rlolney58

Hi Folks
We are both dual citizens between US & UK. We moved from the UK in 2016 due to careers, and due to the Brexit vote (we were in our home in France having coffee in bed the morning of the vote results). We love it here in the US but we are soooooo concerned (actually scared) about the cost of medical insurance and the current political climate that we just want to leave as fast as we can. When we were reviewing costs, etc. we learned that our medical insurance premiums would amount to 25% of our total living expenses. Our mortgage is only 22% of total living expenses. And, we all know that medical insurance premiums will continue to rise at astronomical rates; they will never go down. We honestly believe that we could/would slip right back into British life. However, moving back would mean that we would have to start completely over for any material items (house, furniture, car); and we have 5 dogs to ship as well.

Currently I am retired on Medicare and my spouse is currently working with healthcare from their employer. My spouses job is in jeopardy, so hanging on as long as we can.

Are we being naive to think that our MAIN reason (and probably only reason) to move back is due to the medical costs here in the US (they are absolutely out of control; ex: $938 for a blood test CBC).

Thanks!
"Bewildered in Massachusetts"

SkiBoySpouse

I can't help with decisions, but we are moving back to UK from west coast USA for similar reasons (although we still own our house outright/no mortgage in the UK) I work for a hospital and my medical insurance and costs are insane and I am also seeing my job in jeopardy. We already have wheels in motion: packers are coming in a month and we fly a few days later. Current living situation is rental property so easy to leave. no pets, so we don't have THAT to worry about. But the overall feeling of unease about the future 'quality of life' in the USA is definitely making us happy to have made this decision.

SanDiegogirl

Presumably, that cost above is what a healthcare facility MIGHT have on their price list, but it is not what, say, Medicare would pay, nor any in network insurance company.

My main concern if moving back to the UK, would be the standard of care in the NHS.

While hubby and I pay a fortune for Medicare, plus a supplementary plan, we cannot complain about the quality of service we get.

rlolney58

Yes, agree about Medicare. I find it worth the cost. My spouse is only 55 y/o so won't qualify for Medicare for another 10 years. That price I gave you for the CBC was on the bill sent to us as the insurance denied the charges because we had yet to reach the $5000 deductible. UGH!!

rlolney58

That means when my spouse is no longer working, we have to pay "individual rates".... So far we have found that to be ~$600pcm + $250pcm to cover the deductible. And guess what? There are no medical services in our area or within a 50-mile radius.

SkiBoySpouse

I don't have personal experience of the current NHS but my Mum-in-Law has been in and out of hospital the past few years and is currently living at home and has carers come in three times a day. Much as she complains when in hospital that they keep taking her for scans (to determine the issue which put her there) the care she has received has been outstanding. And the fact there is zero charge for the ambulance to get her there, or the scans or the stays (one was 4.5 MONTHS on a ward) it's a far cry from the USA. Here, I find most people are afraid to go to see their GP except for their annual physical as the co-pay and any ordered tests and or diagnoses and treatment can get REALLY expensive and sometimes insurance takes a very long time to even approve a test. And don't get me started on incorrect billing and the back and forth to get it sorted (and the occasional mistaken move of the bill to collections...). The USA healthcare system and the insurance which is truly necessary is really broken. Yes the care is excellent when you get there, but the anxiety for how to pay (or IF insurance will pay out) is insane.

Pulaski

As SDG said, either you, nor anyone else pays the "sticker price" on the bill. Even if you haven't met your deductible and have to pay "out of pocket", you still pay the heavily discounted rate agreed between your insurance company and the medical service provider.

SanDiegogirl

Yes, that is worrysome if spouse is much younger, lost their job, and would then, potentially, have to pay individual policy costs - unless of course they got another job.
Always something to take into consideration if moving to US at the age of 50+ ......

Pierre_Tete

Well as others have said, the 'list' price for any procedure or medication is totally bogus. It serves two purposes: 1) to scare you into thinking you couldn't possibly afford to pay cash for anything because it's a closed shop and discounts are only negotiated with insurance companies not Mr&Mrs Joe Cashpayer (that's my uncharitable explanation) and 2) this is the figure the provider gets as a tax write-off in the event the bill is not paid (I am told this is the real reason. Can anyone verify?).

I have regular blood tests every year at Quest. The top line on last year's bill was $1000. The 'insurance negotiated price' was $120. Yeah absolutely bizarre.

My wife is going onto Medicare this year. The base cost is $175 per month but the basic plan puts you on the hook for 20% coinsurance on most things with no out of pocket limit (really scary!). To defray those costs, my wife is planning to get Supplemental plan G. Her costs will be:
Part A $0
Part B $175
Part D $35 ish
Supplement G $200 ish

Total per year $5000 with very low copays and deductibles, so that's pretty much as expensive as it gets and it gives you some peace of mind that costs are contained. For a couple that's $10k which is not trivial, but because the cost is the same for anyone making less than about $180k, it is a regressive 'tax'. $10k from an income of $50k is a big deal. If you make $150k, not so much.
A job loss without medicare is something to be concerned about but remember if you buy a policy on the ACA marketplace, the cost is subsidized if your income is below about $80k. if you suffer a big drop in income an ACA policy might be very cheap indeed, though I have heard that outside the cities the choice of medical services on these plans can be limited.

But what would your financial situation be in the UK regarding taxes which pay for the NHS? I am retiring next year and I am likely to stay in the USA but I've toyed with the idea of going 'home'. I have played around with numbers for taxes and medical insurance both in the USA and UK. I have spreadsheets for both. The results of course are highly personal but in rough figures based on my estimated retirement income from multiple sources my Federal and State taxes add up to 5% of my gross (at most). Medical insurance (Medicare for wife, Cobra for me initially) is about 11%. In the UK, I estimate our tax percentage on the same income will be about 15%, which obviously includes paying for the NHS. So on that metric for me it's almost a wash. But reduce the income by half and you get very different results with the UK coming out significantly cheaper, and increase your income and the USA is cheaper. I'm somewhere in the middle.

Pulaski

Americans don't understand what tax write-offs are and how they work. Whether it's [1] a unit of product that failed QC, [2] a business expense/ overhead, [3] depreciation, or a [4] bad debt (customer did not pay you), you only get to deduct the amount you actually paid out of pocket.

In the case of [1] above, if you're deducting all your overheads, raw materials, energy/ fuel, labour costs, etc, the the business is effectively get all the write-off they're entitled to.

In the case of [2] you get to deduct whatever you have a receipt for, for example the cost of raw materials, the electricity bills paid, the rent on your factory and offices, wages and salaries paid to employees, the price of an airline ticket to visit a customer or supplier, etc. Or if an employee drives somewhere on business in a vehicle they (not the business) own, they get mileage reimbursment at the rate specified by the IRS.

In the case of [3] you get to deduct the amount per the IRS rules and formula, and the calculations are based on the amount paid for a machine, vehicle, or building.

In the case of [4] You only get to deduct the amount you actually spent, so basicially the same as 1 above

I have seen numerous posts on YT, Reddit, Farcebook, and other forums, where people seem to think that tax write-offs are an effective business model. Whereas in reality, write-offs are only designed to ensure that all money spent by a business in the course if running the business, is deducted from income to reach taxable profit. Taken to the extreme, the maximum write-off is the sum of business expenses, reducing the profit to zero, and therefore the taxes paid to zero. No matter how many tax write-offs a business has, they cannot turn a tax bill into a tax refund.

So in the case of a medical service provider, such as a test laboratory, it's similar to [1] and [4] above, where they're deducting the cost of materials, salaries, rent, etc., and how much was billed customers that was not received is wholly irrelevant.​​​ In other words, taxable profit = gross revenue actually received - actual costs/ expenses actually paid out of pocket.

Pierre_Tete

So what are we saying? My first assumption is closer to the truth - the bullshit top line cash price has no business basis at all and is just a scare tactic? Wouldn't be surprised at all. I've had estimates for minor surgery which scared the bejeezus out of me, then when I saw how little the insurance company paid I called the hospital to make sure I wasn't on the hook for the rest. Turns out not. They were ok with what insurance paid and I was mad as hell for being panicked at the initial inflated estimate. My current employer only offers a selection of high or even higher deductible insurance plans so I want to know in detail what I'm on the hook for before signing consent and it's often frustratingly difficult to get an accurate answer, apart from those stupid initial non-insurance prices.

rlolney58

Sorry, not to sound rude, but would you like to tell our doctor's office & insurance company that??? We just paid the bill.... I've had the medical office tell me "We charge $X. If your insurance company won't pay our rates, the balance is left to you to pay". Seriously, I'm not kidding! I blew a gasket.... Then they had the audacity to turn us over to a legal firm bill collector!!! Legalized crime, IMHO

And, this is the primary reason we are consider emigrating back to the UK. It would be cheaper for me to purchase a BUPA plan on top of NHS. HOWEVER, if we can find a solution to this ordeal we would prefer to stay where we are instead of starting completely over from scratch.... at 66 y/o (me)

vikingsail

For me I think it is fair to say I sympathize with yours and others predicatement re US healthcare. Having been a recipient of both systems in recent years personally and managing family members in the the UK. I still say I woud rather attend an NHS facility than a US one. At least that is my experience.

My rationale, as appears to me to be amplified in these posts, is this; as a US healthcare recipient you are never truly at peace. You are always concerned at a minimum about costs (potntial or actual) and what they might be. For me this weighs heavily on me and I am sure others and I cannot believe it is good for anyones health. The stress of bills (often 6 months or longer later) is just that = very stressful. Even if you know they are managed in a maximum deductible plan.

The feeling that you are owned and have no control over who or what amount might be presented for payment, once you have sought any kind of medical opinion, is extremely one sided. And if you are lucy enought to have a plan, knowing you have to budget for a maximum deductible each year especially in retirement is worrisome and cumbersome.

Compare that with the UK where money is not really an issue apart fromm some small copayments = think prescriptions for some.

I sum it up like this. Compare the difference. You go to a UK ER room late at night and all they want to know is your name and date of birth. You go to a US facility and the first thing they ask for is your picture ID and credit card information. It serves to illustrate where the focus is in the US which in my humble opinion generally speaking is not on the patients welfare but on profit.

I have an elderly (80s) friend and his wife attended a major healthcare provider in the San Diego region recently and was told she had a form of cancer (lump) on her face. The Doctor told her to her face (no pun intended) that he would not be making any money from her procedure??? whether she chose removal or radiation. Oh and that same 80 and 90 year old couple are struggling and scrambling after many years of using the same provider because toward the end of last year the provider summarily kicked them and thousands of others of their plans and refused to accept Medicare because they were not making money?

Versus the UK where a family member in the last 6 months has had a myriad of tests to investigate posible cancer ie multiple bloods tests, MRI, CAT scans, Heart tests etc etc = nothing charged, no charges whatsoever. That in the US would have instantly after the first test have exceeded anyones annual maximum deductible which is usually $6K on average.

No for me its the NHS every time which is why I am transitioning well before Medicare applies.I wish you well in your decision and hope this assists.

Pierre_Tete

Very true. It is a very big factor why I am thinking of the possibility of returning home after retirement, but I have to weigh that against kids and grandkids here.

With regard to Medicare can you clarify your elderly friend's experience - was that using original Medicare or Medicare Advantage? There is a big difference. Since the government sets original Medicare reimbursement rates I'm sure some providers drop patients due to lower profits, but folks I know on Advantage plans seem to have much more year-to-year turnover in their network doctor choices. I used to live in an 55+ community (and most were in fact 70+) and in general they seemed happy with original Medicare. But yes, things are never static and there's always an uneasy feeling that if you have good affordable insurance and a good network of specialists this year, that could change next year.

vikingsail

Unfortunately I do not have the finer details. I do know they previously received excellent healthcare with minimum fuss. My point was to illustrate the uncertainty of care. I know they had been with the provider for many many years. And suddenly they offloaded them? This combined with being in your 80s/90s means they have been left scrambling to figure out new resources. Not the time of life that you want to be doing that with declining cognitive abilities and health issues. You can imagine the complications given everything is now digital....and as competent as they are, they are simply not fully digital age literate.

As with most things it is a balance of pros and cons, burdens and responsibilites versus benefits. For me that falls on the side of exiting the ever evolving US healthcare system which is cost/profit driven. The one thing I think I can say for certain is it will not change in my lifetime.