7 ms·
No doubt based on that recommendation Ames is a great place to live, but you're still in the American healthcare system which could financially drain you dry fr
by technofiend 7y ago
No doubt based on that recommendation Ames is a great place to live, but you're still in the American healthcare system which could financially drain you dry from one major medical incident. The article specifically mentions cheap healthcare as the other draw besides cheap cost of living.
- colechristensen 7y agoI don't really understand this. Max out-of-pocket for insurance plans now is very reasonable. If you can afford a $250k house, you can afford the max out-of-pocket cost for many many years.
- chrisseaton 7y agoDon't you also have to pay the actual insurance premium as well? Before you even get to the out-of-pocket costs? I have friends in the US who pay thousands a month for health insurance premiums.
- colechristensen 7y agoAll except the smallest employers are required by law to provide health insurance to full-time employees and may have employees contribute up to only 10% of their household income. I did some random shopping for a typical family of 5 and found a max rate of ~$1600/mo for insurance premiums. You would only pay this if you were self-employed, part-time employed at a pretty shitty job, or unemployed and run out of the various mechanisms to keep your insurance. After that you have to spend your net worth until you qualify for the insurance benefits for the poor in your state. In reality, with various employers I have paid between $0 and $200/month for insuring just myself. (I have paid $0, I don't remember the most expensive, but it was <$200 in any case) Who gets screwed and bankrupt are the lower-middle class who can't manage to get a full time job, especially single parents who get sick. The system is biased towards benefitting married partners with children, only one person needs that full time job to cover everyone. If you are in the middle class or above and do only a small amount of planning, you're fine. If you are below the middle, you generally have to lose everything or go bankrupt before the system will help you – people in that position are often the least equipped to figure out and head through the optimal path for themselves and end up making very bad decisions. We don't need public healthcare, we need better support which reaches higher up the income scale and better education.
- nodemaker 7y agoI find the idea that employers should have anything to do with healthcare quite revolting. Healthcare should be a deal between you and the government for which you should pay taxes. This and some other reasons are why I cannot fathom living in the US under 250K a year.
- colechristensen 7y agoWhy? Why is one large bureaucracy better than the other?
- mellosouls 7y agoOne of the large bureaucracies will be there as long as you're alive, and there is no need to switch between health provider paperwork or worry it will disappear when you change jobs or become unemployed.
- freeone3000 7y agoBecause one isn't in an adversarial relationship with you?
- ohithereyou 7y agoI have some bad news for you - the administrative state is very much in an adversarial relationship with you if you do anything other than breathe.
- baddox 7y agoYou may be in the fortunate position that your government is not in an adversarial relationship with you. There are many people with that good fortune. But there are also many people who are not in that position.
- pjc50 7y agoThe government isn't an "at will" arrangement from which you can be sacked?
- ethbro 7y agoAt 65 you're eligible for single-payer, government-supported Medicare. I'm not old enough to be keeping an eye on the numbers, but it looks like ~$450 / month for hospital (free) + doctor (subsidized) + prescription (pay).
- danielhughes 7y agoThat’s correct but Medicare is not a viable option for Americans living abroad because it does not cover overseas healthcare.
- seanmcdirmid 7y agoMedicare should work in Guam and other US territories.
- geomark 7y agoThen you consider that the total unsubsidized out of pocket cost for a surgery at a private hospital in one of the medical tourism destinations amounts to only a few months of premiums. And on top of it the service and hospitality with which the medical care is delivered is unlike any you've ever even imagined in the US.
- trevyn 7y ago>I have friends in the US who pay thousands a month for health insurance premiums. This sounds like an entire family with a higher-level plan, correct? Higher-level plans have correspondingly reduced out-of-pocket maximums, to the point where the out-of-pocket maximum can be as low as $2000/year — so your premium is nearly your entire spending.
- lotsofpulp 7y agoMy parents in late 50s pay $2k per month for a bronze plan with an OOP max of $14k.
- wavefunction 7y agoI am just about to sell my father's $320,000 house so I can pay for his nursing home care. He sadly did not have the foresight to acquire long-term disability insurance or put his assets into a trust so we'll be paying out of pocket until his money runs out and he goes on Medicaid, which will still only cover 60% of his care. $320,000 / $8000+ a month (not including rising costs) means he has 3.25 years of care coverage paying out of pocket which I don't consider many years.
- stock_toaster 7y agoDon't forget about the annual max gift tax limit (15k for 2020). Your father could reasonably gift you 15k a year (possibly another 15k to your spouse if you happen to be married) to reduce his savings a tiny bit quicker, so medicaid kicks in a bit sooner. At that point you could maybe even claim your parent as a dependent, and help him pay for his medical costs (which I think you can also deduct?). I'm not sure on the particulars, and certainly don't take the above as any kind of financial advice -- I just started looking into this for an aging parent myself. Though, it might be worth talking to an accountant and see what is applicable for your location.
- stevenwoo 7y agoThere are the local medicaid/medicare administrations and elder care law specialists that can advise on medical care as well as the various tax writeoffs and eligibility for programs that the poster should investigate now since rules vary so much from state to state in the USA, and he is talking about years of care.
- DennisP 7y agoIf I understand correctly from my non-CPA googling, $15K is just the amount you don't have to report to the IRS. You can give more, up to a lifetime limit of several million, before the gifts are taxed. How that interacts with medicaid, I have no idea.
- Gibbon1 7y ago
- trianglem 7y agoI just got billed $22,000 for a rabies course and I have good insurance. Four rounds of immunoglobulins are expensive.
- rhacker 7y agoWhoa, I always figured that Rabies would be like a state covered thing, given that generally every case makes a news article. Sorry that happened to you, did you for sure come in contact with Rabies or just suspected?
- trianglem 7y agoStray dog so there was a small chance.
- technofiend 7y agoNow you know why I'm waiting to see my PCP despite having earlyish symptoms of heart disease. Should I have a heart attack it's better to leave my wife a cheap, dead corpse and a life insurance payout rather than an expensive out of work husband. That's the calculus of the American medical system.
- colechristensen 7y agoAre you uninsured? Get checked. Think about it. If you're worried about money you will spend less if you catch and manage something early than if you're late and whatever you have doesn't kill you but makes you very sick. If you're not insured, get insured. Financial planning via expecting death is just foolish.
- colechristensen 7y agoDid you "get billed" that much in that this is what you now owe? Or did you get a "bill" that listed before-insurance numbers which nobody pays and might as well be spit out by a random number generator?
- tptacek 7y agoIsn't this article about retirement-age Americans, who are covered by Medicare?
- danielhughes 7y agoCorrect so a lot of the comments are not relevant to the article. But to clarify, Medicare does not cover Americans who choose to live abroad.
- tptacek 7y agoRight, but the point of the argument is that people might leave the US because health care is so much cheaper abroad.