Medicare for RExpat/Not Worked in the US
 

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Moderator ntoe

And speaking of Switzerland, we (I'm an American, my husband is Scottish) have lived in Switzerland for 30 years. We have excellent, very expensive private health insurance here (and are going to make enquiries about keeping it, though that's doubtful). We are hoping to retire to the States at the end of this year. What is the current situation with the new legislation, etc., for retirees (who never contributed to Medicare) to get affordable health insurance? I know the new law comes into being in 2012 (unless the Republicans do a nasty). Does anyone know how it will work in practical terms for a returning expat and a Brit?? Thanks!

Re: Using NHS in America
 

It will be very expensive and unlikely to be very good.

Do you have any existing issues?

Are you old enough to buy into Medicare?

Re: Using NHS in America
 

It will be 2014 before it is fully implemented with the health insurance exchanges.

Re: Using NHS in America
 

I thought the law was supposed to come immediately into effect with regard to pre-existing conditions? A young (26 year old) American girl was working for my company here and - as Switzerland obliges all residents to purchase private insurance - she did. A year after her arrival in Switzerland she was diagnosed with Stage IV kidney cancer and had to have 4 major surgeries (2 brain surgeries) - probable cost $1 million to the Swiss insurance company, all covered by her basic insurance coverage. She was finally able to return to the States last summer as she was able to get health insurance there (she had no health insurance in the US prior to her stay in Switzerland) - so I'm assuming excluding patients for pre-existing conditions is no longer legal. I haven't contributed to Medicare and am not old enough yet - I've understood if you don't contribute to Medicare for at least 10 years prior to age 65 - you can't get it.

Re: Using NHS in America
 

No, you are overestimating how big the changes are. It's not as cut and dry as just "insurance," there are different types, private and group.

Firstly, pre-existing condition is a legally defined term and it doesn't really mean pre-existing condition. It is defined as something that you have been diagnosed with, received medical advice for or been treated for in the previous 6 months. Anything could happen outside that period and it legally isn't a pre-existing condition. There are also a few things, like pregnancy, that can't ever be called pre-existing condition.

Group is basically what you get via an employer, since HIPAA was introduced they haven't been able to deny you a policy for a pre-existing condition but it can deny coverage of that condition for 12 months (18 if you enroll outside open enrollment periods). If you have had creditable coverage, which the insurance in Switzerland should be, you can use the time you were insured with that against the exclusion period as long as you have had no gaps of 63 or more days between coverage. So if you have had creditable insurance for 10 years and then immediately got group insurance in the US you would have no wait time for pre-existing conditions to be covered. However, if you wait 3 months to get a group policy then you can't use the 10 years of insurance so would have to wait a year for pre-existing conditions to be covered.

Private insurance can do anything they want pretty much. However, the law that went into place today says that people under 19 can't be denied a policy because of pre-existing conditions. That law will be expanded to everyone in 2014. That only means you can't be denied, it doesn't mean you will be offered a good or affordable policy.

For you, unless you get a job that offers health insurance you will be on your own. You may or may not be offered a policy which may or may not cover any conditions you have but almost certainly it will cost you a lot. If your state has a high risk pool you might be eligible to join but they are generally quite expensive and average coverage. In 2014 all that will change is you will be guaranteed a policy but the price could be anything. It's important to remember that the word "affordable" has no legal definition in terms of healthcare in the new laws so is essentially meaningless.

It's very, very complicated and you will need to spend many hours researching it if you think you will be needing insurance. Never believe a quote unless you have a written contract to sign that has a price on it, most are teasers based on somebody in their early 20's in perfect health.

Re: Using NHS in America
 

You can buy into Medicare at age 65 without contributions..

I assumed that you will not have access to a group policy, sounds like you are not coming back to a job which provides it.

Re: Using NHS in America
 

By "buy into" Medicare what do you mean? No, we are both planning on retiring, so no work-related health care.

Gosh, it sounds like the "revolutionary health care bill" is a dud. Will it improve anything at all?

Re: Using NHS in America
 

With respect, it'll improve the lot of many, while negatively impacting almost no one at all - except, perhaps, the insurance providers.

Ian

Re: Using NHS in America
 

If you mean a dud as in it doesn't offer free healthcare for all, then yes, it's a dud. However, it will improve options for people who were/are un-insurable, guarantee all children have insurance, tries to make a primary doctor the center point of care, allow children to be covered on their parents policies longer so they don't leave college with no job and no insurance and helps make data sharing and access more efficient.

Re: Using NHS in America
 

Call me bemused. I don't understand - it seems like there will still be exclusions for pre-existing conditions + potentially exorbitant health insurance costs. There was THAT before! So the law only really affects children then? That's good but not enough. How disappointing.

Re: Using NHS in America
 

For preexisting conditions for a person is denied health insurance, there is a temporary $5 billion government provided risk pool available until the 2014 health exchanges are in place.

She may have been covered by the risk pool or possibly she got a job with a company that had a health insurance plan (she then cannot be turned down for coverage and cannot be charged more than any other employee of her age).

Re: Using NHS in America
 

There will not be pre-existing conditions in 2014. This gives a rough idea of what it's all about.

http://www.healthcare.gov/law/about/index.html

http://www.healthcare.gov/law/provisions/index.html

Re: Using NHS in America
 

In 2014, everyone will be able to get health insurance at a reasonable price (similar to Switzerland with a maximum premium of 10% of family income). The cost of health insurance through the health exchanges will be $0 for family incomes below 133% of the poverty level and will be subsidized for families below 400% of the poverty level.

Besides the income subsidies, the government will pay the additional cost of premiums for preexisting conditions.

All of the above assumes that the family does not have employer provided health care plans.

The following is a calculator that will estimate the cost of health insurance in 2014.

http://healthreform.kff.org/SubsidyC...spx#calcParams

Re: Using NHS in America
 

I think this reflects a lot of people's views - but I don't believe the new health law was ever intended to be the final answer or a perfect solution. It's just a step in the right direction, and will be improved on in the future as people realise what is possible and what they ought to be able to expect.