# US Health Insurance for ExPat's 65+ How Much?



## shadowmeister (Apr 23, 2015)

Good day to you all,

New to the forum and in search of a little advice.

I am about to be sworn in as a US citizen, its been a long process and i look forward to putting the process behind me.

Once i am officially a US citizen i would like to look into the possibility of bringing my lovely and aging parents to live out their retirement it a not to far away neighborhood. I would like to bring them over as US citizens also, and i understand the costs and the paperwork process we have ahead of us, however our main issue is Health Insurance - its very frightening, i think i recall quotes being in the $1,000's per month.

So i want to see if the experts out there have experienced similar things, or have any important advice they can offer to help with the process, especially trying to shave numbers off the cost.:fingerscrossed:

A little background information, my father is ex British Army, and i am not sure if there are any loop holes within the US military about possible benefits that may help with the cost - any help will be graciously appreciated.

regards,

Shadowmeister


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## BBCWatcher (Dec 28, 2012)

Head over to Healthcare.gov to get an estimate. As an alternative, HealthSherpa.com is an unofficial site that you may prefer for a quick estimate. Importantly you'll also want to input their estimated household income since that'll determine whether they qualify for federal subsidies to help them buy medical insurance.

As a random example, a separate household consisting of a 65 year old and a 67 year old, both nonsmokers, with a combined income of US$30,000 living in Los Angeles could get medical insurance for $0 per month. That is, the federal subsidy would fully support buying a "bronze" level insurance policy in that scenario.


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## Crawford (Jan 23, 2011)

One would hope that if you are bringing your parents to the US to live they are going to have income above 30K per annum and won't have to depend on Government subsidies.

While subsidies for the premiums MAY be available for your parents, deductibles and co-pays will not be subsidized; and the cheaper plans (cheaper in monthly premium terms) usually have higher deductibles and out of pocket expenses - upwards of 3K per annum per person.

Without subsidies, you should be budgeting for between 500 and 1,000 dollars *per person* *per month in premiums* (at least) plus the out of pocket expenses. The older they are the more they will pay.

You should also be keeping in mind the costs if they need to move into sheltered/nursing accommodation in the future. That is extremely expensive.

No loophole for the military.


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## twostep (Apr 3, 2008)

Tricare or VA benefits apply to US veterans and eligible family members only.


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## BBCWatcher (Dec 28, 2012)

Crawford said:


> One would hope that if you are bringing your parents to the US to live they are going to have income above 30K per annum and won't have to depend on Government subsidies.


Why would one necessarily "hope" that? If they qualify for federal premium support they qualify. Or, more precisely, most of us hope for a $1 billion per year income, but there's nothing particularly unrealistic about emigrating to the U.S. with a $30K/year income.

Consider a perfectly reasonable example. This couple could emigrate to the United States, buy a modest home (even paying for it entirely in cash), receive an income consisting of interest and dividends and a U.K. national pension (of $30K per year total for example), and have a considerable amount of wealth that also supports their lifestyle. That would be a perfectly viable, entirely financially comfortable arrangement -- and that would also mean the couple qualifies for federal subsidies to help buy medical insurance. Subsidies are entirely income-based, not wealth-based.



> While subsidies for the premiums MAY be available for your parents, deductibles and co-pays will not be subsidized; and the cheaper plans (cheaper in monthly premium terms) usually have higher deductibles and out of pocket expenses - upwards of 3K per annum per person.


A deductible of $4500 in this case would be typical for a bronze plan in Los Angeles in this example. But out-of-pocket costs for all covered services would be capped, too. (With bronze level plans typically at about $6000.) None of that would be particularly problematic in the circumstances. The primary point of medical insurance is to help pay for care without resulting in financial ruin. That insurance is available to this couple, in this particular scenario free of charge.



> Without subsidies, you should be budgeting for between 500 and 1,000 dollars *per person* *per month in premiums* (at least) plus the out of pocket expenses. The older they are the more they will pay.


Yes, that's possible, but there's no need to guess. That's why Healthcare.gov is available -- it's easy to get an accurate estimate, including federal subsidy calculations if applicable.


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## Crawford (Jan 23, 2011)

Understood BBC Watcher. 

The whole point of my post was that your post, while giving the rosy picture of getting your medical insurance for zero cost, is not providing the whole picture. 

Out of pocket expenses could mean thousands of dollars a year - especially with bronze plans which usually have high deductibles and co-pays. Even capped at $6K a year this is 500 bucks a month. One hospitalisation will eat that up.

To not budget for high medical costs in old age in the US is simply foolish. Latest figures from reputable organisations such as AARP say that a couple from retirement age to death could expect bills of up to 250K to cover all their expenses. 

Have to have a drug which is not on the formulation table or included in the plan's offering? You are looking at hundreds of dollars. Need assisted living or nursing home care? Get out your wallet.


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## BBCWatcher (Dec 28, 2012)

Crawford said:


> Out of pocket expenses could mean thousands of dollars a year - especially with bronze plans which usually have high deductibles and co-pays. Even capped at $6K a year this is 500 bucks a month. One hospitalisation will eat that up.


I don't think I was offering a particular characterization, rosy or otherwise. Healthcare.gov has all those details, carefully explained. Hopefully most people are familiar with the concept of medical insurance, and certainly I would expect the original poster would be since he already lives in the United States. In the unlikely event he's not, Healthcare.gov is still his friend.



> To not budget for high medical costs in old age in the US is simply foolish.


Who was arguing otherwise? I certainly wasn't.



> Latest figures from reputable organisations such as AARP say that a couple from retirement age to death could expect bills of up to 250K to cover all their expenses.


Yes, and PPACA-compliant medical insurance helps cover a large portion of those costs.



> Have to have a drug which is not on the formulation table or included in the plan's offering? You are looking at hundreds of dollars. Need assisted living or nursing home care? Get out your wallet.


Sure. Where have I argued otherwise?

The U.K. NHS doesn't cover every medical service free of charge either, such as long-term care.

Look, I'm trying to help the original poster achieve his goals, which is what we should all be endeavoring to do here, to be helpful. He wants to bring his relatives to the United States, and he's asking about medical insurance. There are excellent medical insurance options available now. Yes, of course, medical insurance isn't omnipotent, and there are other considerations. Medical insurance won't help you if you get lost driving in, say, Iowa. Fair point, you've made it, now let's move on -- and welcome his parents to the United States if he and they would like to make that happen.

By the way, I didn't pick the US$30K/year figure by accident. U.K. median household income is approximately US$35K/year (considering households of all ages), so I picked something fairly representative of a U.K. retired couple's income, knowing nothing about them except that they might be a "typical" U.K. household. I then documented that assumption by providing the income figure I used, characterizing it as a specific example in a specific place.


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## Bevdeforges (Nov 16, 2007)

OK, a completely honest question here: Assuming that the OP will be sponsoring his/her parents for a Green Card, and that requires the OP to serve as their "sponsor" - with all the minimum income requirements that go with that.

Are the ACA health care subsidies excluded from the rule that says that new arrivals can't receive public benefits for 10 years?
Cheers,
Bev


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## BBCWatcher (Dec 28, 2012)

Bevdeforges said:


> Are the ACA health care subsidies excluded from the rule that says that new arrivals can't receive public benefits for 10 years?


Yes, they are excluded. They are not within the "public benefits" scope referred to in immigration law.

PPACA subsidies are provided entirely in the form of refundable tax credits, via the U.S. tax code -- and available as advances through Healthcare.gov or, if applicable, the authorized state insurance exchange. Just like other aspects of the tax code -- the EITC is another good example -- these refundable tax credits are available to "green card" holders and U.S. citizen residents alike.

Legal negative (or less positive) personal income tax rates are not considered "public benefits." Many other benefits are not considered "public benefits" for these purposes. Walking on a public sidewalk -- built and maintained with public funds -- is not considered a "public benefit" in the immigration law sense, to pick another example.

And before anybody gets agitated about how the law works, this is _exactly_ as designed and as all other civilized, developed countries provide to their legal residents. (The U.K. for example via the U.K. National Health Service.) The original poster's parents will pay lots of taxes in the United States, directly or indirectly -- sales taxes, property taxes, etc. But if they are low or moderate income they will be eligible for refundable tax credits that they qualify for. A major part of the PPACA closed coverage gaps for legal residents and non-Medicare-eligible elderly. The fact the two individuals can be and will be insured also means that uncompensated care is reduced (especially in hospital emergency rooms, the most expensive type of care), reducing everybody's medical and medical insurance costs. This, too, is exactly as designed.


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## twostep (Apr 3, 2008)

We have posters who consider Obamacare the greatest thing since sliced bread. It may be for some but not for those who found their policies and coverages change drastically and those who found themselves staring at their 2014 tax returns. It all depends on an individual's personal situation.

OP's parents may be young and fit enough to enter the U.S. workforce thus earn eligibility for Medicare and employer coverage. 

If the UK system works similar to Tricare they may be able to use the retiree benefits of the UK Forces. If it satisfies coverage for tax purposes I do not know. 

And yes, there is always Obamacare. Please consider the number of providers and facilities who throw considerable wrenches at those patients.

OP may want to check into self sponsorship as far as Affidavit of Support is concerned to avoid potential financial burden upon his family in a worst case scenario. But again - speculation as not much information was given.


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## Bevdeforges (Nov 16, 2007)

One thing to consider (whether for the OP or for the parents coming to the US) is that US style health insurance - even under Obamacare - is not really like the NHS or any other "national" health care system, no matter how much you wind up paying. As mentioned above, you need to allow for "co-pays" and deductibles in any policy you purchase. There simply isn't the type of all-inclusive health care coverage in the US that you find in many European countries. 

But the parents may be able to qualify for Medicare after living for 5 years (I think it is) in the US. There is a way to "buy into" Medicare after 5 years of residence. Check the Medicare website for information.
Cheers,
Bev


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## Donnezmoi (Jan 17, 2014)

According to Bloomberg yesterday, the renewal requests from "Obamacare" providers in the state exchanges are coming in 7-15% higher than last year's rate in the lowest charging states. Still, the national average for a "silver" level plan should be $300-350 per person.


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