# Help with healthcare



## Carofort (Oct 7, 2014)

Planning to move to Florida next year and now looking at the cost of healthcare. Can anyone suggest the best route to take? Have done some research but finding it quite confusing. We are 75 and 60 yrs.


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## Crawford (Jan 23, 2011)

I don't believe Florida has a State run exchange for health insurance so you should go to the Federal Health Insurance website to find out what health insurance plans are available for you in whichever part of Florida you are intending to retire to:

https://www.healthcare.gov/


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## BBCWatcher (Dec 28, 2012)

I completely agree. Healthcare.gov is the place to go.

A couple questions, though. Are you eligible for U.S. Medicare? Or will your spouse be eligible for Medicare? I'm assuming you're the older person in your household and that the "we" means you're married, but please clarify if those assumptions are not correct.

Medicare eligibility is generally determined based on whether an individual has paid at least non-trivial amounts of U.S. payroll tax within any 10 calendar years or more. (Not necessarily for 10 calendar years.) If an individual has never worked in the United States (and never worked for the United States government overseas) then that individual is probably not eligible for Medicare. If there's some doubt you can check whether you're eligible for U.S. Medicare via the U.S. Social Security Administration's Web site.

I'm also going to assume that neither one of you is eligible for the other public medical systems in the United States. As one notable example, I'll assume that neither one of you served in the United States military. If you think you might be eligible for one of these systems, please advise.


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## Carofort (Oct 7, 2014)

No neither of us has paid any tax in the US. We are retiring from the UK as our daughter is now a US citizen. I will look at the site you suggest I have done some research but was finding it difficult to narrow down our options.


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## BBCWatcher (Dec 28, 2012)

OK, your task is very straightforward then. You'd purchase a medical insurance policy through Healthcare.gov, and you'd check back annually at the same Web site during the open enrollment period to see if you can get a better deal compared to the simple renewal offer you receive each year from your previously chosen insurance carrier. Pretty simple. You and your spouse will not be eligible for Medicaid or for Medicare, so you can rule out those two programs.

You may be eligible for U.S. federal government subsidies to purchase medical insurance through Healthcare.gov. The subsidy level will depend on your income. (Note: Not on your wealth. Theoretically you can be a billionaire, have a bad year in income terms, and qualify for the maximum federal government subsidy.) That Web site should be able to tell you what your estimated subsidies are and what the final price is per month for every policy offered. Be sure to read the details about each policy you're considering, including your chosen policy's selection of doctors and medical facilities "in network" and its list of covered prescription drugs.

Don't worry about getting your income _precisely_ right. Just make a good faith estimate. (The subsidy level will be corrected when you file your U.S. income tax return, and you'll settle that up as part of your tax bill.) If you enter less than about $20,000 of household income then Healthcare.gov might claim you're eligible for Medicaid. You're not (since you're in a special category), so if you get "Medicaid" as the answer simply go back and input $20,000 (or a slightly higher figure -- $20,000 should work for a 2 person household) until you get the Web site to tell you what the price of Healthcare.gov medical insurance policies would be. Then you'll have a rather good estimate of the prices (with maximum subsidies) for the various medical insurance policies. (Some of them should be $0 in that case.) If your household income is higher than ~$20,000 then of course input the true number to get the right estimate.

Note that most of the Healthcare.gov policies have relatively high deductibles, meaning you'll be responsible for paying the first few thousands of dollars of medical expenses each year, typically. Your Healthcare.gov medical insurance will then kick in once you hit your annual deductible. In other words, it's _insurance_, not a public healthcare system like the NHS. Be sure to include that deductible and other unreimbursed medical expenses in your household budgeting.

You'll see "Bronze," "Silver," and "Gold" (at least) medical insurance plans at Healthcare.gov. It's just like the Olympics: gold is better than silver, and silver is better than bronze. "Better" means, other things being equal, the higher metal insurance plan pays for more of your medical costs. A gold plan should have a lower deductible, lower co-pays, lower annual out-of-pocket maximum, etc., etc. than a silver plan, for example. It's a quick way for Healthcare.gov to give you some idea what you're dealing with before you dig into the details for each policy you're considering.

If you qualify for the maximum federal government subsidy you'll want to skip the Bronze plans completely because your subsidy will fully pay for a Silver plan. You'll probably have to pay a monthly fee if you then want to upgrade to higher metal plan.

Welcome to the United States. Hope that helps.


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## BBCWatcher (Dec 28, 2012)

As a follow-up, I checked the 2014 medical insurance policies available through Healthcare.gov for a two person hypothetical household living in Miami, Florida, with an annual household income of $20,000. The $0 monthly premium option in that case is the "Silver Deluxe AX Dade" plan underwritten by Preferred Medical Plan, Inc. I can't get an exact unsubsidized premium calculation -- you age 65+ people without Medicare and Medicaid are tricky that way  -- but it looks like it'd be over $1200/month. So the federal government would pay roughly $15,000 per year to buy your household's insurance if you select that policy and if your household income is ~$20,000. If you've got a much higher income that should start to give you an idea of the cost of medical insurance in the U.S. (Unsubsidized it's not cheap, but U.S. medical costs are not cheap either.)

That's a silver plan, obviously. Silver Deluxe AX Dade has a $0 annual deductible and a $1000 per person ($2000 per household) annual out-of-pocket maximum. Those are really very good. "Bronze" plans are usually in the $6000/$12000 individual/family range for out-of-pocket annual maximums. It is an HMO (Health Maintenance Organization), meaning it pays your medical expenses when you visit the HMO's own network of (state licensed, regulated) doctors and medical facilities, like most medical insurance plans. (And that's analogous to the NHS, actually. The NHS doesn't pay if you go to a doctor outside the NHS.) If you choose an out-of-network doctor or facility you either may not be covered at all (this policy) or your co-pays and deductibles may go up. Genuine _emergency_ and urgent medical treatment is generally covered anywhere, including with this particular policy, though with this particular policy you have to pay $50 for each emergency until you hit your annual out-of-pocket maximum. Having 20 emergencies per person would be a really bad year, so that's unlikely.

Be careful that you triple check whether your doctor, diagnostic lab, medical facility, drug, etc. is "in network" before you select it. Refuse anything out-of-network unless you're sure you want to pay for it or unless it's a genuine medical emergency (when you may be in no position to refuse anyway). There's a _huge_ difference between in-network and out-of-network. You really, really don't want to be paying out-of-network medical expenses in the U.S., a form of barely legal extortion really.

All plans offered through Healthcare.gov are required to provide several free "wellness" services to help prevent medical problems.

Some U.S. medical insurance policies offer worldwide coverage for emergency and urgent care. Check the fine print since that might be a useful feature to have if, for example, you decide to take a day trip over to the Bahamas (or whatever).


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## Carofort (Oct 7, 2014)

Wow BBC Watcher that's a comprehensive reply! Thank you so much for taking the trouble to find that out. We know it will be expensive (healthcare) but other than that it looks like retirement in the US will be financially easier. I will follow up on your advice. Thanks again.


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## Crawford (Jan 23, 2011)

Carofort said:


> Wow BBC Watcher that's a comprehensive reply! Thank you so much for taking the trouble to find that out. We know it will be expensive (healthcare) but other than that it looks like retirement in the US will be financially easier. I will follow up on your advice. Thanks again.


This is an interesting perspective, and I wonder why you think this.

We are a retired couple living in California. Comparing costs with my sister who lives in Norwich, Norfolk, we find that our property tax is far in excess of her council tax although our homes are comparable in size, utilities are more expensive here, and charges such as for cell phones are higher here. Food is about on a par, as is clothing.
Public transport is usually poor in most place outside of metropolitan areas so a car is essential with its relevant costs. Maybe Florida is considered cheaper than,say living in the North of England, where heating costs are a large part of household costs - although in Florida one needs air conditioning most of the year.

The other much higher cost here is for health insurance. Don't underestimate how expensive it can be (especially if you are not getting subsidies. Personally I would say that living in the US on less that 20K income is existing not living). 

Hubby and I pay nearly a thousand dollars a month in premiums for healthcare and we are on Medicare (the plan of Senior Citizens). That does include a supplemental policy which eliminates co-pays, deductibles.

I would look carefully at your budgeting since I presume you are on a fixed income and would not be working.


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## BBCWatcher (Dec 28, 2012)

Careful here, Crawford. The "Obamacare" subsidies are tied to _income only_. As mentioned, you can be technically "income poor" (or "income modest"), get a great subsidy for medical insurance, and be extremely "wealth rich." I've just described many of the well-to-do retirees in the world: they're spending out of savings that are yielding low interest from safe bonds (for example). If you've got a pile of savings that'd take a century to run through with a comfortable standard of living, no problem. Some people (too few!) are in that fortunate situation.

Also, Florida really is different than California. Based on mid-2014 data, Florida's average cost of living is right on par with the U.S. national average, while California's average is about 27% above the U.S. national average. These are averages, so your mileage will vary, but with everything else being equal you can expect California to have a cost of living about 27% higher than Florida's.

Private automobiles are significantly less expensive to own and to operate in the United States compared to the United Kingdom. Sure, if the difference in public transportation availability tips you over into owning a car in the U.S. versus not owning a car in the U.K., the overall financial impact may be negative. But if you already have a car in the U.K. then you're likely to come out ahead in the U.S. on that score, perhaps by a lot.

The U.K. does not have a favorable national pension system for those who retire outside the U.K., so it's important to understand that problem. (As I understand it the U.K. halts all inflation adjustments for national pension recipients living overseas while they're living overseas, and those inflation adjustments while they're out of the U.K. are never recoverable. If/when they return to the U.K. the inflation adjustments resume but only from their now lower pension benefit in real terms. U.S. Social Security has no such penalty. COLAs are provided to all beneficiaries regardless of place of residence.)

The U.K. has a very high VAT. Sales tax in Florida is much lower.

Anyway, "it depends," but one could easily imagine circumstances where retirees from the U.K. would find Florida comparatively less expensive than the U.K. overall.


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## Crawford (Jan 23, 2011)

British State pensions paid to retirees in the US are increased annually as per pensions paid in the UK.

The UK and Britain has a reciprocal agreement with the US for such a facility.


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## BBCWatcher (Dec 28, 2012)

Thanks goodness for that! However, I'll continue to criticize the U.K. for that awful _generalized_ policy even while they carve out a treaty exception for the U.S.


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## Carofort (Oct 7, 2014)

Yes I realise there are a lot of things to consider. We are picking our spot carefully so we do not have to run a car - we both cycle anyway! One thing - I believe the US is, like the EU, included in the countries for which we DO have an inflationary increase. Checked this again this morning to make sure I had not misread things. Not that the increase is particularly wonderful! Thanks for all your help, no doubt I will return to this forum later down the line.


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