We are both over 50 years old and in relative good
health. This is a problem age for
self-employed individuals and early retirees because private insurance plans
are expensive at this age and Medicare does not kick in until one turns
65. Pure catastrophic health insurance
is ridiculously priced or is simply unavailable. Further, private plans have limited coverage
while traveling and Medicare does not pay for health care costs outside of the
US.
In our research we were surprised to find that several
countries around the world ranked higher than the US in quality of health
care. In most cases, the cost of health
care in these countries is significantly less than in the US. Since we hadn’t
yet decided if we wanted to obtain residency in another country the option of
utilizing a national health plan wouldn’t be available to us.
Health care and insurance work differently in every
country. First we needed to figure out
how to obtain coverage (and health care) in Spain. Spain ranks very high
internationally in the quality of health care, in fact, much higher than the
US. Spain has a national social security
system which provides public health services to its residents for free or at
extremely reduced cost. Our perception
of public health care was that you might wait for hours to see a doctor or wait
days or weeks for an appointment but it will not cost you anything out of
pocket.
In all the countries we have researched there is also a
limitation of coverage in the public health service, for example, one might be
covered for a specific surgery, but reconstruction or cosmetic procedures that
would be normal in the US might not be covered in other places. However, the cost of these additional
procedures in other places can be a fraction of the cost in the US.
What should we do? A
requirement for an extended visa or residency in almost all countries is that
the applicant has made provisions for health care coverage. You can purchase international coverage that
will cover you in most places if you are planning to be in several countries. International health care coverage generally
excludes coverage in the very high cost countries (including the US) so it is
not an alternative if you are planning to spend significant time inside the US,
the UK, or a few other countries.
A country specific insurance plan is less expensive and has
the advantage of being tailored to work within that particular country’s
existing healthcare system. Most plans
we found both international and country specific can be purchased month to
month or at least quarterly so there is no long term commitment to a specific
plan. However, the old pre-existing
condition thing can creep into coverage anywhere so staying within one
insurance company’s plans can have the benefit of getting you past any waiting
period that might exist for coverage of a specific problem. By purchasing from a large international
insurer, like BUPA your time under contract begins when you purchase your first
policy and continues as long as you are insured with them, even if you were to
change your country of residence and plan several times under their umbrella.
We looked at many plans and found some great service
providers that offer English speaking agents so that communication is not
difficult. Everything can be handled
over the internet with applications or health questionnaires signed and
scanned. We were actually surprised at
the ease of obtaining quotes and descriptions of coverage
For us, we chose a BUPA plan for Spain. The Bupa program in Spain is called Sanitas
and it is offered for purchase through agents. It is Spain’s largest private
insurance plan and offered the most options for us at a very reasonable
cost. The plan covers us for regular
doctor visits, lab work and hospitalization within Spain and also covers us for
up to 60 days of travel time outside of Spain for accidents or injury
(including the US). If we were
traveling in the US and had an accident the BUPA network in the US is United
Health Care.
A one page application and a one page statement of health
was emailed to us, we filled them out, signed them and scanned them back. Assuming we would get long questionnaires
about previous health histories and adjustments to the basic premium quoted we
were amazed when the following day we received an email simply asking what
credit card we wanted to have our premiums charged to each month and when we
wanted our coverage to begin.
Copays and deductibles work a little different than in the
US but you can generally modify your coverage and out of pocket costs to arrive
at an insurance premium that works for you.
Compared to US health insurance plans, coverage may seem to have lower
maximum reimbursement but remember, health care costs a lot less in most other countries.
Our plan looks like a regular US PPO plan with no
deductible. Our copay for doctor visits
is 12 euros and for a hospitalization it is 24 euros, all lab work ordered by a
physician is included. Prescription
drugs are not covered simply because they are so affordable in Spain that
coverage is not necessary. Dental care,
on the whole, is very good in Spain and significantly (40% to 50%) less
expensive than in the US but dental coverage is relatively expensive so we
decided to exclude it.
This plan was very similar to a private plan we had in the
US that cost approximately $2,000 per month (for both of us). There was very little medical information
requested (mostly surgeries in the past 10 years and any chronic conditions) and
the company did not blink at any of our historical medical information. This plan costs us 140 euros or about $185
per month for the both of us together.
Wow, suddenly our monthly budget for designing a life
overseas became much more reasonable and we started to seriously think that we
might just be able to continue to live elsewhere around the world before or after
our Peace Corps Service. We were
beginning to get the idea that even on our very limited budget we might really be
able to afford it now instead of waiting for that ever elusive “retirement”
age.
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