Cruising and the Affordable Care Act.

[w32honu]

Right now I have an employer sponsored plan. It is actually quite expensive over all. The employer pays a good portion of the cost. But as we all know over the past 15 years the burden of these costs have been slowly transferring to the employee. Even for the so called "Cadillac" plans. The plan is just a basic 80/20 plan with fairly high deductibles.

The ACA plans provide the same or better coverage at apparently affordable prices. In the end it is just private insurance. It seems that one could retire and have the same level of coverage, and thus piece of mind, at seemingly affordable prices. It seems to dovetail nicely with a cruising lifestyle as well. At this point in my research I am not finding much to dislike.

Still curious about the real world experiences……….

[SV THIRD DAY]

Originally Posted by denverd0n

ave established legal residence in another country, in which case you would be subject to their laws, yes.

Actually No. If you are out of the United States for a defined period of time per year (330 Days/yr or something close to that) then you are freeded from the Requirement to buy into Obamacare. So right there is a great reason to go cruising!

Our families Health Insurance went up more than 3X due to the "Affordable" Care Act. From $395/Mo to $1300/Mo. The bonus was that the only OBGYN Doc that will see my wife is 2.5hrs away now rather than in our home town. Oh ya...the ACA is great all right. It's great for the people getting welfare payments (known as subsidies) from the Government (their fellow citizens). However, it sucks for those pulling the cart paying for other people's free stuff. We cancelled our Obamacare plan and won't comply, fine me.

But the serious question for cruiser remains. Why do you want/need the ACA anyway when you can buy an out of USA policy/plan for so cheap anyway? We paid $1600/yr for a great catastropic out of USA plan when we were cruising which gave us all the protection we needed for our Family of 4! Those plans are still available. I know it's hard for folks that haven't lived outside the USA to grasp but health care outside the USA is good quality and Cheap! A Colonoscopy is $385 in Mexico...why do you need insurance for that? Removing a skin cancer patch on my wife's arm was $60. MRI for my daughter was $275. Eye surgery for a friend was $700 for a detached retnia. Get a good Catastropic plan for the heart attack, storke, cut off leg type of event and then just pay out of pocket for the day to day health care costs.

We confuze "insurance" with "healthcare" in the USA and as my wife found out having "insurance" under the ACA didn't give you "healthcare" when no doctors in town would take the plan due to it's poor reimbursement structure.

[Paul L]

Originally Posted by sailorboy1

Are you saying your Obamacare policy covers you out of the US? Out of network and out of the country are different things.

Yes, it includes coverage under the BlueCross/BlueShield Worldwide PPO B program. That said, I've never tried to claim on it and I doubt we'd get to the deductible on an out of country claim.

[w32honu]

Originally Posted by SV THIRD DAY

But the serious question for cruiser remains. Why do you want/need the ACA anyway when you can buy an out of USA policy/plan for so cheap anyway? We paid $1600/yr for a great catastropic out of USA plan when we were cruising which gave us all the protection we needed for our Family of 4! Those plans are still available. I know it's hard for folks that haven't lived outside the USA to grasp but a Colonoscopy is $385 in Mexico...why do you need insurance for that? Removing a skin cancer patch on my wife's arm was $60. Get a good Catastropic plan and then just pay out of pocket for the day to day health care costs.

$1600 per year for a family of four is a fantastic deal!!! What company was that? Curious what the preexisting condition clause might be………? Unfortunately that is an issue for me.

We have checked BUPA and they are very expensive!!! High deductibles. And would not work for me with preexisting condition………

Can you post more information?

[w32honu]

I like the idea of purchasing insurance for a catastrophic situation and pay as you go in another countries economy for the more day to day needs…….

ACA exchanges might work for that. There might be better alternatives. My guess is that it will always boil down to cost and the fine print.

[SV THIRD DAY]

The plan was a $10K deductable and I found them from an Welcome to the Seven Seas Cruising Association thread about cruisers insurance. We had several friends that also had similar plans. I will ask "the boss" when she gets back to the boat about the company particulars for you.

But once you are out of the USA....the entire pricing of Health Care plans chages, which is just one of the reasons we are outta here as soon as the kids get out of school and with what's been going on lately we can't figure out why we even wanted to come back...ha ha ha

[w32honu]

Thanks Rich………..

[dohenyboy]

Unless you are a "resident" of a foreign country or stay out of the USA 330 days in the year, you must participate in the ACA or pay a fine.
Foreign insurance does not satisfy the requirement of the ACA.
Being a "resident" requires more than just coming and going on a tourist visa or even working abroad. You have to establish residency. The. IRS uses basically the same test for the ACA as the income exclusion test. If you are NOT subject to income tax in the other country, you probably will NOT qualify for an ACA exemption. Most cruisers will not satisfy the residency test
For example, if you cruise on your boat in The Bahamas AND you get a residency card but not a work permit, it might not be sufficient to qualify you as a "resident" of The Bahamas for purposes of the ACA.

(Notice that its "The Bahamas" with a capital T.)

The 330 days are "full days." If you arrive in the US at 11:59 pm, that one minute counts for a day. And you must keep records to prove when you arrived and when you left the USA..
I believe its IRS Publication 54 that details the income exclusion test.


Sent from an undisclosed location on the high seas or from the lounge chair by the pool, you decide.

[SV THIRD DAY]

Most Cruiser will meet the "330 days out" exemption and that's pretty easy to track and prove, or just tell the IRS that your hard drive crashed with your records and then you recycled it...what it worked for Mz Learner. If they don't buy that, you can just file a Hardship Waiver and be clean also...what a mess of a law...

[Kenomac]

Originally Posted by SV THIRD DAY

Most Cruiser will meet the "330 days out" exemption and that's pretty easy to track and prove, or just tell the IRS that your hard drive crashed with your records and then you recycled it...what it worked for Mz Learner. If they don't buy that, you can just file a Hardship Waiver and be clean also...what a mess of a law...

I've been trying to convince my wife that we should buy private catastrophic coverage as you suggest for quite some time. Currently we're on her employer plan which costs over $37,000 per year for the two of us with no pre-exiting conditions. Fortunately, we only pay $6000 or so of that amount out of pocket & her employer pars the rest, but as I understand... this will probably end in a year or two and we could find ourselves dumped into Obamacare.

[Canibul]

Originally Posted by Paul L

I just looked up the international policy referenced above, BUPA, and the quote was 5x what I pay for an Obamacare policy and covers less.

********. I had a total knee replacement under BUPA and the extra costs, copay, etc to me was zero. BUPA pays 100% of hospital, pharmacy, and therapy. 100%. And I totally got to pick the doctor, the hospital, all of it. THEY PAID 100%. All I was out was the airfare to Texas, and that was my choice. I go there anyhow to visit family.

You have no clue which of their several policies we have, so saying you compared our BUPA policy to an "Obamacare" (there's your agenda by the way) policy is an outright lie. And I'm calling you on it.

The BUPA policies vary widely, based on age, deductible, where you actually live etc.

How did you get a quote from BUPA without lying about where you live, since you don't even qualify for expat policies? Did you tell them you were 95 and smoke three packs a day and live in Haiti? Did you go for zero deductible? If BUPA was five times the cost, it wouldn't have a single customer. We'd all just sign up with St. Brendan's Isle and pretend to be Florida residents.

This is pure political agenda. And it's ********.

[Paul L]

Originally Posted by Canibul

********. I had a total knee replacement under BUPA and the extra costs, copay, etc to me was zero. BUPA pays 100% of hospital, pharmacy, and therapy. 100%. And I totally got to pick the doctor, the hospital, all of it. THEY PAID 100%. All I was out was the airfare to Texas, and that was my choice. I go there anyhow to visit family.

You have no clue which of their several policies we have, so saying you compared our BUPA policy to an "Obamacare" (there's your agenda by the way) policy is an outright lie. And I'm calling you on it.

The BUPA policies vary widely, based on age, deductible, where you actually live etc.

How did you get a quote from BUPA without lying about where you live, since you don't even qualify for expat policies? Did you tell them you were 95 and smoke three packs a day and live in Haiti? Did you go for zero deductible? If BUPA was five times the cost, it wouldn't have a single customer. We'd all just sign up with St. Brendan's Isle and pretend to be Florida residents.

This is pure political agenda. And it's ********.

I went to their web site and put in the info for a Quick Quote. Since they don't offer on their quote a selection for general out of country on their form (like a full time cruiser would need), I selected the next country we will spend the most time in. That is French Polynesia. The quote was approx. 5x what I am spending now. Not political at all.
I could not find anywhere on their site the actual policy to review the pre-existing conditions definitions.

[sailorboy1]

Well my wife is a Human Resource manager and has been to the various training on ACA and I asked her some of the questions from this thread and she doesn't know.

There are still lots of unknown things far as ACA as can be seen on this thread where people are swearing they are right ever though they are different than the other person swearing.

[mbianka]

I was at the Oyster Bay Oyster festival last year and New York State had a information/sign up booth for the ACA (Obamacare) plan. I already have a Bluecross plan which I pay for out of pocket through a group plan. I asked a fellow at the booth should I sign up for the ACA plan instead. He gave an emphatic NO! Stick with what you have. That was good enough advice for me. Good thing because I later found out my primary care doctor is not taking patients under ACA. I may be living out of the country for few months soon and I will probably look for a catastrophic plan like Rich mentioned and pay local rates for non emergency medical care if needed.

[Boatguy30]

If you live in a state that is not expanding Medicaid like FL and you have any dependents you might have a problem with not making enough money. For example if you are a budget cruiser couple with 2 dependents, you can cruise on less than $23,500 a year. However that is not enough to qualify for the subsidy.

I'm actually quite possibly in this situation and may need to take some additional capital gains near the end of the year to get my income high enough. If you make $1 less you are supposed to have to repay the entire subsidy.

I have yet to see how this actually works. Also complicated by the fact I have not been required to file since 2009 so will be a real challenge and possible major red flags when I file for this year.