Glasgow Girl

Liquidate to cash. If you want to invest in any kind of shared investment then take the cash and reinvest in regulated US mutual funds (the equivalent of UK OEICs, Unit Trusts and ITs). Any fund sold by a legitimate broker in the USA will be regulated. Shared investments are pretty much any kind of investment outside of cash deposits , property, and collectibles like wine, cars, etc. US mutual funds are extensive and have the same or better options than those available outside of the US. They are some of the best in the world with funds covering all markets and sectors. You won't be short of choice.

As I said, the tax implications of owning any kind of investment that is not regulated in the US are draconian. You are subject to these taxes the day you arrive, so make sure you sell BEFORE you get here. The only thing you should retain overseas are cash, property and collectibles. The taxes on regulated US funds are very fair and reasonable.

They call shared investments sold in any country other than the USA, PFICs. Google taxation of PFICs and if you can follow the nauseating details you will be ready to get rid of all of them once you understand the extensive paperwork requirements and tax ramifications.

bostonwilly

Hi Glasgow Girl, SanDiegoGirl and Rete,

Thanks for all the explanations of the healthcare costs, that is very complicated and also very important to understand what's covered, what's not, what we need to keep budgeted each year, etc. Dental costs not being capped is surprising to me - what about if there's an accident and significant restorative surgery is needed? Same question for vision. Or are cases like this normally considered part of the health plan rather than specific dental or vision? I need to ask their HR all these things.

On the investments I think this is something I need to look into some more, but converting everything to cash will not be difficult.

Cheers

Glasgow Girl

In the case of an accident your medical policy may cover some or all of the cost. The injury has to be severe and not merely cosmetic like a broken or missing tooth. Depending upon the details you could also claim on your auto, home or personal liability insurance, and if another party was responsible for the accident then you could claim on theirs. You can claim on more than one policy if there are caps on any one, and some states even allow you to double dip.

Who pays what, and how much will be determined by the nature of the accident, what procedures are required, who is responsible for the accident and the fine print of all policies involved. You won’t get a definitive answer until you are unfortunate enough to be in a position to need it, but in general you should have coverage of some kind in the event of an accident requiring extensive treatment.

Another useful thing to know is that if your wife has dental insurance through her employment and you also have it, then you can claim on both policies up to 100% of the cost. So if yours covers 50% and hers covers 50% then you can get each insurance to pay half the cost. Unfortunately, that is not the case for most medical insurance.

SanDiegogirl

With regard dental costs. If your child falls off their bike and breaks a number of teeth, your dental policy will pay up to $1,500 for restorative work and you will be liable for the rest. It could be thousands of dollars if a lot of work is needed. That is just the way it is. Dental work is expensive in the US and one just has to pay for it. In some dental practices they have their own dental insurance policy which you pay for in montly premiums and which you could use in addition to your company policy,
For budgeting purposes, you take into account your monthly premiums, deductibles, co-pays and out of pocket costs - that at least will give you a worst scenario.

bostonwilly

Hi all,
Thanks for the further advice.
So I think my healthcare budget should be about at least $20k per year? ($6.5k premiums, $15k OOP, -$2k HRA). Plus something to cover eye and dental care. If I've still not got it then please slap your foreheads in desperation and feel free to walk away and leave me as a lost cause!

tht

that is probably way to much if no disaster strikes... I just allocated enough for worst case year , and you only need to top it up if you use it. If the plan you choose is eligible an HSA is also a tax efficient way to do that.

bostonwilly

Hi tht,
Thanks, yes that makes more sense, I'll make sure I budget for it that way, then anything less than that in future years is a bonus.
Cheers

Glasgow Girl

Totally agree with tht. Budget for your annual premium because that is a guaranteed expense, and assuming your family have no chronic illness or serious medication requirements then perhaps have a reserve of one years maximum OOP, $13K I believe as you outlined above. After that I would budget about $2K OOP for a normal year in which there are hopefully no accidents or serious illness. That would provide for $4,000 of routine medical expenses. Even though you have to pay the full cost prior to the deductible, most doctors visits will be in the $150 +/- range unless you need a specialist which could be twice as much and more depending upon the nature of the specialist, annual checkups are free (well, included in the cost) and routine medications are usually reasonably priced. Once you hit your deductible your doctors visits will be very affordable, so again, unless you have a serious condition your should not spend too much more, and if a serious condition arises then you have your reserve fund to cover your for the first year and provide you time to think about the future.

With kids, I would expect to dip into your reserve fund now and then because accidents will happen, and routine stuff like tonsillitis can’t be ruled out, and that will get expensive quickly. If you can bunch non emergency procedures into one calendar year and max out the OOP that is another way to help with cost. The opposite with dental. Plan your dental work to max out your deductible each year (and no more), delay treatment for non emergencies to the next year if you can.

Others with kids might comment on how much they typically spend on health in a routine year. I only have to budget for the two of us. We are pretty healthy and rarely have even $2K of medical expenses.

tht

all preventative stuff is free... but yes swimmers ear with a prescription maybe $1-300. And by way of example my youngest needed ear tubes because he had fluid in them... not an emergency or accident, but because it involves general anesthesia. I think it cost a few thousand $’s...

I was in Singapore maybe 3 years ago.. I got a credit card spend alert... it was for $995... and said Plastic Surgery of Westport or similar... I txt my wife... my son fell at daycare and split the skin on his forehead... that’s the place recommend on the moms FB group and would not take Insurnace... pay up front and try to claim... refunded $0...

tht

This 1000%. If you need stuff doing, get ready to spend big!

I had been traveling extensively and neglected my teeth, I was seeing the dentist in the UK once a year while living in NZ etc.. anyway after I got married the boss sent me to her dentist... I had 2 plans, mine and hers so $3000 a year limit..... well let me tell you.... her office was amazing, you look out at St Patrick’s cathedral from the chair...

But I needed a ton if work doing... we worked out a strategy and did it over 3-4 years... maxing both dental policies and I probably paid another $2-3k out of pocket each year... by way of example 1 white on-lay (similar to a crown) cost $2200+ on its own... she worked her way around replacing all my childhood NHS stuff and got everything in great shape.. while it is expensive, and this may have changed in the UK, the tech they use here is amazing... they use lasers to cure fillings and are able to make temp onlays in the office to put on while you wait the week for the real ones to be ready to fit..

bostonwilly

Thanks for the info, it sounds like one can spend an awful lot on teeth! And anything else too.

Going off topic a bit:
I've never met any dentist who hasn't looked on work by previous dentists with disdain; literally every time I've had to change dentist the new one has said something like "oh dear, what happened here? Why did they do that?"! So, I'm going to be pretty sceptical of any dentist who says that everything has to be redone.

About childhood NHS stuff - do you mean silver amalgam fillings? Did they tell you that they have to be removed because the mercury leeches out and poisons you? That's what they told my brother in law in Washington too - but sadly it's a complete load of rubbish. The amount of mercury which leeches out over time is insignificant, and orders of magnitude less than the amount which will get swallowed if those fillings are ever removed. Clearly the best thing is never to have amalgam fillings at all, but once they're in it's safer to leave them where they are than remove them.

Rant over

Anyway, this all sounds expensive, I'll have to brace myself for the bills!

Cheers

tht

no, no bs or fear mongering.. I could see the issues with my own eyes, the new digital real-time x-rays they use here make easy and I could “feel” the issue and now they are fixed... I am sure there are shady ones who try to generate more work... but from my own experience I found the opposite here... the best providers are mostly closed to new patients most of the time, and you have to know people to even get in the door...

bostonwilly

Hi tht,
The best ones are booked up - sounds like dentists everywhere! Good to know that you've had good experience and dentists with integrity over there.
Cheers

SanDiegogirl

Not all US dentists have integrity..... I was referred to an endodontist by a new dentist for a re-working of a root canal due to infection (so he said). $1K later and at the end of a 1.5 hr treatment the endodontist more or less said could not do much, due to calcification etc etc. Come back for additional surgery if infection flares up. (which it has never done)
A rather strong letter, basically asking what had I paid a grand for, and a quick reference to the Dental council, he refunded me my money due to 'inabillity to complete work' ..... presumed dentist got a kick back from him too.

ddsrph

I think the endodontist is the one at fault for charging that much for treatment he couldn’t complete. I know he spent a lot of time trying but should have largely eaten that loss. The referring dentist did you a great favor by referring you to a specialist rather than barging in and making matters worse. If the failing root canal can’t be retreated the same way as was done initially a surgical procedure where the root tips are exposed and a sealing material is placed in the very ends of the roots. It’s called a apicoectomy.