BristolUK

Pulaski

Which as I explained already is less than the reduction in my tax bill on moving to the US, so $250 isn't a cost, its a reduction in the taxes we saved. Why is that hard to understand?

Seriously though, you should get out more. $250 isn't enough to rent a house for a month (even in my neck of the woods I doubt there is much chance of renting anything that isn't a decrepit trailer for less than twice as much). $250 is unlikely to be enough for the payment on any new car. The federal government says that $250 isn't enough for a low income individual in a low cost area to buy groceries for a month. Across much of the US, $250 isn't enough to pay the electricity bill during the summer (AC season). $250 is just about enough to buy one summer concert ticket in the 4th or 5th row at an amphitheater in the US, to see a band that either you probably haven't heard of, or are about 30 years past their prime. $250 is just about enough to buy enough petrol for a month at $5/gal (US) to get you to work every day 40 miles away if your car gets 35mpg.

Your life must be really in a dumpster if you don't think that $250 for health insurance isn't a great deal.

BristolUK

I didn't say whether it was a good deal or not. I was reacting to the idea that $250 a month was a modest amount.
It seems that you're the one that didn't understand my reaction. I'm hearing the privileged voice from a couple of days ago. You know, the one that blamed people for not being wealthy enough to be able to make a nice pension pot for themselves.

Steerpike

Although there are dozens of variables at play here, looking at it very simplistically for a moment - the average household income in the US is supposedly $84k (or $75k after taxes); the median household income in the UK is 31k GBP (yes, comparing median to average is not mathematically correct but close enough for a broad analysis). This suggests household income levels are higher in the US, and therefore, paying $250 / mo ($3k / yr) in health insurance premiums in the US vs zero health insurance premiums in the UK could still be argued as being 'advantage US'. But there are too many variables and assumptions to make this anything other than a 'gut feel'. Since this discussion is happening in the context of being an expat, I would think most expats here are going to be at the average or above income level.

My 'disagreement' with Pulaski's 'numbers' would perhaps be more along the lines of suggesting that the 'premiums' are only a small part of the equation. Your $250/mo ($3k /yr) is minor in comparison to out of pocket expenses, in the event you actually have a serious medical condition. Speaking of my own coverage, my policy has a 'Maximum Out Of Pocket' (MOOP) figure of $8,000/yr. So if I'm going to compare my situation here vs being in the UK, I'm going to take a worst-case scenario and assume a 'bad year' with $8k of costs plus $3k of premiums - $11k total. Now, I'd argue that I'm still ahead of the game even with $11k of expenses every year, and the 'average income' numbers above would tend to support that. Yes, you can further argue that having a 'Heath Savings Account' (HSA) helps further improve this, and you don't have a 'worst case' year every year, but then the analysis gets way too complicated.

tom169

I think an unreported benefit of the health insurance is the costs that insurance companies negotiate with healthcare providers in this world of in network vs out of network.

The hospital + other fees for child birth was billed at around $30k (I don’t have exacts in front of me). Of which insurance capped at around $8k and if memory serves me we paid around $5k from one of our HSAs.

We both receive around a $1-1.5k a year from
employers to fund HSAs. Then there is the tax savings and investments. Even with the crappy short term market results there is still a gain in both accounts.

I know from speaking to the billing folks there is a 50% discount for cash payment, but definitely insurance discount was more than that.

There is also a charitable arm if you are underinsured / can’t afford it and they will help. Not many people know about that though.

I believe we pay around $220 a month for insurance. Mine costs $10 every 2 weeks and my wife/son is around $100 every 2 weeks.

The current system for benefits at our employers does reward a little bit of planning if you can help it - we clawed back a couple thousand in profit for taking out hospital stay insurance. We were planning a child and planned for a hospital birth, so that worked out.

There is also limited purpose FSAs - my wife knew she wanted some dental work done this year, so that was another tax free expense.

Then there is dependent care FSAs which helps with daycare. Not a large amount in comparison, but it helps.

Those 2 can be ran in parallel with a HSA.

Rete

Other than the lost of wages for some jurors whose employers do not pay them while on jury duty, why do so many people find serving to be a negative?

I have served on County, City and Federal levels of jury duty over the years. I've sat a few cases. Yes, I was paid by my employer and the time in jury duty was not deducted from my personal or vacation time. I've only been resident in MS for 6 years and have already been called to serve. They didn't want me once they discovered I've crested the hill and am on the downside.

S Folinsky

Although summoned, I have never been empaneled. Under the California one day one trial system, most often I never even made it out of the jury assembly room. In three criminal voir dires, I have been kicked on peremptory challenges. The only real pain in the rear was setting aside a week for the possibility of coming in for that one day.

Steerpike

Back when I was working and at the peak of my career, it's wasn't a 'money' thing, it was a time thing. I was always involved in high-profile projects on tight deadlines in small companies; having the potential to be sucked into a prolonged trial was a nightmare scenario for both me and the company I worked for; small startup companies don't have 'substitute' resources sitting idle just in case a key employee gets sucked away. It was traumatic enough when someone took vacation! But now - I'm retired, and I'd quite welcome getting called for an interesting case ... though as you say, I'd probably get rejected due to the very fact I'm retired!

S Folinsky

I was reliably informed that hardship waivers were hard to come by for excuse from jury duty in general but liberally granted for long cause cases. Three days was the dividing line.

retzie

I'm not really sure why we are doing this dance again. There are situations where you can find yourself on absolutely the right side of US health insurance: no contribution to premiums, no copays, no deductible, access to an outstanding network. And you can also find yourself on absolutely the wrong side of US health insurance: no employer plan, or a plan with high contributions/copays/deductible and/or crap network.

As an individual, you do NOT have access to all the levers that affect these factors. No amount of clever HSA planning will help you if your employer doesn't offer one. Could you go looking for a job that does check all the health insurance boxes? I guess you could try, but (a) there is no reliable way to find out what plans/options an employer offers from the outside, (b) you may need to change industries completely, and (c) no matter how willing you might be, your skills/interests may not actually have any possibility of landing you a job in a well-insured position. And of course there is the truly American irony: the scenarios that are cheapest for the end-user are often the ones that go to the highest earners.

In light of the above, the only real answer to the question of whether health insurance in the US is affordable is "it depends". It depends on what you have access to, it depends on what "affordable" means to you, it depends what your health needs might be. And once all those things are factored in, the optimal solution can land anywhere on the spectrum from "Outstanding" to "Impossible".

Jolly Good

At last...the voice of reason.
Well done that man!

sid nv

Can we please return to the original posit - it's really quite simple.
Expat for less than 12 months = FAIL.
Expat for 12 months or greater = PASS.
And if one has expatted to more than one foreign location for greater than the deemed 12 months, then that counts as a PASS for each location. So one can accumulate several expat passes, I suppose they could be termed 'E' levels. And it would be nice to receive a printed certificate of each 'E' level pass in order to have proof of one's expatability.

Pulaski

Yes, it does get very complicated because of all the variables, but I have tried several times, and given up before getting a precise answer, .... mostly because precision isn't helpful when there are big picture variables in play.

That said, before giving up I had reached a significant conclusion, which is that as long as we continue to max out out HSA contributions, the rate of depletion of our HSAs by maximum OoPs for consecutive and continuous years, is only about $2,000, and dividing our aggregate HSA balances by that number would take us well beyond statutory retirement age, and probably beyond average life expectancy. So with that conclusion, a precise answer isn't really necessary. .... And every year that passes sees a further increase in our HSA balances and reduction by one year in the (unknown) time for us to need/use our HSAs for healthcare expenses.

Steerpike

This is an excellent review of the situation overall, but I think it's worth noting that things have changed quite a bit in the last decade or so. US health insurance is still a wild and crazy system, but one thing the ACA (Obamacare) has brought is more predictability, especially to those WITHOUT access to the generally very good 'group health plans' that employers offer. Maximum Out Of Pocket numbers are now legally limited (circa $8,200 for an individual), and insurance companies can no longer deny coverage for pre-existing conditions, so this does help limiting exposure. Further, there are now some pretty impressive subsidies on premiums. I projected my 'retirement' income to be $50k this year, and as a result got a hefty subsidy on my premium. Had I predicted less income, the subsidy would have been greater. These subsidies were increased significantly by Biden (though they are set to expire next year). And even though I have a crappy plan from a state 'exchange', the network seems decent enough - I haven't had any issues seeing good doctors.

vespucci

Off topic, but I just want to mention that this is not really very impressive, given that he campaigned on "Medicare at 60".