Cruising and the Affordable Care Act.

[w32honu]

Forgive me good people of the Forum……. I want to toss out a few questions regarding Obamacare. Pragmatic questions for the American crowd……or anyone for that matter. Not sure how long this will last but this is meant to be entirely Sans politics…………

Is anyone participating?

If so…… general opinions as they relate to our nomadic life style?

General cost? Is it truly "Affordable"?

The "exchanges" are focused on individual states and counties. What if you are out cruising and mobile?

What if you are foreign (out of the country)?

Finally if one chooses to not insure there is a "fine." Does this fine apply to to individuals living out of the country?

Thanks in advance. I did a search of the Forum with no great success. Hope this doesn't become a political hot potato too quickly……..

Cheers

[denverd0n]

Originally Posted by w32honu

Is anyone participating?

Not personally, but I have a friend who is, and I work in the health care industry, so I'm reasonably familiar with it.

Originally Posted by w32honu

General cost? Is it truly "Affordable"?

Depends on a variety of conditions, but I would say, in general, yes.

Originally Posted by w32honu

The "exchanges" are focused on individual states and counties. What if you are out cruising and mobile?

For the purposes of the IRS, you still need to have a state of residence. You will use their exchange.

Originally Posted by w32honu

What if you are foreign (out of the country)?

See above. For example, those who use St. Brendan's Isle as their address of residence, would use the Florida exchange for their insurance.

Originally Posted by w32honu

Finally if one chooses to not insure there is a "fine." Does this fine apply to to individuals living out of the country?

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

[w32honu]

Thanks denver……..

Sounds like if one were traveling out of the country for an extended period of time and did not have access to healthcare in their state of residence then it would make sense to drop coverage and just pay the fine. I assume that approach would be much less expensive.

I wonder whether this insurance covers any healthcare costs incurred outside of the country or the state of residence?

[djmarchand]

OK, I will stick to the facts, just the facts Maam:

Lots of people are participating, millions.

Nomadic life style. Well this can be a problem but it is an inherent part of private health care insurance and nothing to do with Obamacare. All policies are sold under state regulations. In order to offer the lowest price, insurance companies have developed networks. So if you sign up for Blue Cross of North Carolina as my wife did, their network only covers North Carolina. So if you need to see a doctor in another state, that is an out-of-network provider and your insurance reimbursement will be lower.

There may be some state plans that offer nationwide networks, but not in North Carolina.

And a related answer. You have to pick a state of residence and buy your insurance from that state's approved carriers. For US cruisers most have established a state of residence which also says where you pay state income tax, if any.

Is it affordable. Well it depends on what you mean affordable. Obamacare is designed so that no family spends more on healthcare insurance than about 10% of family income. So to make that work you get subsidies if your family income is below about $65,000.

If your income is zero then you are eligible for Medicaid at no cost. If your family income is about $32,000 then you will get a subsidy for about half the premium and your net premium will be about $3,000 per year.

I don't exactly know how foreign care works. Maybe it is out-of-network and paid as such. Not like Medicare which pays nothing out of the country.

I would bet there are exemptions to the fine for foreign residents.

There you are, just the facts.

David

[Paul L]

It depends a lot on your income level and what you are trying to accomplish with health insurance. For us, we want to protect our assets from a catastrophic loss caused by a big health care cost. I have a friend who had an unexpected heart condition show up last summer. The bills were up to $800,000 last I talked with her. This is the kind of expense or the long term illness expense is what we want health insurance for. We do not need it for the general health costs -- especially as almost all our time is outside the US where health costs are generally very reasonable (quality of care high).
We used local a Regence policy prior to Obamacare with a high deductible ($7,500-10,000). It was relatively expensive when we started (about $450/month for 2). But the yearly increases were way, way higher than inflation. After 4 years it was something like $650/month -- basically getting out of hand and we were getting ready to drop it. Now with the subsidized policy via the health exchange, we pay about $110/month for two. The policy covers more and has a lower deductible than our old policy. It doesn't generally cover care outside the US, except emergency stuff. But if something happens to one of us, we can end up in the US for care and not have to go broke in the process. Whether you qualify for a health exchange policy and ts costs depends a lot on your annual income (and the state that you are a legal resident of).
Some like the alternative of the international health policies. They are not covered under Obamacare, and all the ones I've looked at have onerous pre-existing conditions clauses.

[w32honu]

Thanks Paul,

I am just about to retire. We will most likely participate in the ACA. So it is the practical real life experiences that are most helpful…...

[Canibul]

We're US citizens, and residents of an island nation. We use a forwarding service in Florida, but by no stretch of any imagination are we Florida residents. We buy health insurance from a company called BUPA, which is specifically for people like us. You can't have it in the US.

[natew]

I'm interested in this topic as well. We are set to cast off in about a year and this is something I think about all the time as it is something I haven't figured out yet. It is a shame that we are forced into buying this terrible health insurance that is relatively expensive and basically worthless for what we plan since it will not provide any international services and likely even in an emergency we would be forced to pay out of pocket and fight for a reiumbursement.

Our only out is that we may make little enough annually to qualify for assistance to reduce or eliminate the cost so i'm guessing we will likely just apply for that and never use it.

[Paul L]

Originally Posted by natew

I'm interested in this topic as well. We are set to cast off in about a year and this is something I think about all the time as it is something I haven't figured out yet. It is a shame that we are forced into buying this terrible health insurance that is relatively expensive and basically worthless for what we plan since it will not provide any international services and likely even in an emergency we would be forced to pay out of pocket and fight for a reimbursement.

Our only out is that we may make little enough annually to qualify for assistance to reduce or eliminate the cost so i'm guessing we will likely just apply for that and never use it.

So how do you decide this is terrible insurance and worthless? For us it is better insurance than I was able to get in the pre-AffordableCareAct era, it is significantly cheaper for us and it it does what I need insurance to do -- cover me when the expenses would threaten to bankrupt me. If you don't want an Obamacare policy, then just buy an individual one. 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.

[sailorboy1]

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.

But that all depends on where you are going to be cruising/living and gambling that in the event of a major medical you can get back to the US. If you are out of the US an Obamacare policy is worthless if you can not get back to the US.

Maybe in the end Obamacare may change how US citizens cruise. In the past I figured I had to get out of the US just due to the health insurance/costs, but maybe now it will end up being less expensive to stay more in the US.

Only time will tell.

[natew]

Originally Posted by Paul L

So how do you decide this is terrible insurance and worthless? For us it is better insurance than I was able to get in the pre-AffordableCareAct era, it is significantly cheaper for us and it it does what I need insurance to do -- cover me when the expenses would threaten to bankrupt me. If you don't want an Obamacare policy, then just buy an individual one. 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.

How? I guess simply because American health insurance is not accepted anywhere outside of the USA... That should be a first clue as to how bad it truely is when you consider that most other health coverage offered in nearly every other country in the world is accepted in almost every other country in the world. Well except for the USA who doesn't accept anyone elses coverage.

I do get that you can always buy a plane ticket home... Except maybe after you've already had a heart attack, or severely broken your leg, or some other case where you would really NEED the cover and are sitting in a hospital in some foreign country basically unable to leave. Meaning that paying for it is basically useless, and good luck for those who have dreams of getting some type of reiumbursement for foreign emergency coverage half the time we can't even get the insurance to cover explicitly covered items that have been provided by our in network doctor. WOW the number of bills I get for unpaid items that I have to fight to get them to pay. Sorry I don't put much faith in anything.

Third, i guess, is that my wife and daughter are both belgian and french citizens which MUCH MUCH MUCH better coverage available to them that also covers in full services in foreign countries. Such a shame I will be taxed by obamacare or forced to pay for some useless insurance for them when they will have legitimate, and even better coverage.

[Paul L]

Originally Posted by sailorboy1

But that all depends on where you are going to be cruising/living and gambling that in the event of a major medical you can get back to the US. If you are out of the US an Obamacare policy is worthless if you can not get back to the US.

Maybe in the end Obamacare may change how US citizens cruise. In the past I figured I had to get out of the US just due to the health insurance/costs, but maybe now it will end up being less expensive to stay more in the US.

Only time will tell.

My policy covers out-of-network providers at a reduced rate. Since I am looking at catastrophic coverage as my need for health insurance, the policy works well while out of the country for me. All my normal bills for health care outside the US have been very reasonable, including surgery in Panama. If something big occurs, I have the Obamacare policy to fall back on . Exactly why I want insurance. My old homeowners fire insurance policy wasn't worthless because my I never used it.

[djmarchand]

Well it only took a few hours to go beyond facts!

Almost everything that was said negatively about Obamacare or US health insurance was there long before Obama and will be there long after he is gone and even if the AFCA is modified or repealed.

Why don't foreign policies cover US claims. Simple, the claims cost several times more than the same thing in the home country.

But I can't see why US insurance won't cover foreign care. Actually I think that it does. Had a friend who got ill on a safari in Kenya. His expenses which included a week of hospitalization (at 1/4 the US cost) was covered by his US policy.

But if you are going to be out of the US for an extended period, buy an international policy like that which was mentioned above. Then you have to decide based on your income, resources, level of risk that you can accept, whether you buy US insurance. If your income is low then US insurance, either Medicaid or Obamacare, might not cost you too much.

David

[sailorboy1]

Originally Posted by Paul L

My policy covers out-of-network providers at a reduced rate. Since I am looking at catastrophic coverage as my need for health insurance, the policy works well while out of the country for me. All my normal bills for health care outside the US have been very reasonable, including surgery in Panama. If something big occurs, I have the Obamacare policy to fall back on . Exactly why I want insurance. My old homeowners fire insurance policy wasn't worthless because my I never used it.

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

[Paul L]

Originally Posted by djmarchand

....
But if you are going to be out of the US for an extended period, buy an international policy like that which was mentioned above. .....

If you are buying one of those policies as US resident cruiser that is out of the country, unless you are very young for a cruiser, you will find the quotes pretty darn high. In addition, pay special attention to the policy legal definition of a pre-existing condition and the lifetime limits placed on pre-existing conditions. On some policies a pre-existing condition includes anything you went to doctor for or should have gone to a doctor for. AffrodableCareAct polies do not have pre-existing conditions limitations