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Old 01-02-2021, 18:51   #346
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Re: Early retirement and health care for boaters

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Are you looking to purchase health insurance for being out of the country, or are you wondering about health care costs/availability/quality outside of the US? I've not had health insurance for outside of the states, so no ideas there. My experience from a long time ago (Bahamas, Eastern Caribbean, Trinidad, Venezuela, Bonaire) is that health care is of high quality (US and European trained medical professionals) and very very inexpensive. (I had a bad staph infection when we were in the Bahamas that required lancing and daily visits to the nurse for bandage changes (with antibiotics packed in there) for 2 weeks. At the end of the treatment period, I was (very apologetically) handed a bill for the full amount: $50. That was the tourist price, far more than what Bahamians would pay.)

If you're not familiar with the term medical tourism, you might want to investigate a bit as that might put your mind at ease about the quality of care outside of the US.
Yeah - Our current understanding is that many places it's simply not an issue - you need medical attention, you go to the doctors and get it and it doesn't cost all that much. Living in Texas, it's pretty common knowledge about "Dentistry Vacations" to Mexico.

But as we plan on seeing as much of the world as possible, we'd like to find out more about health care costs and what cruisers do about them in places where it may not be that simple. I really don't even have an example of where that might be, that's how little I know about specifics.
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Old 01-02-2021, 19:00   #347
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Re: Early retirement and health care for boaters

Here's a Sailing Totem post about healthcare when cruising from 2014, so some stuff may have changed, but it's a place to start for you anyway.
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Old 01-02-2021, 19:15   #348
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Re: Early retirement and health care for boaters

Stay tuned now that Biden is president. I had ACA from the start, and it was reasonably priced for good coverage. Then the Republicans spent many years trying to sabotage it, and the price went way up as the coverage turned to crap.



(Sorry, conservatives, but that is how it was. You got sold a bill of goods that all of us are paying for now.)


The hope is that Biden will fix it somehow, either with a public option or altered rules that give you more reasonable options.


In the short term, the doctor is correct. Buy bronze-level coverage for the least amount of money and a large deductible. Then take the amount of the deductible and put it aside.


That's much cheaper than paying many hundreds a month more for better coverage that you will likely never use.


The reality is that most of us go to the doctor a couple of times a year. It's not worth paying $400 a month more to get a lower copay. You just want to be covered in case of cancer or a major accident. 4K or 6K will seem cheap if someone brings you back from the brink.
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Old 02-02-2021, 05:14   #349
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Re: Early retirement and health care for boaters

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Actually participated in the ACA and medicaid expansion (costs are pretty uniformly lower in these states).
While costs may be lower, access may be worse. Remember that primary care and specialist offices have to put a cap on the number of CMS patients they see, or they would go out of business due to low reimbursements...and if you live in a Medicid expansion state as a Medicare patient you are competing with an increased number of Medicaid patients for a fixed number of appointment times.

My wife and I are at that inconvenient age where we are old enough to have realized that Medicare will be bankrupt by the time we need it but aren't young enough for whatever comes next to be available.

So our plan is to retire outside the US and engage in medical tourism.
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Old 02-02-2021, 05:31   #350
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Re: Early retirement and health care for boaters

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Anecdotes aside, you do realize that by almost every measure, the Canadian healthcare system beats the US. Outcomes are superior in general. We live longer, have fewer system-related complications, have a lower disease burden in general, and it costs about 1/2 the price. Oh, and no one has to worry about how to pay their healthcare or insurance bills.
I've spent quite a bit of time in Canada, and own a vacation home there (that I have not been able to return to for a year and a half now (thanks to winter and now Covid) despite continuing to pay taxes. So I'm quite familiar with the system there. Canada is a much more homogenous country genentically than the United States. The quality of food in Canada is appreciably higher than in the US. As a result, you don't see nearly the same rates of obesity that you do in the US, and those two factors alone do more to account for your relative disease burden than anything intrinsic to the two health care systems. Canadian primary care doctors are just as busy as their American counterparts and don't do any better a job when it comes to preventative care.
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Old 02-02-2021, 05:51   #351
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Re: Early retirement and health care for boaters

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Stay tuned now that Biden is president. I had ACA from the start, and it was reasonably priced for good coverage. Then the Republicans spent many years trying to sabotage it, and the price went way up as the coverage turned to crap.
.
Good for you. My experience was different. "Like your plan keep your plan" was a lie. For my fam our plan was no longer available. Best we could do was less coverage for over twice the price.
Now back to the OP topic; I have lived in Mexico as well as the Philippines. imho The best bet in MX was simply out of pocket for very reasonable priced care at a top level (MX scale) facility. In PI my wife was able to get Phil health and we "bought in" to a private hospital. There are decent hospitals in both countries but BUT if you have a serious issue there is not a top level hospital and quick trip in an ambulance always available. Stroke, heart, life threatening injury, the outcome in a developing foreign country is grim but affordable. Some good news is I believe Medicare is operational in Puerto Rico. Possibly the other Territories as well.
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Old 02-02-2021, 06:51   #352
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Re: Early retirement and health care for boaters

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I've spent quite a bit of time in Canada, and own a vacation home there (that I have not been able to return to for a year and a half now (thanks to winter and now Covid) despite continuing to pay taxes. So I'm quite familiar with the system there. Canada is a much more homogenous country genentically than the United States. The quality of food in Canada is appreciably higher than in the US. As a result, you don't see nearly the same rates of obesity that you do in the US, and those two factors alone do more to account for your relative disease burden than anything intrinsic to the two health care systems. Canadian primary care doctors are just as busy as their American counterparts and don't do any better a job when it comes to preventative care.

Not wanting to promote this drift, but I can find no evidence to support either of your claims.
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Old 02-02-2021, 08:45   #353
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Re: Early retirement and health care for boaters

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Anecdotes aside, you do realize that by almost every measure, the Canadian healthcare system beats the US. Outcomes are superior in general. We live longer, have fewer system-related complications, have a lower disease burden in general, and it costs about 1/2 the price. Oh, and no one has to worry about how to pay their healthcare or insurance bills.

I'm pleased you've had such excellent care. Indeed, the USA offers the best of the best for those who can afford it. But it's not a very good system when judged against peer countries.

Here's just one study. There's a huge amount of information about this:

U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?

And here's a nice summary document of health system data looking at the wealthiest countries.

https://www.commonwealthfund.org/sit...01-30-2020.pdf

I'm not trying to piss on the US healthcare system. But it's simply false to suggest it is better than the rest. By most measures, it is the worst.
Maybe we should just leave it as you are very happy with Canada's healthcare system, and I am very happy with the US healthcare system. So, we are both happy.
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Old 02-02-2021, 08:46   #354
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Re: Early retirement and health care for boaters

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Maybe we should just leave it as you are very happy with Canada's healthcare system, and I am very happy with the US healthcare system. So, we are both happy.

Works for me .
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Old 02-02-2021, 09:29   #355
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Re: Early retirement and health care for boaters

Read 'Health Reform: The End of The American Revolution?' by Lee Kurisko a Canadian doctor.

Just one data point but it's good to get a broad perspective of the pluses and minuses.
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Old 02-02-2021, 10:17   #356
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Re: Early retirement and health care for boaters

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Read 'Health Reform: The End of The American Revolution?' by Lee Kurisko a Canadian doctor.

Just one data point but it's good to get a broad perspective of the pluses and minuses.
I really didn't mean to drive this thread into a competition about who's healthcare system is better. We can have that pissing match somewhere else .

I just feel I need to respond when someone posts a mistaken or misspoken claim posing as fact. But if we go down this rabbit hole here, it will lead to thread closures.
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Old 02-02-2021, 10:46   #357
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Re: Early retirement and health care for boaters

No arguments Mike. You posted links about the shortcomings of the American medical system, I posted a book written by a Canadian doctor about the shortcomings of the Canadian medical system. Nothing's perfect but we do the best we can in the system we live in.

And putine really isn't a health food but I love it.
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Old 02-02-2021, 16:23   #358
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Re: Early retirement and health care for boaters

I a non US citizen living in America. Been here since 2000 had a green card since 2011. I have only ever had 1 significant health issue, which was a kidney stone incident in 2011. I had a sunday night ER visit with a cat scan that resulted in a $5000 bill and the kidney stone diagnosis.



With a referral from the ER, I was able to get an appointment with the only urologist working in the county 2 weeks later. In the meantime, "just take your pain medication and drink lots of water".


2 weeks pass, I have my first appointment with the urologist. They take a urine sample and I meet with the doctor for about 45 seconds, who says to keep taking the pain medication and drinking lots of water... I get 2 bills, $280 for the urologist visit and another $150 lab fee for the urine sample lab tests. This goes on every 2 weeks for the next 3 months. The pain medication i am on is so strong I technically would get a DUI for driving my car to work.


After 3 months, the stone has not passed, my kidney is still in spasm, I develop a bladder infection. Feels like one is passing lava, one drop at a time. This results in another ER visit and an ultrasound. Another $3000 bill from the hospital.



The urologist finally decides, perhaps the stone is not going to pass on its own, we will go ahead and do an endoscopic process using a laser to blast the stone so it can pass. I go in for the procedure in the OR, get knocked out am in the hospital 2 hours before being revived and kicked out. The procedure failed, the stone was forced back into the kidney. Urologist put in a stent. I get a bill from the hospital for over $30k for the 2 hours.


My next visit to the urologist, I find the partner I was seeing has been terminated. I'm now seeing the partner who founded the business before he sold out to the local hospital. He reviews my chart, says the stent has to be removed immediately. Outpatient endoscopic procedure at his office, no anesthetic of any kind. To say it was uncomfortable would be an understatement, not to mention that it bled for the next 2 days... Great, another nearly $1000 bill from the urologist office + another $150 lab fee.


In the end, my deductible for my $4000/yr insurance policy (just myself) was $6500. Once I reached the $6500 limit, then the insurance company got involved, negotiated the nearly $40k in bills down to less than 1/4 of what had been invoiced with the result that after I had paid my $6500, they only had to settle the $3500 balance.


Do I think the $40k was justified for the few hours that I lay on a bed with no-one attending to me (not counting the endoscopic procedure) ? No. Is this what passes for the best care in the free world ? No, I don't think so. But its the only hospital in the county and the only urologist. I'm pretty pessimistic overall on ever getting anything for all the money that has been spent over the last 18 years. Nearly $72k + interest basically pissed away, extracted from working class people for fear one might ever end up in their grip because of some unexpected health crisis.
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Old 02-02-2021, 18:25   #359
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Re: Early retirement and health care for boaters

This may be useful to some of us in this conversation. An English interview with a Pacific Cross agent in the Philippines. If I understand this correctly Pacific Cross offers global coverage.
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Old 02-02-2021, 20:01   #360
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Re: Early retirement and health care for boaters

If youíre not cruising in North America (CA and US) then you can generally just self insure and pay as you go. Exceptions to true affordability, but still a lot cheaper than North America, are New Zealand, Australia, and most of western Europe. Any other expensive places if you have to visit a doctor and/or hospital?

I only know of New Caledonia as a country that requires proof of health insurance for entry. Any other countries like that?

Given that, until we decide to cruise North America or countries like New Caledonia, is there any reason at all for health insurance?
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