Netcord29582

Hi all
So I'm a Brit in the USA (Florida) and have been for 12 years. Previous to that I spent til age 35 in the UK. I am married to a US citizen who does not have a visa to live and work in the UK.

The wife and I have an ongoing discussion about retirement and where we should line ourselves up to reside. We are still 15-20 years away from it. I miss England and we can see ourselves living in either place.

Obviously we can stay in the US and she can visit the UK on a tourist type visa but my concern is US healthcare and the costs associated with it. I know we can apply for medicare when we are 65 but we'll still be paying out $$ and say one of us gets a serious health issue and we are out of pocket lots $$.

I know how the UK operates and while I am aware that the NHS is struggling, the system itself is so much cheaper. Btw I am also aware my wife would need to go through a lengthy process to be accepted in the UK too!

So people, if you had the choice to retire in the UK or the USA which one would you chose?

Thanks in advance!

robin1234

There are more important considerations than the healthcare comparisons. Plus, you're both pretty young so there's no knowing where NHS or Medicare will be when the two of you reach retirement age. The way it is now, yes, there can be significant out of pocket with Medicare, but you have choices that limit the out of pocket. (Medicare supplement plans etc.)

Another choice, of course, is where in the US to retire, since the US has places that are hillier and less humid than FL.

I myself spend half my time in the UK and half in the US.

lansbury

We lived in the UK and made the choice to retire to the US. The factors which had the greatest influence on our decision, was where the bulk of our family lived. Where the bulk of our pensions would come from. In both cases that was the US, and the US meant the bulk of our pension was not subjected to exchange rate fluctuation.

With health care it isn't just the cost to consider it is the availability as well. Last time I needed physio in the UK I waited 12 weeks for an appointment. Here 3 months ago I got an appointment in 2 days. At the same time I needed an MRI and had it done next day at 9pm at my local hospital. I doubt I would have been seen as quickly on the NHS. When your left arm suddenly stops working after a fall, being seen promptly and treated is very reassuring. OK it was more expensive than it would have been in the UK, but I consider the $200 a month I pay for medicare part B, and medicare supplemental insurance well worth the prompt appointments and treatment I received. The lack of worry and stress made it worthwhile. My out of pocket cost for 3 months of physio, 2 MRIs, one set of x-rays and 3 specialist appointments was $500. Talking to my DIL in the UK who is a nurse at BRI I would probably still be waiting for the first visit to a specialist. Here my arm is back to normal.

morpeth

A lot depends on your financial situation in regards to medical expenses, whether payment of the premiums etc in USA are worth the cost vs some delays with NHS. I prefer UK for medical simply as it eliminates the worry about costs, and I haven't checked but there are private alternatives in UK as well. My experience with NHS, although there can be delays, has been positive.

Other factors lead me to prefer the UK overall- proximity to Europe at a reasonable cost, greater public transport : most parts of America one needs to drive, which as one gets older can be a challenge. Also, I found in UK a much different attitude with government services- easier to find out what is available than in US, but in UK there is so much available sometimes one can miss benefits/services that are there.

The other issue is geographical location- what will the particular location be like in 20 or 30 years time ? There are parts of UK in the north that will probably remain somewhat similar, don't know about the south; but same goes for USA : I can think of small towns in Northwest ( northern Idaho, eastern Washington parts of Oregon) of maybe parts of New England, that probably will remain with the same attractions. But will major cities and surrounding areas be livable in 20 or 30 years ? I read that Los Angeles now has 50,000 homeless people, what happens if that ends up at 200,000 or more ? One negative in UK is definitely housing prices.

I would vote UK if one could spend portion of winter in better climates !

Netcord29582

Thanks Robin
Yeah I agree, I don't know exactly where the NHS / Medicare will be in the future but I guess I'm going by an 'all things being equal' scenario. We're just trying to make some sense of things that's all.

I guess what I'm concerned about is if either one of us gets a major health problem, which let's be honest is quite possible, then our out of pocket expenses will be extremely large over here in the US to the point where it could wipe us out financially. Minor issues I can see being ok with the regular coverage. I am not aware of the supplements and how well that covers major health issues.

Can I ask you... are you retired with that split? I assume you have to declare one country as your main residence right?

Rete

Several points that you haven't mentioned that would factor into a decision is whether you have children. Do you have US Citizenship. Does your wife truly want to live her senior years away from family and friends and would you be financially able to sponsor her for a spousal visa when the time comes.

Netcord29582

Thanks Lansbury for your reply.
I think my concern is major health problems. My mother had kidney cancer and it was diagnosed and treated fantastically in the UK. She's also had both hips done too and all went great. I know it's not the same everywhere in the UK, nor is it getting better.

My worry is major health issues in the US. How well does Medicare + Supplementary payments cover you? What cost are they and how much can you potentially pay out of pocket for a major health issue?

Netcord29582

Rete... you make good points and all we're doing is looking into the health care system at this point.

HKG3

You will need to think about your wife's UK visa before moving back to the UK with her.

Another thing you may wish to think about is how up-to-date your own NI contributions are? Your UK state pension depended on your NI contributions. You may want to pay voluntary NI contributions to keep up your UK state pension entitlement.

https://www.gov.uk/pay-voluntary-cla...onal-insurance

Rete

We're retired and our supplemental is fantastic and if we ever see a bill it for something under $20 and that appears to be only for husband who has had laser surgery on his eye. When I had laser surgery on my eye (with the same medicare and supplemental insurance btw just different doctors and different states) there was only the $30 co-pay.

But then our supplemental is excellent coverage and our premiums are only $1500 a year for both of us but it is through a union.

Medical coverage will change in this country and it can and does change rapidly. What is norm today can be non-existent tomorrow and that includes our excellent supplemental.

Great to have a handle on the medical insurance aspects in the US but as another poster pointed out, 10 to 12 years from now it isn't going to be the same here or there.

Netcord29582

Thanks again and yes I understand that things change. I'd just rather have a better grasp of things now as a starting point. Sounds like your plan is excellent. I may be scared by the fact that I'm self employed and have to cover 5 of us on a plan with a huge deductible.

morpeth

My parents had Medicare with the supplementals and also private insurance, they always seemed to get a flood of paperwork and also had to pay something. I guess though key question is what will US system be like in 10 years, who knows ? UK will still have NHS, it is too ingrained in the political landscape to be eliminated. American system is terribly expensive nd inefficient when looking at costs vs availability of medical care 16% of American GDP applied to health care vs 10% in UK as I understand it, so it would not surprise me if costs for medical care coverage increase over time.

But maybe someone could answer- as far as I know is Medicare residency-based ? I know NHS is suppose to be.

Netcord29582

Yes HKG3 I agree..... I've been in touch about my state pension and obviously am aware that a visa for my wife is a long process especially approaching retirement age.

robin1234

Yes, my wife and I retired about four years ago. I consider myself resident in the UK. I have a high deductible Medicare advantage plan, with a maximum out of pocket of bout $6,500. I only took that approach because I'm only in the US five or six months a year. (I literally haven't used any medical services in the US for at least three years.) I just pay my Medicare Pt. B premium, and the Medicare advantage plan has no further premium. But to address your concern, there should never be catastrophic costs if you are a Medicare recipient. (I think this has been covered by other posters.)

lansbury

I pay medicare part B deducted from my social security payment. My Medicare Advantage plan is $88 per month and that includes prescriptions. Deductible is zero, with a maximum out of pocket in 2018 of $3,400 in network or $6,700 out of network. My wife has an identical plan.