Groover

Hello. Over the last 14 years my wife (USC) and I (UKC) have lived in the US and now the UK. During that time I became a dual-citizen and now while we are living in the UK my wife is about to hopefully become a dual-citizen.

We are looking at the next steps which is to spend six months in each country, starting in a few years time when our financial ducks are in a row.

Income, housing, pets, etc. are all solvable problems, but what I cannot seem to solve is healthcare.

My wife is disabled and has Medicare so in the US she would have access to a Medicare Advantage HMO plan. I would get an individual plan. All pretty straightforward.

But what about the UK? My understanding is that we would be able to access the NHS if we are out of the UK less than 182 days a year (applies to England only), but that limit could easily be changed by a future government. Also I'm not sure that even applies to GP/prescriptions or only hospital treatment. It's all very confusing.

Bupa UK excludes pre-existing and chronic conditions, so we can't use that.

Travel insurance purchased in the US for the UK for six months at a time might be an option? She would need to be treated in the UK rather than having to return to the US for treatment though. Are there any plans that fit our situation?

My wife has daily injections. If that is obtained under her US plan can they provide six months worth of medications for a long trip in one go? I think probably not.

Any other options? Anyone else here choosing to be "international snowbirds"?

Thanks, Andy

jmood

Bump.
Surprised this hasn't been answered.

Pulaski

Seems like a classic "first world problem" to me. If you can afford to flit back and forth with your pets, you can afford to pay for the necessary medical insurance, and if you can't afford the insurance, then perhaps you can't afford to flit back and forth after all.

I suspect that the answer is more of a 5:7 split not a true 6:6 (183:182) split, thereby attaching your medical treatment more clearly to one country, and also clarifying your tax position too.

jmood

Ah, I see. What would be the tax/insurance position if you did split 6/6. Or if you split say 5, 5 and the remaining 2 in random places you vacation in?

scrubbedexpat099

May be a question of terminology, UK resident as far as the NHS is concerned and visiting the US,.

Groover

Yes, I think you are right. As far as I can tell we just have to prove that we are ordinarily resident in the UK. See http://www.hmrc.gov.uk/manuals/cbtmanual/cbtm10020.htm "Ordinary residence: leaving the United Kingdom". Reading through that list I think we can meet all of the points raised. If the split is 5:7 US/UK then the proof is stronger.

Andy

Groover

I can't find any health insurance in the UK that covers pre-existing conditions. Can you please provide a link? Thanks!

robin1234

I did see the OP when it first came out, didn't realise it disappeared off the front page unanswered!

We are thinking of something similar, but with me spending (say) eight months of the year in the UK and my wife spending most of her time in the US.

One thing I'd say, I'm reconciled to paying, and continuing to pay, Medicare Part B from age 65 on even if I don't live in the US and don't use Medicare. That way I protect my options for the future, if I end up living full time in the US at some time in the future.

Because, inevitably, people who are lucky enough to survive into their seventies, eighties, maybe nineties, have to recognize that at some point the desire and ability to fly back and forth dwindles. In very old age you have to settle in to one place to live, probably independent living or assisted living or whatever ...

Pulaski

Honestly I'm not sure, but I would guess you'd run a heightened risk of audit by the IRS in both countries.

So, live in the UK for more than six months of the year, and use the NHS.

rpjs

The UK government has recently proposed giving ex-pats the right to access the NHS if they have built-up a sufficient record of NI contributions. This is still only a proposal but worth keeping an eye on as it will benefit lots of people in this sort of situation.

Giantaxe

This is what I'm hoping for.

Additionally, don't some Medicare Advantage plans cover treatment outside the US?

Steve_

You could get prescriptions in the UK but you'd have to pay, but the prescription costs may not be that bad, depends on what she takes. The prices aren't insane like they are in the US. So you may be able to manage that way and get some travel insurance in case there's an emergency while in the UK.

But anyway the key point I just wanted to make is that if you claim healthcare benefits, that is a key test for tax residency.

And being a US citizen you have to file a 1040 anyway. And now with Obamacare if you reside in the US you have to have healthcare coverage.

Given that travel insurance usually goes up in a puff of smoke or massively increases in price after the first time you use it, I'd do it from the US end because it's undoubtedly more expensive in the US in an emergency.

I.e. be resident in the US and a visitor to the UK. The NHS isn't going to be as anal as a private healthcare company would be about your bill.

Plus you've got to file a 1040 either way, but you can avoid all the UK tax stuff by being resident in the US. Remember to cut all your ties to the UK, NHS card, DL, etc. anything only a resident would have. Because you meet the HMRC test for residency otherwise.

jmood

Why does holding a UK DL make the person a UK resident for HMRC?

scrubbedexpat099

Sounds like they would be better off being resident in both countries.

They have to buy O Care anyway and they would use the NHS in the UK.

durham_lad

Sorry that I missed this initial post, since we plan on doing something very similar.

Our plan is to split our time at least 7/5 UK/US, and be classed as domiciled in the UK, paying taxes in both countries as per the dual taxation agreement.

We will still be 3 years short of Medicare when we move, and plan to continue our current US Health Insurance, and then sign up for Medicare at the appropriate time. (Medicare will not cover us in the UK and the NHS will not cover us while in the UK).

Currently our HI, a PPO plan from Blue Cross Blue Shield, covers us worldwide and just this week I have been online and looked up "in-network" Doctors and Hospitals for the places we'll be spending a lot of time this year, a month staying with my brother in MacKay, Australia, 3 weeks staying with a friend in Brisbane and a month staying in Hobart, Tasmania. I've made copies of the details onto my iPad and Google Drive in case we get sick or injured while in those places.