It has 20K deductable, 0% copay, $3MM max annually, is for inpatient only and is good anywhere in the World. Anything under $20K annually you pay out of pocket except you get $400 paid for annually for physical exam, and typical tests your doctor might order like for blood work, etc. for your age when you go for a physical.

Everywhere except the USA you can go to any provider or hospital. Alliance will pay them direct if the provider agrees. In the USA you work directly with Olympus Managed Healthcare. If I had excluded the USA it would have cost $212 a month.

You can play around with the annual deductable, copay %, and annual max out of pocket to suit you. I just wanted to be covered for the big hit. I am healthy and Guatemala Medical costs and prescriptions are dirt cheap. I actually prefer the care I get in Guatemala compared to the USA or anywhere else. The only issue is does Guatemala have the procedures, etc needed for your illness that has cropped up.


The thing you need to check carefully is how it works if you are constantly moving from country to country. They may not cover you if you are always moving. There are restrictions about this and how much you travel away from your country of domicile. We spend at least 1/2 the year in Guatemala. So that counts as our country of domicile and the medical costs of your home country effect what the premium is. The $20K deductable/0% copay works for me because Guatemala has very good health care for most things at a fraction of the cost in the USA. The annual maximum for my plan is $3MM.

Cigna offered similar coverage for about the same price except their annual max was $1MM and they did not include the $400 a year for physical and related tests. If you get the wrong thing and have to go to the States $1MM is not enough.

Thank you for taking the time to provide such detailed reply..very much appreciated. I will give them a call ....

[Mike OReilly]

Originally Posted by robert sailor

Depending on where your cruising it's not all bad news. As long as your not cruising in the USA then most medical expenses can simply be paid for out of your cruising kitty because the costs in most other countries is very low compared to the USA.
We cruised the Med for a couple of years and i needed to have the services of medical specialists a couple of times and my costs were dirt cheap and the Dr.s were first rate. While the USA does have the most expensive health care in the world it doesn't have the best health-care.

+1 … on both counts.

Canada’s healthcare systems (they’re provincial, not federal) are not free, but they are a heck of a lot cheaper than the USA. So is every other developed countries systems. And like virtually every other developed country, our health outcomes are better.

Be that as it may… I think Robert’s second point is key. Outside of the USA, healthcare is not overly expensive. Our plan is to maintain our provincial healthcare as long as possible, but to pay-as-we-go for our international travel. The exception being the USA. I have a high tolerance for risk, but travelling in the USA without health insurance exceeds my comfort level. A broken arm could destroy me financially

P.S. A personal peeve. This is an INTERNATIONAL forum. When you ask for assistance regarding something specific to one nation, it would help to note which country you are inquiring about, or from. How about a subject that reads: Early retirement and health care for USA boaters. That way I could ignore it (and we’d all be happier ).

[Brentolsen]

Originally Posted by Mike OReilly

+1 … on both counts.

Canada’s healthcare systems (they’re provincial, not federal) are not free, but they are a heck of a lot cheaper than the USA. So is every other developed countries systems. And like virtually every other developed country, our health outcomes are better.

Be that as it may… I think Robert’s second point is key. Outside of the USA, healthcare is not overly expensive. Our plan is to maintain our provincial healthcare as long as possible, but to pay-as-we-go for our international travel. The exception being the USA. I have a high tolerance for risk, but travelling in the USA without health insurance exceeds my comfort level. A broken arm could destroy me financially

P.S. A personal peeve. This is an INTERNATIONAL forum. When you ask for assistance regarding something specific to one nation, it would help to note which country you are inquiring about, or from. How about a subject that reads: Early retirement and health care for USA boaters. That way I could ignore it (and we’d all be happier ).

If i stated only USA then I would miss out on all the replies from nice people like you from all over the world sharing their experiences and opinions....sorry if my lack of specificity in the title offended anyone...only 18 posts thus far...newbie error I guess...

[hellosailor]

Admission to the dance, indeed. What you have to pay monthly will buy you "in network" access, with often large out of pocket costs and co-payments until you've paid up some five or ten grand in that year. So if you have a plan in one city, but need a hospital stay only 500 miles away, still in the same state? Yeah, the first five grand can easily be out of pocket.

The healthcare.gov web site can be used (set up a throwaway account) to compare offerings in any state, fwiw. And that can all be expected to keep changing every year, the same way that some states went up 30% this year. Some carriers simply stopped offering coverage.

There is also a little-discussed federal subsidy program. IIRC only for non-profit hospitals, it allows (and requires) them to review your income and base your fees on that. If you ASK about aid, they may turn a $4000 ER visit into a $200 bill, but you have to know to ask, and you have to be at a participating hospital. Somewhere online there are listings, you might try asking a local hospital's financial aid office where to get information.

The problem is, you have to do a lot of homework, ahead of time, and then make sure that you or someone caring for you can call the right choices when things are not going well. There are clever hospitals that will say "Prepay your ER bills now, here's all it will be" and then, quietly, they don't tell you that your insurance covers ANY ER, but not necessarily a penny after you've been formally admitted to the hospital. Gotcha.

Sadly the same thing goes for any care, any stay. The other day I heard a doctor telling a patient "Your insurance wouldn't authorize the MRI, so I'll order an X-ray, that will still do." Really? Probably 20x cheaper and it will still do? Or the hospitals that routinely hang an IV of saline solution (at $100+ per liter, when it costs them $1) "just in case" without any specific need. That's just their conservative and profitable policy, but as a patient, you can decline--if you know in advance.

[buzzstar]

Originally Posted by taxwizz

I live in Canada, and here health care is FREE.
I think that the USA is the only country in the First World that does not provide free public health care to help cure people.

But you have a great military.

Free? I do not think so. TANSTAAFL. If it is truly free, you are getting something worth exactly what is paid for it.

[HBrew]

Originally Posted by Augi

Check with Alliance International insurance for expats. Cigna has a similar product.

I am 61 and the plan I got via Alliance cost $230 per month. It has 20K deductable, 0% copay, $3MM max annually, is for inpatient only and is good anywhere in the World. Anything under $20K annually you pay out of pocket except you get $400 paid for annually for physical exam, and typical tests your doctor might order like for blood work, etc. for your age when you go for a physical.

Everywhere except the USA you can go to any provider or hospital. Alliance will pay them direct if the provider agrees. In the USA you work directly with Olympus Managed Healthcare. If I had excluded the USA it would have cost $212 a month.

You can play around with the annual deductable, copay %, and annual max out of pocket to suit you. I just wanted to be covered for the big hit. I am healthy and Guatemala Medical costs and prescriptions are dirt cheap. I actually prefer the care I get in Guatemala compared to the USA or anywhere else. The only issue is does Guatemala have the procedures, etc needed for your illness that has cropped up.


The thing you need to check carefully is how it works if you are constantly moving from country to country. They may not cover you if you are always moving. There are restrictions about this and how much you travel away from your country of domicile. We spend at least 1/2 the year in Guatemala. So that counts as our country of domicile and the medical costs of your home country effect what the premium is. The $20K deductable/0% copay works for me because Guatemala has very good health care for most things at a fraction of the cost in the USA. The annual maximum for my plan is $3MM.

Cigna offered similar coverage for about the same price except their annual max was $1MM and they did not include the $400 a year for physical and related tests. If you get the wrong thing and have to go to the States $1MM is not enough.

I bought an IMG GlobeHopper plan. I have no idea if it will be actually usable if it is ever needed, does anyone have experience with this plan? Any major issues getting health costs recovered?

Thanks, Hamish

[danielamartindm]

You're basically waiting out being eligible for Medicare, which is great insurance at low cost. If you are in good health and find that unsubsidized Obamacare premiums for your income bracket are onerous, you might look into health care ministries as a stop gap measure until you qualify for Medicare. For destitute Americans, Obamacare amounts to what Jay Leno quipped as "A McDonalds Obama Happy Meal": You order whatever you want, and the guy behind you has to pay for it. For the rest of us, it amounts to high premiums, high deductibles and co-pays, and high out-of-pocket expenses if you use it.

[Paul L]

Looking for residency in a state that expanded Medicaid with the ACA plans might not work well for an international cruiser. To get approved for Medicaid expansion coverage your income must be just under the level for ACA subsidy insurance. The policy you get will be a very restricted policy that is only useable in the state of issue.
If you have an income range that is within the ACA subsidy range, then those policies will likely be your best bet. Perhaps in conjunction with a DAN evacuation policy. The fact that the ACA policies have high deductibles is not really an issue for cruisers, as small things can be paid with cash while cruising usually at affordable rates. The insurance you need is to primarily protect your other assets so that a $750,000 cancer treatment bill doesn't leave you or your spouse bankrupt.

If you don't qualify for the ACA subsidy then you can pay full fair for a standard US policy or look at an international policy. Be very careful on the international policy and look at the definitions and coverage restrictions for pre-existing conditions. Some (many) are onerous.