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NPCampbell · 02-02-2021, 20:55

Quote:

Originally Posted by fxykty

If you’re 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?

The only reason for health insurance is to cover something that would otherwise cause an unrecoverable hardship for you.

For mundane things like a checkup, paying out of pocket is just common sense. It's typically more expensive to use insurance as you are adding the overhead of the insurance company to the cost of the procedure. This applies even in the US.

However, for things like cancer treatment, expensive prescription medication regimens, etc., it will most likely be prohibitively expensive in any country you go to unless you are covered by their sovereign plans or you have insurance.

NPCampbell · 02-02-2021, 21:59

Quote:

Originally Posted by Shanachie

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.

Biden and the Republicans have nothing to do with the success or failure of the ACA. The ACA had so many structural problems from the start that it is doomed to failure.

The ACA was only reasonably priced from the start ... as long as you were below 400% of the poverty line and someone else was subsidizing the cost of your insurance. For healthy or young individuals over 400% of the poverty line, they received no subsidies.

Millions in this group chose to pay the non-insurance penalty because it was considered too small to force them into purchasing expensive insurance policies. This net exodus of "healthy" individuals capable of paying the premiums left the ACA with insureds with higher than average expenses or less ability to pay the premiums. Additionally, it incentivized companies to reduce the hours of millions of employees so they would fall under the threshold of having to pay insurance ... brilliantly stupid. Higher premiums are/were inevitable. It's a bad system with a poorer implementation.

I long for the old days when I could buy a catastrophic policy, with no frills, that wasn't required to pay for a laundry list of expensive procedures that I will never ever use. Unfortunately, the ACA outlawed those policies ... go team!

belizesailor · 03-02-2021, 18:44

Quote:

Originally Posted by NPCampbell

The only reason for health insurance is to cover something that would otherwise cause an unrecoverable hardship for you.

For mundane things like a checkup, paying out of pocket is just common sense. It's typically more expensive to use insurance as you are adding the overhead of the insurance company to the cost of the procedure. This applies even in the US.

However, for things like cancer treatment, expensive prescription medication regimens, etc., it will most likely be prohibitively expensive in any country you go to unless you are covered by their sovereign plans or you have insurance.

I lived in Guatemala for about a decade. Even major medical procedure costs were far from catastrophic (as they are in the USA). So affordable that I quit bothering with insurance years ago (which was also quite affordable there).

Ive had friends who collectively had knee replacement, hip replacement, abdominal hernia surgery, throat cancer (successful outcome), major burns, hysterectomy, back surgery, etc in Guate. All had these issues dealt with on the private side of the system and none managed to spend over $10K, most much less. All had great expriences.

The public side of the system is substabtially less. Ive helped locals out with medical costs, some for major medical issues, and costs were often just a few hundred dollars...with only a couple of exceptions for more serious matters.

Now living in Panama, healthcare is more expensive here, but still quite reasonable.

My healthcare expriences (fortunatley nothing major) have all been very positive and very affordable.

At least in Central America anyone who can afford to be cruising isnt going to be ruined financially by healthcare costs.

fxykty · 03-02-2021, 22:43

Between the two of us we have citizenship and permanent residence in New Zealand, which has a relatively comprehensive and free medical system for accidents and illness. Sometimes long wait times for non-urgent issues (e.g. knee or hip replacement) but pretty good for critical issues.

So, do we need to bother with any sort of health insurance (outside of North America), given that we can just fly back to New Zealand if the local health system cannot treat us? We would effectively be self-insuring for repatriation flights.

I guess that could fall down if we are in an ICU in a coma and need to get ourselves back to NZ, or pay the going rate for a medical evacuation. Hmmm.

sailorboy1 · 04-02-2021, 04:39

Guess maybe it is time to just give some facts for US:

1 - anyone can sign up for an ACA plan
2 - your income determines if and what subsity you will qualify for
3 - if you are below the Federal poverty level you will not get a subsidy and will get bounced to Mediaid and it will depends on your State what that means
4 - you need to understand what the ACA plan means by "income" and that there ways to get it even if you don't work. There may be penalties involved, but those are probably less that the subsidy so still makes the insurance less expensive.
5 - my ACA coverage cost has increased over the last 4 years, but is costing me less than $50/mo for a couple

The only reason I have been able to afford health insurance the last 4.5 years is because of the ACA program. It isn't prefect, but then no system is.

smj · 04-02-2021, 04:57

We’ve been on ACA plans before and found good coverage but last year we checked into it and the plans have changed drastically. The plans give good service if your in your location or state, but once out of your base location you are uninsured unless it’s a true life threatening emergency. Didn’t match up for what we needed as a cruising boater.

sailorboy1 · 04-02-2021, 05:26

I look at my ACA as "major medical" when out of network (State of Florida). But did use at an urgent care in MS when wife broke arm so it does provide a use.

AKA-None · 04-02-2021, 08:03

For US citizens I don’t believe that aca is viable once you reach Medicare age

Shanachie · 04-02-2021, 09:05

Westcliffe01, it may be that I'm reading your message incorrectly, but it sounds as if you were paying your medical bills directly because you had a $6,500 deductible.

You should never do that. A major benefit of health insurance is that you are eligible to pay the rates negotiated by the insurance company, which are a fraction of what doctors and hospitals will otherwise charge.

Always insist that every bill be channeled through the insurance company to get the discounted rate. And then check with your insurance company to ensure that happened. This also applies to dental insurance.

Crafty doctors and hospitals will tell you that you don't need to involve the insurance company because of the deductible, but all they are trying to do is get you to pay the inflated rate.

They will also try to bill you directly without telling you it hasn't been reviewed by the insurance company.

If a hospital wants you to pay a few hundred dollars of good-faith money up front, that's fine. But when hospitals ask for full upfront payment, direct them to insurance because you will have a hell of a time getting it to return the overpayment.

belizesailor · 05-02-2021, 01:03

Quote:

Originally Posted by fxykty

Between the two of us we have citizenship and permanent residence in New Zealand, which has a relatively comprehensive and free medical system for accidents and illness. Sometimes long wait times for non-urgent issues (e.g. knee or hip replacement) but pretty good for critical issues.

So, do we need to bother with any sort of health insurance (outside of North America), given that we can just fly back to New Zealand if the local health system cannot treat us? We would effectively be self-insuring for repatriation flights.

I guess that could fall down if we are in an ICU in a coma and need to get ourselves back to NZ, or pay the going rate for a medical evacuation. Hmmm.

Medivac insurance is relatively inexpensive. I have a policy for about $275/year that covers us both. Im not sure if that includes repatriation to home country or not.

belizesailor · 05-02-2021, 01:04

Quote:

Originally Posted by AKA-None

For US citizens I don’t believe that aca is viable once you reach Medicare age

And Medicare does not pay outside the USA.

belizesailor · 05-02-2021, 01:07

Quote:

Originally Posted by Shanachie

Westcliffe01, it may be that I'm reading your message incorrectly, but it sounds as if you were paying your medical bills directly because you had a $6,500 deductible.

You should never do that. A major benefit of health insurance is that you are eligible to pay the rates negotiated by the insurance company, which are a fraction of what doctors and hospitals will otherwise charge.

Always insist that every bill be channeled through the insurance company to get the discounted rate. And then check with your insurance company to ensure that happened. This also applies to dental insurance.

Crafty doctors and hospitals will tell you that you don't need to involve the insurance company because of the deductible, but all they are trying to do is get you to pay the inflated rate.

They will also try to bill you directly without telling you it hasn't been reviewed by the insurance company.

If a hospital wants you to pay a few hundred dollars of good-faith money up front, that's fine. But when hospitals ask for full upfront payment, direct them to insurance because you will have a hell of a time getting it to return the overpayment.

Ive seen the opposite too, esp outside the USA: a higher rate if insured and a lower one if not.

fxykty · 05-02-2021, 11:04

Quote:

Originally Posted by belizesailor

Medivac insurance is relatively inexpensive. I have a policy for about $275/year that covers us both. Im not sure if that includes repatriation to home country or not.

Who is your provider?