SDER

Okay - one of the determining factors on whether I should move back to the UK from the USA is whether I would be better off in the UK or USA at retirement.

Firstly, I cannot foresee being a homeowner or having significant retirement funds in either country

Soooo..

1) Medicare versus National Health Service - which is better/cheaper? Would I need to buy a Medicare top up in the USA or have any other Medical expenses with Medicare

2) if something happened to me ie. medically etc., and was not able to afford housing, where would I be better off UK or USA? Would I be thrown out on the streets in either country or would I be put in a home?

3) Again housing - Are there any cheap housing programs in either country for retirees? ie. Developments for retirees where you dont have to pay high rent, or high mortgages. If so, how much roughly are these?

4) which country would have the higher government pension (have paid into both governments)? If so how much would I receive approx?

Any other differences/advantages on either country?

Thanks!

Mummy in the foothills

I can only answer from what I have seen here as a home visit nurse mostly to medicare retirees in a low income area.
Yes they really did need a top up policy, how much they cost depends on what you want. You can do anything from nothing (and have limited services) to HMO like Kaiser (friends Dad has that it seems to suck) or a PPO like Blue cross, you still have to see in service doctors and hospitals to keep you share of cost down.
National health, no cost at point of service.
Here in US if you cannot live alone and end up in a nursing home (god forbid) unless you have some sort of health plan that covers this stuff, they make you spend all your money then cover basic care. I have been into and worked in a few homes, the private one was gorgeous, but didn't give as good a care as I had seen in a UK council run home (I've only ever been in two in UK and worked in one so that knowledge is limited). The ones filled with medicare only patients were abysmal, from my experience.
Housing? Where I am there is no housing for people who can't afford anything.
There are really cheap rentals in my tiny town (4 way stop kinda place) but nothing exclusively for indigent old folks.
On a sad note. I went out to visit one of my patients on the day he and his family were being evicted for non payment of rent. The sheriff was there I went over and tried to make sure he had all the dressings I could get to him, as I left, they only place they had found for him to stay at, was the mens homeless shelter one county over, he had 30 minutes left to vacate. He had no legs, no transport after that day and trying to get his wheelchair and bags into the small car a friend came in was proving difficult.

I have no idea how much ther retirement pensions here in US are, doesn't it depend on how much you have paid in?
Uk I only know to get a full pension you have to work 30 years. But theres some sort of agreement between the two countries from what I can gather. I'm sure someone will come along who knows more about that I remember reading about it here.

farmerwife

1. NHS would be less expensive generally compared with Medicare. For Medicare, if you have 40 quarters contributed you would receive Medicare Part A (hospitals, briefly)as a "no charge".
Part B still costs $96.40 per month (doctors, briefly), generally deducted from your monthly Social Security check.
Which leaves Part D, (meds), cost of which depends on your choice of Plan (100s of confusing options, most of which still have deductables and copays which can add up.)
Part C, (used to be) the "medigap" part, is optional supplemental coverage. Medicare doesn't cover you for overseas for instance.
4. How much you receive for Social Security depends on how much you have paid in, and when you decide to start receiving it. A calculator and other info available here - http://www.socialsecurity.gov/planners/#calc

SDER

OMG X 2!!! So, if you wanted to be covered for doctors visits you would have to pay Medicare $96.40 per month?
what do you mean by briefly, when it comes to doctors visits & Hospital? Thanks....
If you dont mind, how long would you have to pay into medicare to have 40 quarters?
Do you have to pay for the Part D plan (to receive meds) as well as the copay?

Golly! My decision on my future is quickly being made.

I am so pleased that I posted this question on this forum, and received such knowledgeable answers. I just had no idea!!

Thank you both!

farmerwife

Part A coverage - hospitals
Part B doctors, + outpatient hospital services, some other medical services - up to a %.

Here's the long version - http://www.medicare.gov/MedicareEligibility/Home.asp?dest=NAV|Home|GeneralEnrollment#TabTop

40 quarters is basically 10 years if you worked continually ( 4 quarters x 10 years).

Yep the monthly pmt for Part B (raises annually, who knows what it will be in the future) is paid by all, unless destitute and on your State's Plan.

Part D has costs too. My MIL pays $50 per month for her plan, and her out of pocket per month for meds still around $150. Some meds you have to fight for coverage with the company (doctor's letter saying nothing else works etc, Celebrex for example). Some meds not covered (Tussionex for example).
There are 100s of plans, varying by State.
Good Luck! - it's a minefield!

(link seems to be broken - try this for a summary - http://www.medicare.gov/MedicareElig...nguage=English

SDER

I am so shocked at how much one would be paying for just basic care through medicare! If I wanted basic coverage through Medicare ie. Doctor, hospital, meds - I would be looking at $150 (excluding copays)?!

Seriously...how do people who retire with an average retirement survive?

It really looks like I would be better off retiring In the UK, bearing the medical coverage in mind, as well as one of the points Mummy in the hills brought up (council run home in the UK being better than a private one in the US)

surly

You can only qualify for a council run home if you have less than XXX pounds not sure of the actual amount. If you own a home forget about it.
If you piss everything away and never saved a penny you have it made in the UK. If you saved and own a home you're screwed.
Looks like the UK would be your best bet,

Mummy in the foothills

Or live in Scotland where the nursing homes aren't means tested for placement.
My Dad ended up in a private Catholic nursing home in UK. He had nothing but his OAP and a tiny pension from Hotpoint. He moved to the home after a long hospital stay and the county covered the whole thing. I was really grateful for that, he was clean and comfy for his last two months in this life.
When they said they got him a place with the sisters of mercy (or something like that) my sis and I thought he'd burst into flames when he got their, the least religious man we know
My mother visited him once (divorced over 30 yrs) and the nuns were the best, she thought it was a lovely place for him to end up.
No overwhelming smell of piss and popcorn like the US homes.

surly

I was involved in getting a relative a place in a nursing home in the UK.
It's not all roses as you paint it. Especially in the greater London area, and some of them smell of piss too.
They wouldn't even consider her until we sold her home, and we had to get a bank loan to cover the cost until her home was sold, at considerably less than market value I might add.
I would agree a nursing home in the UK would be preferable to what you might end up in here in US if you have a limited income.

As a footnote the place she ended up in wasn't run by Nuns but a Pakistani, and cost over 2000 pound a month

Bob

Might want to look into any state run plans on offer.

Mass has reduced rates for a state plan medical, but you'd need to be earning less than $12K to get it and the rates are a sliding scale and it's really only for basic coverage.

Each town has to also set aside cheap housing and where I live, that's $300K condo by the mall, next town over, it's a little less but it's in a right dive of the town...for old folks home there isn't much, nothing cheap. There are some nice places that the state could help out with if you were suffering from some serious issues but it's grim pickings.

On the other hand, there's quite a few "cheapish" but very nice old folks homes up in Maine.

Another thing to look at are meds, prescriptions, you might find stuff at walmart/target etc on the $4 plan which can be good, other wise you could be expecting a lot of money depending on your insurance...it's partly why you see 80 year olds greeting people at the doors at Walmart, they don't do it because they enjoy the job but for a need for medical insurance.

dunroving

For the medical care side, you can't beat the UK ... with the caveat that there is a certain truth to the "post code lottery" thing (standard of care is better in some areas than others).

I think the NHS is becoming overburdened though, and it will only get worse as people continue to lead unhealthy lifestyles and expect the NHS to rescue them. The decision to make prescriptions completely free is IMO also a big mistake - too many people pestering doctors for prescriptions they don't need, don't take, and flush down the toilet into the water treatment system.

I read recently (in the Times) that almost 20% of the population of Milton (not far from where I live) is on Prozac.

So, while the NHS is currently a better bet than Medicare, I think there is a trainwreck just waiting to happen. Things change.

Mallory

When you get old, you are better off in the country where you have relatives who can help take care of you.

As far as paying for Medicare - yes you do have to pay, if you are over a certain income. If you under a certain income, it would be topped up with Medicaid (healthcare for the poor), where you would pay nothing for medical care, meds, or nursing home.

Social Security payments (state pension), would normally be about double what it is in the UK. The UK has the lowest payments of state pension in Europe. The US payments are much higher, so that offsets a lot of the Medicare fees. There is a reciprocal agreement between the countries, and your years would be topped up either way. You stand to get more if you are paid in the US, because you would get paid at US rate. The full pension in UK would be about $7k per year.

Most people in nursing homes in this country (unless they are wealthy), are actually being paid for by Medicaid. My MIL owned a house, and did not have to sell it while she was in the NH. In the US when in a nursing home, the house is not sold until after the person dies, and then if you owe Medicaid something, it can be paid out of the sale. My MILs estate was not charged anything. In the UK (unless there is an infirm person living in the house), the house has to be sold before the person goes in the home, and the money used to pay for their care.

I have had several older relatives in nursing homes in both countries, and believe me there are good and bad in both places. You have to shop around.

Sheltered housing in the UK is not free unless you have a VERY LOW income. You have to pay rent, means tested. My mum and her sister both lived in sheltered housing when they were elderly, and both paid rent.

As I said - best to live near family, wherever that may be.

lansbury

Actually that isn't the case.

My mother had a stroke and after she left hospital need to go into a nursing home as she couldn't look after herself anymore. She owned her own home.

Brent Council paid for the first 12 weeks of care while she was assessed to the level of care she needed and we all agreed the home I had chosen was in fact where we wanted her to be and could provide the care needed. After 12 weeks they carried on paying the bill while I sold her home. When it was all finalized I repaid the Council the cost of the home from week 13 onwards. That is how the system is required to work.

surly

That certainly wasn't the case for my relative.
She lived in Hounslow, and we had to get a loan from the bank to bridge the gap between the time she moved into a nursing home and the sale of her house.
Things may have changed as that was in 1997. We got absolutely no help from the council or anyone else, in fact as soon as they knew she owned her own home they as much as washed their hands of her.

The Horticulturalist

Not sure that's correct. In theory you have 'free personal care' for the elderly (though family members of mine have found it hard to get that service), but that's doesn't cover the accomodation costs, you would still be required to pay the remainder.

If you needed nursing home care then none of the cost of that would be covered.