# UK to US - Decision Time - Pitfalls? Houston



## mr.t (Sep 21, 2012)

Ok,

Thanks to the people offering support on already on the financial stuff.:ranger:

So, financials to consider:


Witholding Tax - 'Pay as you earn' is the closest UK thing for State and Federal Tax (Mine probably 28% of salary)
401k - Your Pension Plan - Tax free deductions
Social Security Payments - 7.65%
Medical - $1000's for family
Visa costs - Own and family

Prospective company is offering:

30 days lodging for me
Money for family visa and shipping of heirlooms ($5000)
Family move out up $7500
House hunting trip up to $5000
All costs associated with my work visa

The role is home office so no car allowance 

Salary isnt quite enough so pushed them a bit!

I have frequented Houston and like it, so thats all good.

Anything else that could put a spanner in the works before I say yes?:fingerscrossed:

One thing.. how much will family cost? Wife/3yo/6yo

Thanks in advance 
Mark


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## twostep (Apr 3, 2008)

The company does not have an option but to pay for your visa.

There is no way to tell how much cost of living for a family of four is. It depends on your needs and wants. 

Read the fine print on the medical coverage. Are paid time off, overtime, repatriation covered by your contract? Expect expenses such as car/insurance, deposits for rental/utilities/TV/phone, required school supplies, drivers licenses, household basics ... .


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## Crawford (Jan 23, 2011)

You say that you have to consider visa costs - own and family - but then you say that the prospective company is offering to pay all costs with work visa.

So is the company paying for the visa(s)?

If it is an L or H visa they *must *pay for the necessary visas. There is so much paperwork and documentation the company has to provide you really don't want to have to do visa applications on your own.

Which visa will you be getting?


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## twostep (Apr 3, 2008)

Crawford said:


> You say that you have to consider visa costs - own and family - but then you say that the prospective company is offering to pay all costs with work visa.
> 
> So is the company paying for the visa(s)?
> 
> ...


An individual CANNOT file H1B or L1 nor pay for the cost. That is called fraud.


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## mr.t (Sep 21, 2012)

Crawford said:


> You say that you have to consider visa costs - own and family - but then you say that the prospective company is offering to pay all costs with work visa.
> 
> So is the company paying for the visa(s)?
> 
> ...


Two Step - Thanks, Cost of living comment accepted.. Cars will be my downfall!

Crawford - Company would be paying expenses for my Visa.
_*'The Company will pay for expenses that are incurred in conjunction with obtaining the necessary work authorization for you to work with XXXX in the U.S'
*_

Not sure of the Visa type yet - Imagine 'H' or 'E' as not transferring but will find out - Are you saying they must sort my family visa's out? 
_*Miscellaneous expense allowance of $5,000, to be paid with your first pay check (can be used for temporary storage, family VISA fees, transportation of family heirlooms, etc.)*_


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## twostep (Apr 3, 2008)

mr.t said:


> Two Step - Thanks, Cost of living comment accepted.. Cars will be my downfall!
> 
> Crawford - Company would be paying expenses for my Visa.
> _*'The Company will pay for expenses that are incurred in conjunction with obtaining the necessary work authorization for you to work with XXXX in the U.S'
> ...


Downfall or not - your family needs reliable transportation. 
A lump sum relo bonus you have to pay tax on and pay family visas out of. I do not know about the family visas being paid by you. Others may know more about a potential issue. 

H1B means 10/2015 unless you fall under very specific requirements. E - which E?


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## Crawford (Jan 23, 2011)

Put it like this, I have not heard of a company arranging and paying for the worker's visa but not doing the same for the family.

I suppose they are not obliged (or legally responsible) for the family visas, but it would be a very unusual situation since the visas for worker and family are processed and issued together.

Definitely whenever I have read about someone getting an H visa the company has arrranged and paid for worker and family visas.

The E visa however is a different animal. You should clarify which visa you are getting as they don't have the same requirements or benefits.


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## mr.t (Sep 21, 2012)

Thanks for the guidance again.. The question of visa has been asked.
Tax on allowances is an obvious point I missed.. Thanks
Have chased for more cash to make the decision easier, will know this week!
The company is not that used to employing expats (small division of large company) and are on a learning curve too by the sounds of it.

I relocated to the UAE for a US company and the incentives where somewhat bigger and more people there to support transistion.


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## Loosehead (Nov 18, 2013)

It looks like your employer will cover these, but there are a bunch of visa related fees that your employer is not necessarily obligated to pay.

MRV fee - payable at the time that you submit your DS160 for the visa interview. This varies from $160 to $270 per applicant, depending on the visa type

Issuance fee - For UK passport holders applies only to L2 and E2 visas and is $105 each

L visa fraud prevention and detection fee - Applies to principle applicant only (L1) and is $500

I appreciate that your employer will reimburse you for these, but you should be aware that you will have to pay them and claim back.


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## Crawford (Jan 23, 2011)

Loosehead said:


> It looks like your employer will cover these, but there are a bunch of visa related fees that your employer is not necessarily obligated to pay.
> 
> MRV fee - payable at the time that you submit your DS160 for the visa interview. This varies from $160 to $270 per applicant, depending on the visa type
> 
> ...



I never paid up front or at all for any of these fees when transferring on an L1. The company paid for all of these fees for myself and husband.


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## twostep (Apr 3, 2008)

Crawford said:


> I never paid up front or at all for any of these fees when transferring on an L1. The company paid for all of these fees for myself and husband.


OP is taking about H or E but has not yet shared details.


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## Crawford (Jan 23, 2011)

twostep said:


> OP is taking about H or E but has not yet shared details.


I've never heard of an H visa holder paying for any visa or filing fees either.

E visa, as said, totally different situation.


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## BBCWatcher (Dec 28, 2012)

I'll pick up a couple other points here.



mr.t said:


> 401k - Your Pension Plan - Tax free deductions


There are two types of 401(k) plans: Traditional and Roth. Not all employers offer Roth 401(k) plans, but many do.

With traditional 401(k) plans your contributions come out of pre-tax income, and your employer can make tax-free matching contributions. (It's certainly in your interest to maximize employer matching funds with either type of plan -- that math is easy.) As long as you make only qualified withdrawals (i.e. withdraw when eligible in retirement), you only pay tax on the withdrawals at then-current ordinary income tax rates. In other words, a traditional 401(k) defers income taxes to a time when you might (might) be taxed in a lower bracket.

The Roth 401(k) is a different offer. You make contributions to a Roth 401(k) plan from after-tax income. Then, if you only make qualified withdrawals (i.e. in retirement), you pay zero U.S. tax on any of the funds you withdraw. All the gains are U.S. tax free. (Well, OK, as a non-U.S. person you'll likely be subject to withholding, but you can get a full refund when you file a tax return.)

In both cases your total contributions are capped at $17,500 per year (last I checked). However, if you can contribute up to the maximum per year, that tends to favor the Roth 401(k) because you end up getting more tax benefit. Another reason to favor the Roth 401(k) in your case is that you're young, and the money will have lots of time to grow, yielding a significant tax benefit.

HOWEVER, a Roth 401(k) can be a bad idea -- or at least a less good one -- if the foreign country where you retire wants to tax your withdrawals. Offhand I happen to know that Italy (to pick a random example) doesn't -- the U.S.-Italy tax treaty protects Roth accounts from Italian taxation -- but not all countries do that. Obviously if you retire to a country that has no capital gains tax then it won't matter.

Anyway, if your employer doesn't offer a Roth 401(k) then don't worry about choosing. The choice has been made. Just make sure you maximize your employer's matching contribution at least if at all possible.

The U.S. also has tax-advantaged accounts called IRAs -- both Traditional IRAs and Roth IRAs -- that you can open at your favorite U.S. financial institution. At your income level you should be able to contribute to an IRA for both yourself and your spouse. Last I checked the maximum is $5500 per person per year (at your ages). One reasonable strategy if you don't have a Roth 401(k) at work is to open a Roth IRA separately outside work and contribute to that. Then you'd have a Traditional 401(k) at work and a Roth IRA outside work. I'm assuming that you have enough to save and want to save for retirement. That'd be a reasonable way to place both tax bets on the future.



> Social Security Payments - 7.65%


It sounds like you've decided you'll be in the U.S. Social Security system rather than the U.K. system during your time in the U.S. That's perfectly fine and probably even a great idea.



> Medical - $1000's for family


Well, no, it shouldn't be quite that much. Your employer should be providing you with health insurance, and the family buy-in should be on the order of $100-$200 or so per month. Employers vary in how generous they are, but that'd be a reasonable estimate in the circumstances. Granted, health insurance doesn't cover everything -- they have deductibles and co-pays -- but "$1000's for family" seems a bit over the top to me, at least if it's many thousands.



> The role is home office so no car allowance


Car allowances are not typical in the United States. It's not like the U.K. where there are substantial car-related tax advantages. In the U.S. the rough equivalent is health insurance, where there's a big employer role (and big tax advantages with employer-provided health insurance).

Car expenses are also not nearly as high as they are in the U.K. Expenses in general, actually (with the exception of healthcare maybe).

Since you'll be home office-based, I'd start off as a one car family and see how it goes. Probably rather well. You're getting a fair bit of money for relocation (all added up), so I'd consider just buying a car with cash. Something like a low mileage recent model year Toyota Matrix, for example. Make sure the car has well functioning air conditioning.


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## Loosehead (Nov 18, 2013)

Crawford said:


> I never paid up front or at all for any of these fees when transferring on an L1. The company paid for all of these fees for myself and husband.


I don't know how you can avoid paying them for an L1 unless your husband's employer filed your DS160 for you and paid the MRV fee, and the anti-fraud fee is paid by the applicant in person at the Consulate at the time of the visa interview. Unless there is another process that is not documented.


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## mr.t (Sep 21, 2012)

Loosehead,

Thanks for your support so far but I am not transferring and have a decision to make this week.

Can we please keep it on topic and have an L Visa discussion elsewhere.


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## twostep (Apr 3, 2008)

Medical coverage for a family of four will run around 500-600$ plus co-payments, deductibles and what nots. A complete handbook outlining details and costs should have been issued by HR as OP has to sign up for coverage during his onboarding window. How does he plan to cover the family during the traditional 30 to 90 day window until coverage sets in?


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## mr.t (Sep 21, 2012)

twostep,

Nail on the head, I have a handbook and it has taken some deciphering due to the terms you mentioned.. copay etc.

Regards
Mark


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## mr.t (Sep 21, 2012)

All,

Again thanks for the help so far.

Here is the response from company:
_Once you accept and return all the documents signed, we will have you work with our Immigration attorney in securing the proper visa to work in the US_

Not very helpful, any advice?


Mark


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## twostep (Apr 3, 2008)

mr.t said:


> All,
> 
> Again thanks for the help so far.
> 
> ...


Interesting concept!


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## mr.t (Sep 21, 2012)

My Reply:

_This leaves it a bit of a risky commitment regarding family visas ie Spouse/Children visa may be dependant upon mine.

Can you offer any reassurance that the family will be able to relocate trouble free?_


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## Crawford (Jan 23, 2011)

mr.t said:


> All,
> 
> Again thanks for the help so far.
> 
> ...


You need to determine which visa they are applying for prior to signing the documentation as this will affect your ability/timeline to get a Green card, wife able to work etc.


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## EVHB (Feb 11, 2008)

If the company isn't more willing to communicate with you regarding these issues, I would stay away from them!
Do you have to pay them up front for something?


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## mr.t (Sep 21, 2012)

It's a small division of a big company and I genuinely think that the 'Talent Recruitment' chap is trying to fast track the job acceptance for medals.
The main contact (guy who wants me) is back today and is reviewing the whole thing so we will see

Recruiting expats is new to them (well this guy obviously) and I think there is some homework required for them, it is just a little sensitive as I still want the job and not pee off people.
The comments reflect someone who doesn't understand the subtleties or intricacies of visas and the impact/worry of an expat.

No up front money.. This is a genuine role in senior management and I have been to visit.


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## mr.t (Sep 21, 2012)

Ok, now happier

My contact has recently completed 10 expat visas, turns out to be a bit of an expert.
Mine will be 'E' to H1B aiming for green card or US Citizen.

Thanks all for your help guys


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## twostep (Apr 3, 2008)

mr.t said:


> Ok, now happier
> 
> My contact has recently completed 10 expat visas, turns out to be a bit of an expert.
> Mine will be 'E' to H1B aiming for green card or US Citizen.
> ...


Slow down a shake - H1B potentially effective 10/2015, small division - will they have to go through labor certification? Did you ask?


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## mr.t (Sep 21, 2012)

Two step,

Not asked, I have to trust them at some point as I am not an immigration expert

What's the impact?


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## twostep (Apr 3, 2008)

mr.t said:


> Two step,
> 
> Not asked, I have to trust them at some point as I am not an immigration expert
> 
> What's the impact?


If everything goes smooth - a year or two, if not - lets not worry about it.

Congratulations! Welcome to Texas! It was an interesting learning curve for me. 

Do not forget to get a statement from your current auto insurance stating that you have been a good driver. It may save you a bit. Go on the site of Texas DMV (Department of Motor Vehicles), down load the drivers ed booklet and get ready for your and your wife's drivers license. Texas offers reciprocity with several countries but will retain that license. So - start from scratch:>)


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## mr.t (Sep 21, 2012)

Ok, next dilemma!

The start date due to visa processing puts me into more than 186 days in the UK for non domiciled tax criteria
Ie I won't be out the UK for six months and would have to pay HMRC tax on US earnings as well as federal tax.
Can I be in the US on my ESTA on holiday whilst my visa is processing.
Any other options...?
Would the HMRC taxation of the US money be off the top line salary and allowances?

I owe you guys wine/beer!


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## twostep (Apr 3, 2008)

mr.t said:


> Ok, next dilemma!
> 
> The start date due to visa processing puts me into more than 186 days in the UK for non domiciled tax criteria
> Ie I won't be out the UK for six months and would have to pay HMRC tax on US earnings as well as federal tax.
> ...



How about some information first? Which "E" does this company plan to bring you to the US on? Look at US immigration as Lego for grown ups or furnishing a house with IKEA.


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## whatabout (Aug 19, 2014)

BBCWatcher said:


> I'll pick up a couple other points here.
> 
> 
> There are two types of 401(k) plans: Traditional and Roth. Not all employers offer Roth 401(k) plans, but many do.
> ...


Can you opt not to pay SS contributions whilst in the USA? I know you can continue to pay NI contributions in the UK.

As for health insurance premiums, we paid almost $290 per 2 week pay period, so $7540 per year, for family medical insurance (vision and dental were another $30 ish per 2 weeks) and that was going to go up should we have stayed. That was through my OH employer who were one of the biggest HCPs in NC. 
I think it's worth mentioning that auto insurance will be expensive as you'll be classed as new drivers. We paid $300 per month for minimum (required by law) coverage for a vehicle worth $10k. Maybe insurance was a lot higher in NC than it is in Texas?
Even after 4 years we were still paying a lot more for auto insurance than we paid in the UK, about 4 times as much.


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## twostep (Apr 3, 2008)

whatabout said:


> Can you opt not to pay SS contributions whilst in the USA? I know you can continue to pay NI contributions in the UK..


You cannot opt out of Social Security.



whatabout said:


> As for health insurance premiums, we paid almost $290 per 2 week pay period, so $7540 per year, for family medical insurance (vision and dental were another $30 ish per 2 weeks) and that was going to go up should we have stayed. That was through my OH employer who were one of the biggest HCPs in NC. .


Yes, coverage has gone up steadily since "Obamacare". 



whatabout said:


> I think it's worth mentioning that auto insurance will be expensive as you'll be classed as new drivers. We paid $300 per month for minimum (required by law) coverage for a vehicle worth $10k. Maybe insurance was a lot higher in NC than it is in Texas?.


Texas will be higher due to hail coverage which is a big thing here.



whatabout said:


> Even after 4 years we were still paying a lot more for auto insurance than we paid in the UK, about 4 times as much.


Do you shop around regularly?


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## whatabout (Aug 19, 2014)

twostep said:


> You cannot opt out of Social Security.
> 
> 
> Yes, coverage has gone up steadily since "Obamacare".
> ...


I thought you couldn't- but when BBCwatcher said 
"It sounds like you've decided you'll be in the U.S. Social Security system rather than the U.K. system during your time in the U.S. That's perfectly fine and probably even a great idea" - I wondered. 

Our premiums gradually went up in the 5 years we were in the USA, by about 50% in total. We left in October 2013, and yes we shopped around for our auto insurance and found it was cheaper to keep changing insurers each year.


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## BBCWatcher (Dec 28, 2012)

The U.S.-U.K. Social Security Treaty decides whether you can contribute to the U.S. or the U.K. system. Check the treaty. The U.S. Social Security Administration has a helpful summary on its Web site. Sometimes you can choose which system to join, and sometimes not.

As I mentioned, if you can contribute into the U.S. system within any two calendar years (not necessarily for those entire calendar years) at non-trivial levels then it's _probably_ a wise idea to join the U.S. system if you have a choice.

OK, here are the facts -- and anybody can feel free to check me on this, but let's stick to facts and not get, er, stupid. Medical insurance premiums have been rising in the U.S. for decades. The introduction of Obamacare policies may have caused some discontinuous jump in prices for a very important reason: it's no longer legal to sell non-insurance medical insurance in the U.S. that doesn't (for example) provide any coverage for prescription drugs. There was all kinds of crap available on the market that wasn't actually insurance in any meaningful sense, and some of that crap was cheap.

Obamacare also introduced, for the first time ever, significant federal subsidies for middle class Americans to help them buy insurance. That is, Obamacare significantly reduced the cost of medical insurance for millions of Americans -- making it possible to buy at all, and lowering the cost for many others. Furthermore, Obamacare expanded Medicaid to provide free coverage to those earning up to 133% of the poverty line in states that choose to participate in Medicaid expansion. Obamacare also lowered the cost -- or just plain made available for the first time -- medical insurance to those with preexisting conditions, which is practically everybody at some point in their lives.

We also now have the first data on premium rates for 2015 versus 2014. The final numbers aren't yet in, but all indications are that the second year of Obamacare will see premium rates increase much less than the previous pattern of medical inflation. There are even some places where premiums are decreasing year over year, something unheard of for the past couple decades at least. And if that's not enough, federal subsidies automatically increase to fully compensate for higher premium rates if that's what you face as a member of the American middle class. (Not if you're upper-middle or upper -- the subsidies phase out as your income rises.) All you do to get a recalculated subsidy is go back to your exchange during open enrollment period later this year, shop for a policy, input your updated information, and enroll. In other words, you must do the same thing you did last year, but if you do that you'll get recalculated and find the best deal for you, with boosted subsidy support if necessary.

This is all way better than it was in the past with few exceptions. (Note: Not perfect!) One exception -- perhaps the only one -- is that if you're a high income earner then you (probably) can no longer try to self-insure without paying a tax penalty, and you also have a Medicare surtax to pay (i.e. tax increase) to support the Obamacare system. Is that a problem? I don't think so, but perhaps your _political_ judgment will differ from mine. That one is a political question. You can't usually make _everyone_ better off with any major government initiative, but Obamacare comes pretty close.

Oh, another fact: the ranks of the uninsured in the U.S. are dropping rather dramatically. If medical insurance were unaffordable, that wouldn't be happening. Also, the cost of medical _insurance_ is one thing, but everybody I've ever met who cares about costs cares about _what they have to spend on medical care_, of which a part is medical insurance. If you buy high priced medical insurance but still have to spend a fortune out-of-pocket, that's bad. If your medical insurance cost goes up a bit but you spend far less out-of-pocket, that's a trade any rational person would take. In other words, you have to look at whether a particular medical insurance policy represents _value-for-money_. In the U.S., with Obamacare, yes, there's better value-for-money in medical insurance and medical care. It's not at European value-for-money levels, but it's better.


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## whatabout (Aug 19, 2014)

We left the US before Obamacare, so the premiums I was quoting were pre Obamacare. IMO, one of the big problems in the US is that individual states can opt in/out of federal programmes etc. NC chose not to participate in the Medicaid expansion.
Of course it's important to look at the whole package, not just the insurance premiums. In addition to our premiums rising by almost 50% from 2009-2013, our co-pay for Family practitioner,specialist,urgent care and ER visits increased by between 30 and 50% to $30, $50,$100 and $200 respectively. For anyone who might not understand co-pays are the fixed amounts you have to pay up front.
Regarding the different options available we were on what was called the 20 plan, as opposed to the 10 or 30. So we paid the mid-priced premiums with a mid way deductible and co-insurance, based on the fact that we were healthy with no chronic conditions and not envisaging that we would require any planned investigations, disease management ,surgery etc but that we didn't have the spare cash floating around to be able to absorb a $20,000 medical bill should we need urgent/emergency IP treatment).
So basically we paid premiums and co-pays as stated and then for hospital IP stays etc we would have paid 20% (hence the 20 plan) of the bill, up to a maximum, per person, per year of $10,000, after which the insurance paid everything. 
I was unfortunate enough to require excision of a cancerous lesion behind my ear while we were there. It involved a family practitioner visit and 3 specialist office visits- total out of pocket cost was $130 (the ENT specialist was kind enough not to charge for the post surgery follow up visit). Regarding the surgery (at the office under local anaesthetic), and laboratory work (histology to check what the lesion was) the bill was approximately $1000 and we paid 20% of that, so approximately $200.
Everything like mammograms, cervical smears, and yearly physicals/wellness checks were covered 100%
Our dental insurance only covered preventative dental work, so checkups, clean and scrape etc. My husband paid out around $500 for x rays and to have a gum shield made to stop him grinding his teeth at night.
Our vision insurance covered yearly eye exams and up to $100 per person for spectacles/contact lenses.
Did we think it was value for money?, no. We were paying the same premiums as a family of 6 (or whatever) when there were only 3 of us. I have no idea how they justify figures like $8000 for an MRI scan, the mark up on drugs made by hospitals for in-patient medication is extortionate and much of US healthcare is non evidence based and relies too heavily on expensive and invasive investigations and interventions.


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## Meritorious-MasoMenos (Apr 17, 2014)

Whatabout, Does your comment "one of the big problems in the US is that individual states can opt in/out of federal programmes etc. NC chose not to participate in the Medicaid expansion" mean that your premiums will rise or your benefits will fall because of what NC did on Medicaid, because you're not planning on applying for Medicaid, obviously? Do you have estimates of that? Thanks.


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## Bevdeforges (Nov 16, 2007)

One of the biggest issues in the US with medical care is that medical care and treatment in the US is simply SO expensive. Take a look at any travel health insurance. There is normally one price for a holiday anywhere but the US, and then if you want (or need) to include US coverage, the price easily doubles.

Doctors in the US make more than doctors do elsewhere. Hospitals and treatment centers are very often private - and run on the profit motive. And because the government imposes no limits on the prices charged for prescription drugs, it's well known that drug prices in the US are usually the highest in the world because they price new drugs according to "whatever the market will bear."

You really can't compare health insurance costs in the US with what you pay for health insurance anywhere in the world where there is a national health care and/or insurance system. 
Cheers,
Bev


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## whatabout (Aug 19, 2014)

Bevdeforges said:


> One of the biggest issues in the US with medical care is that medical care and treatment in the US is simply SO expensive. Take a look at any travel health insurance. There is normally one price for a holiday anywhere but the US, and then if you want (or need) to include US coverage, the price easily doubles.
> 
> Doctors in the US make more than doctors do elsewhere. Hospitals and treatment centers are very often private - and run on the profit motive. And because the government imposes no limits on the prices charged for prescription drugs, it's well known that drug prices in the US are usually the highest in the world because they price new drugs according to "whatever the market will bear."
> 
> ...


One of the many reasons we left the US was that it was costing my elderly (76 and 80)parents around $3000 for travel insurance to come and visit us for 6 weeks. Yes, that included coverage for pre-exisiting conditions of basically arthritis,high BP and cholesterol (controlled on meds). Neither of them have ever had any heart attacks or strokes or any hospitalisations for anything in the past 30 years.
My OH worked for a "not for profit" large Healthcare Provider and I could never quite grasp what exactly the big difference was between for and not for profit Healthcare organisations. The charges didn't seem to differ that much from one to another! 
Yes medication is expensive, but costs prescription drugs of vary a lot from one pharmacy to another eg Walmart to Walgreens. The point I made before regarding hospitals marking up drug prices for inpatients was in relation to them charging $20 for 2 acetaminophen tablets, for example. That's plain and simple daylight robbery and from my point of view as a healthcare professional completely unethical. They won't even allow patients to bring in their prescription meds from home to be administered by the nursing staff.

I agree that the biggest problem is ridiculoulsy high charges for care and that's what needs to be tackled somehow.

Back in the UK and the NHS is in a heck of a mess and I find the thought of needing hospital care frightening but for the opposite reasons that healthcare in the USA frightened me. In the UK maybe they won't do enough soon enough, whereas in the US they do too much too soon!

MMM
It seemed to be the opinion amongst many that the extension of medicaid would push private insurance premiums up. I really didn't completely get to grips with Obamacare because we were leaving, however the other argument is that having a lot of people without any insurance coverage pushes up costs for those that do have insurance. Interestingly- I think that was one of the reasons auto insurance was expensive in NC. !


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## twostep (Apr 3, 2008)

My mother visits family several times a year, is in her late 70s, regular travel coverage through ADAC is a few Euros and she carries additional for about 100 Euros per year.

Copays, deductibles - it depends on your policy. SO recently had reconstructive ear surgery (fairly new procedure, surgeon came in from Spain) - as it was considered out patient surgery and follow ups were a total under $20.


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## Bevdeforges (Nov 16, 2007)

Just remember that travel insurance only covers urgent situations, not routine medical care. And many travel insurers won't cover those over age 65, or 70 or some other arbitrary age. In case of a serious accident or illness, most travel policies will only cover treatment up to the point where you can be "evacuated" (i.e. transported) back to your home country medical system. It's really very limited coverage.
Cheers,
Bev


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## BBCWatcher (Dec 28, 2012)

whatabout said:


> ....the other argument is that having a lot of people without any insurance coverage pushes up costs for those that do have insurance. Interestingly- I think that was one of the reasons auto insurance was expensive in NC. !


You're exactly right, and you have good insight into this aspect of healthcare economics. Quite simply, the larger the pool of uninsured people -- who only or predominantly use hospital emergency rooms, the most expensive (justifiably) form of medical care, and often when earlier intervention would have been much less expensive and more effective -- the more the insured population has to pay to support those hospitals and patients. Even if you don't give a damn about the health and welfare of others, _your_ costs go up when somebody else is uninsured. And many uninsured Americans are also those who are making and serving your food at restaurants (for example), so you really want them to be healthy.

The good news is that the holdout states are relenting. Residents of every state pay federal taxes. States that opt out of Medicaid expansion don't get as many federal dollars back, and their residents spend more on medicine. Those states are also at a competitive disadvantage, and there's a lot of pressure for Medicaid expansion from doctors and hospitals for obvious reasons. (Where would you prefer to live? It's comparatively easy to move to a Medicaid expansion state.) Financially it's completely dumb for a state not to participate in the expansion. It's a sweet, sweet deal for the states. Politically...well, that's a political question, and I don't do politics very often.

Anyway, just about a day ago as I write this there were some press reports that Wyoming is now likely to join the Medicaid expansion. Medicaid expansion in that state would insure about 17,000 more Americans, a very big number for that state. It's already tempting to leave Wyoming -- it's one of America's most rural states, and America is now more urban than rural and getting more urban. Plus the weather is dreadful for much of the year, and much of the state may run out of water soon. Less Medicaid coverage just adds fuel to that particular set of fires.

It's a lovely state, though. Just don't get sick there (at the moment) if you're part of the 17,000 in the 100% to 133% of poverty level income range.

To run some very rough back-of-the-envelope numbers here, the population of Wyoming is about 576,000. Let's assume 80% are presently insured in some way, or about 461,000. And let's assume each one of those individuals is consuming, on average, $3000/year in medical services. Let's further assume that the 17,000 uninsured consume $9000/year in medical services on average because of the effects I described above (expensive and too-delayed emergency room treatment). Thus in healthcare spending terms they're comparable to 51,000 insured individuals. And 51,000 cost-adjusted uninsured amidst an insured population of 461,000 is a really big deal, as you can see. It's definitely a non-trivial cost burden.

Substitute your own numbers as you like, but that's the basic idea.

I should also add that Obamacare kicks in some extra funding for provision of medical services in rural areas. It really does cost more to deliver medical services to a rural versus urban population. Whether government should be subsidizing rural living to the extent it does is another political question, but the fact is it does. Even without Medicaid expansion, Wyoming already gets back a lot more federal dollars than it sends. That's a great deal for Wyoming, and Wyoming is now seriously considering taking the sweet deal on offer to improve on their position. This is also one reason why medical care in the U.S. will probably always cost a _bit_ more than in, say, Italy -- the former is simply a more rural country than the latter. (Though medical care in the U.S. shouldn't cost much more than, say, in Canada, another rural country.)


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## Bevdeforges (Nov 16, 2007)

whatabout said:


> The point I made before regarding hospitals marking up drug prices for inpatients was in relation to them charging $20 for 2 acetaminophen tablets, for example. That's plain and simple daylight robbery and from my point of view as a healthcare professional completely unethical. They won't even allow patients to bring in their prescription meds from home to be administered by the nursing staff.
> 
> I agree that the biggest problem is ridiculoulsy high charges for care and that's what needs to be tackled somehow.


I used to be on the audit of a hospital client and I know that the extravagant hospital charges for drugs is, at least in part, an attempt to cover their overheads. When my Dad went into a nursing home, he wasn't allowed to bring his prescription meds with him, even though they were nicely carded up (since he had been living in an assisted living place that handled his medication in a manner similar to how the nursing home did things). I suppose that's due to the litigious culture in the US and covering their posterior.

But in most European countries, when the regulators approve a new drug for use, they take into account not only whether or not the drug works, but whether it works well enough to justify the price the drug company wants to charge for it. They don't have that control over drug prices in the US, and I think the price of medications reflects that.
Cheers,
Bev


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## mr.t (Sep 21, 2012)

Wow, disappear for a couple of weeks and my thread gets swallowed up 

Very interesting though...

...ANYWAY... I have just had initial contact with the legal teams and they have asked me to part complete the following form...

NONIMMIGRANT VISA QUESTIONNAIRE
FOR E-1/E-2 APPLICANTS

Wow, they must be buying my visa? ???????


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## whatabout (Aug 19, 2014)

mr.t said:


> Wow, disappear for a couple of weeks and my thread gets swallowed up
> 
> Very interesting though...
> 
> ...



Well, do you think you meet the criteria for E-1 or E-2?
Employment-Based Immigrant Visa

Which, if any, makes a huge difference to timescales.


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## mr.t (Sep 21, 2012)

whatabout said:


> Well, do you think you meet the criteria for E-1 or E-2?
> [/url]


The immigration legal team have selected E2 after some narrative I have provided so I guess so :rockon:

What sort of timescales are typical? (probably a ball park answer required I guess?)

eep:


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## whatabout (Aug 19, 2014)

Well the good news is that there's no backlog for EB-2 immigrant visas, assuming you were born in the UK. Also, with an immigrant visa your spouse and dependant children will be issued with immigrant visas , which means your spouse will be able to work in the USA. Once your dependant children reach the age of ?21, if you aren't already citizens then they would have to apply for Green cards.

The First Steps toward an Immigrant Visa is a process called Labor Certification. Permanent Labor Certification
Basically it's about proving that the company haven't been able to recruit a suitably qualified US citizen. Now I may not have this exactly right, but you'll get the general idea of the processes involved.
So, as part of the process, they will have to advertise the position they have offered you (including the wage) on internal noticeboard(s) and at least one appropriate job search website and a local newspaper. The adverts must contain the job description and any applicants must be provided with the job requirements /person specification type verbage and the wage. I believe it must also state that they are intending to sponsor a foreign worker to fill the position. The job requirements cannot be "tailormade" to fit your qualifications or experience, nor can they be so restrictive as to exclude applications from US citizens. The wage advertised has to be at least the prevailing wage for similar type jobs and is determined by the employer applying to the US National Prevailing wage center. This is so they cannot advertise a lower wage which would discourage US citizens from applying and also so it doesn't affect wage levels.
I think they have to have the job posted for 2 weeks and then they have to wait maybe 4 weeks before the next step. During that time they have to review the details of any US citizen applicants and document why they don't meet the requirements.
Permanent Labor Certification Details
Then they have to apply to DOL with the job description, prevailing wage and your details etc and wait! The best scenario is that the DOL provide the Labor Certification within 3-4 weeks. At the moment, according to the website, there doesn't seem to be a backlog/queue so applications are being processed as soon as they're received. 
Worst case scenario is that the DOL don't approve it or decide they want to audit the application, which means the attorney/employer has to send the resumes of all the applicants to DOL and they review them one by one. *If the application goes to audit, then it's how long's a piece of string!*, Not sure what happens if they just say "no" regarding appeal or reapplication with changes.
Once/if labor certifcation is issued then the attorney can file a petition for an immigrant visa with USCIS. If the petition is approved then it's then sent the NVC and processed. I'm not sure of processing times, but weeks rather than months as long as they're satisfied that the foreign worker meets the category (in your case E-2 ) requirements. If they're not then I assume they ask for clarification or say no.
Nothing is a definite when it comes to visas unfortunately.

Once you have all of this then you have to have interviews at the US Embassy in London and medicals.

Got all that!

You're in a slightly different position than we were as a family. OH had a Masters and was going to work for a Not for profit that were associated with an academic and research institution so he was able to get an H1-B non immigrant visa very easily.
2 years prior to this I'd been approved for an EB-3 visa as a RN with job offer (after jumping through the pre RN licensing hoops and exams for over a year) but the 5/6 yr backlog for that category kicked in about 3 months after I got approval. Because Nursing is a shortage occupation there is no requirement for Labor certification, but that doesn't help much when there's a 6 year backlog!
We lived in the US with OH working on H visa for almost 5 years. About 18 months before we left the USA his employer ( the same company who had sponsored me for a Green card) applied for Labor certification as first steps for his Green card. They messed up somwhat in HR regarding putting the job on the appropriate noticeboard so that took longer and then DOL requested an audit. At that time there was a 3 month wait time for audits, but over the next few months it increased to almost a year.
About 6 months before we left my Green card "date" became current, which meant I had reached the front of the queue, but the company said that because it was so long since they'd offered me a job and I hadn't worked for 3 years, I had to start applying for and secure another position with them before they would move forward with the next stage of the Green card application.
We had an 18yo who was graduating high school and wasn't allowed to work. Because we were only temporary immigrants we wouldn't have had access to many scholarships etc for college and had been living on one very average wage for 4 years
In the end because of this and other reasons we decided to call it a day.

Hopefully your journey will be much smoother.


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## mr.t (Sep 21, 2012)

Thanks for that, most appreciated.

A very comprehensive overview.

Had a chat with a contact in the UK arm of the company and it turns out the US job has been advertised for a little while and they were struggling to find a match locally.
The only place I would ever emigrate for (after our experience in Dubai) was the US.

Fate? I hope so


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## whatabout (Aug 19, 2014)

mr.t said:


> Thanks for that, most appreciated.
> 
> A very comprehensive overview.
> 
> ...


Both jobs that myself and OH had been advertised for some time,the post I was offered in particular. I think they had maybe 4 or 5 applicants for OHs position.
Now I believe that the job they are offering you will have to be readvertised to comply with DOL certification.
My OH had been doing his job for almost 3 years on H visa and when it came to Green card and they advertised his job, they had around 70 applicants. Of course the US economy and unemployment levels were very different in 2008 to 2013.In retrospect I think maybe fate was trying to tell us that we shouldn't move to the US. No regrets at all, but even if we had got Green cards I don't think we would have stayed.
Good Luck!


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## mr.t (Sep 21, 2012)

Ok, thats for your post and thanks for the kind sentiments.

I already have friends and family across in Houston so the support network is in place.

Also, once I am over there I have other potential future employers as friends.

Sorry to hear that your adventure didnt work out, :fingerscrossed: for ours


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## mr.t (Sep 21, 2012)

Ok, so did the embassy thing today.. Apparently all approved (well verbally at the desk)

Next things house sale and decamp to Houston in November.

Note for embassy visits, I was told no phone, no key fobs from a couple of sources (left everything at hotel) .... Only to find everyone on their phones.. Was quite nice not relying on having one!

Visit was planned to perfection.. Set off on a 47 minute journey one and a half hours before the interview only to find tube shut and london in gridlock! Arrived at 0805 due to a local guardian angel with a random act of kindness! 
Interview time is a guideline.. We queued for 40 minutes after getting to the embassy forecourt. (Then about 50 minutes inside between appearances at counters)


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## whatabout (Aug 19, 2014)

mr.t said:


> Ok, so did the embassy thing today.. Apparently all approved (well verbally at the desk)
> 
> Next things house sale and decamp to Houston in November.
> 
> ...



Seems very fast for a Green card. Well done anyway.


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## mr.t (Sep 21, 2012)

Hi,

Not a green card - E2 Investor Treaty


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## whatabout (Aug 19, 2014)

mr.t said:


> Hi,
> 
> Not a green card - E2 Investor Treaty


Ah- assumed even though you wrote E-2, because you were going to be an employee of a company, and you seemed to have so little info/knowledge re visas, you must meanin EB-2.
So everything I wrote in #45 is irrelevant.

What's the immigration route to permanent residency for E2?


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## mr.t (Sep 21, 2012)

whatabout said:


> you must meanin EB-2.
> So everything I wrote in #45 is irrelevant.
> 
> What's the immigration route to permanent residency for E2?


It is E2 - Employee .. assumed you would know that route as you know so much about Visas  :boxing:

The company is the investor, It is a UK company, incorporated, and they have a treaty with the US...

As I know so little about visas - I have no clue what an *EB2* is. :heh: 

Employer has successfully got people to permanent status with their routes, I'll leave that in their capable hands.


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## whatabout (Aug 19, 2014)

mr.t said:


> It is E2 - Employee .. assumed you would know that route as you know so much about Visas  :boxing:
> 
> The company is the investor, It is a UK company, incorporated, and they have a treaty with the US...
> 
> ...



I think you'll love living in the US. Good luck.


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## mr.t (Sep 21, 2012)

whatabout said:


> I think you'll love living in the US. Good luck.


Why thank you


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## twostep (Apr 3, 2008)

mr.t said:


> It is E2 - Employee .. assumed you would know that route as you know so much about Visas  :boxing:
> 
> The company is the investor, It is a UK company, incorporated, and they have a treaty with the US...
> 
> ...


If y'all are splitting hairs so be it.

BTW - "they" as in UK company do not have a treaty with the US. It is between US and UK.


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## mr.t (Sep 21, 2012)

Who me  .. just acting up a little to the condescending language regarding my visa knowledge.

Whatever the agreement is, its obviously tight as the approval was slick.

Thanks for the advice so far, very much appreciate all the helpful comments with my immigration experience.


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## twostep (Apr 3, 2008)

You are lucky. It looks like temperatures across Texas have fallen a bit due to the recent hurricane. 

It is almost time for an Expat Forum meet up in Houston:>)


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## mr.t (Sep 21, 2012)

Ok people, Howdee, Hi'yall!

I am in Texas, the process was fairly smooth with the support of the legal team on the Visa.

Family still stuck in Newcastle due to house sale.. BOOO .. they will be here in Jan

Living in Hotel Suites... boo again.

Looking for property around the Barker Cypress area.

BUT, In need a mortgage.. someone who can do a UK credit search if possible... anyone know of such persons??

BTW, contrary to popular belief, the service out here on a while is rubbish and people are generally rubbish at their jobs!! sweeping statement and I am sticking to it  :boxing:


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## Loosehead (Nov 18, 2013)

You're in the same part of town as me. I work close to Barker Cypress and I10, but I live close to Dairy Ashford so that I am travelling against the main flow of traffic.


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## mr.t (Sep 21, 2012)

Nice area and close to the park...
We are looking in Coles Crossing.. a bit further north


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## Loosehead (Nov 18, 2013)

Ah, that's Cypress proper isn't it? Don't go beyond the 290 often myself.


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