# Retiring to the US from Canada



## PaulinIndiana (Jan 9, 2015)

I just recently retired from the Federal Government and am moving to the US. This fairly easy for me as my wife is an American citizen.

I am trying to find some answers regarding the US Affordable Care Act and Health Care in general. I have the PSHCP which is okay for everyday dental/medical and prescription use but has no hospital coverage beyond $220 a day fro a room. No physician care or hospital based care is covered.

I am thinking perhaps that some form of catastrophic coverage for that would be enough. Don't really care about a deductible.

Do any of you other federal superannuates who have been here longer have any experience or advice?

Thanks


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## BBCWatcher (Dec 28, 2012)

Have you visited Healthcare.gov yet? That's the official government Web site to find more information on PPACA marketplace policies and other PPACA-related information.

"Bronze" plans would be the closest to catastrophic only medical insurance, though they're a bit better than that, offering some free preventive care services. Be sure to run a simulation to determine how much (if any) federal government insurance premium subsidy you're eligible to receive and look at the "silver" plans also if you would enjoy some subsidies. (The subsidies are tied to the higher quality/better coverage silver plans.)


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## PaulinIndiana (Jan 9, 2015)

BBCWatcher said:


> Have you visited Healthcare.gov yet? That's the official government Web site to find more information on PPACA marketplace policies and other PPACA-related information.
> 
> "Bronze" plans would be the closest to catastrophic only medical insurance, though they're a bit better than that, offering some free preventive care services. Be sure to run a simulation to determine how much (if any) federal government insurance premium subsidy you're eligible to receive and look at the "silver" plans also if you would enjoy some subsidies. (The subsidies are tied to the higher quality/better coverage silver plans.)


I have looked at the Healthcare site and the difference between the plans (bronze - Platinum) are related to the depth of coverage and not the breadth. My Canadian plan which is fully portable as a resident of the USA covers all Doctor visits, prescription drugs and dental. Even the bronze plan would repeat the bulk of these coverages. As stated I only need something that covers hospital services.

There must be some Canadian Federal Government Superannuates living in the US who have dealt with this.


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## BBCWatcher (Dec 28, 2012)

You've got two hurdles to clear, actually. One is the coverage itself, the other is obtaining what's called "Minimum Essential Coverage" from the U.S. point of view in order to avoid the tax penalty associated with not having MEC.

The MEC issue could mean you just have to bite the bullet and duplicate some of your coverages.

It turns out that the vast bulk of a bronze plan premium (especially) *is* for hospitalization coverage. That's the expensive bit actuarially. So even if you have the other bases covered twice, it'll (likely) hardly matter financially. Add in U.S. federal subsidies if you're eligible -- only available for exchange plans -- and that skews the math even more.


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## PaulinIndiana (Jan 9, 2015)

BBCWatcher said:


> You've got two hurdles to clear, actually. One is the coverage itself, the other is obtaining what's called "Minimum Essential Coverage" from the U.S. point of view in order to avoid the tax penalty associated with not having MEC.
> 
> The MEC issue could mean you just have to bite the bullet and duplicate some of your coverages.
> 
> It turns out that the vast bulk of a bronze plan premium (especially) *is* for hospitalization coverage. That's the expensive bit actuarially. So even if you have the other bases covered twice, it'll (likely) hardly matter financially. Add in U.S. federal subsidies if you're eligible -- only available for exchange plans -- and that skews the math even more.


Based on my research there seems to be no consideration for the type of existing coverage that I have and therefore no way to add coverage and have the combined coverage accepted. Looks like the best route may be to drop my Canadian coverage and just go with full US coverage. Our income is too high to get any tax break and the 2% penalty for no coverage would be in excess of $1800 per year. So combining that with the $350 per month I currently pay would go a long ways to defraying the cost of one of the US plans.


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## BBCWatcher (Dec 28, 2012)

Unless your $350/month covers expenses within your bronze deductible/co-pays that you reasonably expect to incur. Prescription drugs for continuing conditions, for example. Then it could make perfect sense maintaining your Canadian plan.

A bronze plan's deductible alone is typically $6000 or more, so that math could work. Except you'd have to check whether another plan's reimbursement counts toward drawing down your bronze deductible/co-pays toward your annual out-of-pocket maximum. I'm not sure.

It's also conceivable the Canadian plan covers things the U.S. plan doesn't, e.g. longer term nursing home or home-based care.

It's not at all uncommon for U.S. residents to carry somewhat overlapping insurance coverages, so I wouldn't get too bothered by that condition alone. If each/both make sense, that's great, even if there's some redundancy.


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## dburnt (Dec 2, 2015)

I retired to the US this year, and my PSHCP is now active; I have not yet filed a claim. As I retired early, I don't qualify for Medicaid yet

As we didn't have PSHCP comprehensive at the start of the year (I was not yet retired), we did go with a bronze plan as a stop-gap measure for the year. Now we are having to decide what to do for the next year. The bronze plan we have is going up astronomically for 2016 (the addition of pension income eliminates any subsidy, despite it being non-taxable income...sigh) This cost, plus the PSHCP premium, is very expensive.

For anyone who has also gone through this...

- when it comes to covering doctor's visits, I know the PSHCP covers based on Canadian costs (i.e. comparably). Does this generally cover most visits? Does it vary by state?
- has anyone confirmed if the PSHCP meets the Basic Essential test? Does anyone know how to go about determining this? I am assuming that it wouldn't because of the hospital stay coverage...has anyone tried to find insurance that will provide only what the PSHCP is missing?


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## PaulinIndiana (Jan 9, 2015)

dburnt said:


> I retired to the US this year, and my PSHCP is now active; I have not yet filed a claim. As I retired early, I don't qualify for Medicaid yet
> 
> As we didn't have PSHCP comprehensive at the start of the year (I was not yet retired), we did go with a bronze plan as a stop-gap measure for the year. Now we are having to decide what to do for the next year. The bronze plan we have is going up astronomically for 2016 (the addition of pension income eliminates any subsidy, despite it being non-taxable income...sigh) This cost, plus the PSHCP premium, is very expensive.
> 
> ...


After almost a year here is what I know. All of the Bronze plans are pretty much useless for day to day Doctor visits, prescription Drugs etc given the $6,000 deductible.. They only really cover catastrophic situations and even then you will pay at least $6,000 deductible for each year plus premiums of a minimum of $1,000 per month. I continue to carry my PSHCP comprehensive and have found that it pretty much covers any visits to a family Doctor, 80% of prescriptions etc. For Doctors it pays 3X the Ontario medical services fee for services and in American dollars (no exchange it is a 1 for 1 deal). So far my Doctor for 3 visits has been satisfied with what the PSHCP pays. I do get a statement in the mail from PSHCP showing what theb Doctor billed and what they covered. It usually show I still owe the Doctor money but upon checking my Doctor said it was enough and didn't ask me to pay the difference. Remember in the US Health care costs are negotiable and most Doctors will also give a discount for cash payment.

In reality the ACA (obamacare) is the worst of both worlds.
Hope this helps


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## BBCWatcher (Dec 28, 2012)

But the foreign coverage is not considered "Minimum Essential Coverage" per the IRS's definition, so there would likely be a higher income tax to pay if you don't have U.S. M.E.C.


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## BBCWatcher (Dec 28, 2012)

dburnt said:


> As I retired early, I don't qualify for Medicaid yet.


I think you meant Medicare. Note that if you do not qualify for Medicare based on your own U.S. work history -- if you're qualifying based on a spouse's -- and if you are not a U.S. citizen/national then you'll have to wait until you reach 5 years of U.S. residence or until age 65, whichever comes later.


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