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Planning for Health Care in Early Retirement

We value our health pretty much above everything. If we had a such thing as a “health portfolio,” it’s safe to say we’d value that above its financial counterpart. Not that we’re perfect on healthy habits (see the great tater tot debate), but we try hard to make good choices so that we’ll be able to enjoy long, healthy lives. We want outliving our money to be a very real possibility, not because we mismanage our funds, but because we live that long. #goals

Something we are thinking a lot about — of course! — is how we’ll ensure that we always have access to good quality medical care at every stage of our lives. We know this is top-of-mind for lots of other American early retirees and aspirants, as well, and it’s hard not to feel like all of the current Affordable Care Act (ACA)/”Obamacare” options could change at virtually any time. We’ll have a new president next year, health plans are dropping out of the ACA,  and the merger of other plans is raising issues about price competition. (Friends in Canada, Europe and Australia — we’re soooo jealous that this is a non-issue for you! Feel free to taunt us dumb Americans in the comments.)

Related post: The Moral Ambiguity of Obamacare Subsidies for Early Retirees

We’re probably a little wacko for considering postponing our early retirement until the health care landscape is a bit clearer, but we’ve also moved past that idea, since we now accept that the landscape will probably always be shifting. We’ll just have to view health care coverage as a moving target, at least until we get to Medicare age, assuming Medicare is still around in 25-30 years. In the end, our health care plan probably won’t end up looking as clean and simple as what we’ve mapped out:

OurNextLife.com // Health care coverage planning in early retirement and traditional retirement

In the meantime, here are the health care options we’re keeping on our radar. (Also, how much does this pinnable image with the ferns look like an actual health plan brochure? Hahaha. No insurance for sale here, folks!)

OurNextLife.com // Planning for Health Care in Early Retirement -- Obamacare, ACA, health insurance, medical coverage

Coverage on the ACA Exchanges (“Obamacare”)

Especially for those who qualify for subsidies (essentially discounts), as we plan to once we quit working, ACA coverage is probably the most affordable option when you factor in everything: premiums, copays and out-of-pocket maxes. Assuming there are any insurers still on the exchanges when we quit, this will be our first stop. Plans on the exchange have to be comparable as “apples to apples,” and are rated as platinum, gold, silver and bronze to make it easy to research the differences between insurers’ plans. Of course, there are still plenty of considerations to keep in mind, especially the subsidy cliff, as expertly outlined by Justin at Root of Good, and the impact of Obamacare on taxes, laid out in detail on Go Curry Cracker. Plans, costs and subsidy limits also vary by state and sometimes county. You can find out prices where you live by visiting Healthcare.gov, and it will route you to your state exchange if you have one.

Non-Exchange Health Insurance

The health insurance reforms mandated by the ACA (having to cover preventive care, disallowing different rates for men and women, no more annual or lifetime health coverage limitations, etc.) apply to all health insurance now, whether or not it is sold on an exchange. So for those who don’t qualify for subsidized coverage on an exchange, it may be a better deal to find other health insurance sold directly by an insurer since you’ll have more choices in most states. It’s smart to look at the fine print, though, since off-exchange plans aren’t held to the same qualified health plan (QHP) standard, and may or may not be comparable with exchange plans in your state. Also note that if you enroll in an off-exchange plan during the open enrollment period, you can’t switch to a subsidized exchange plan mid-year, even if you have a drop in income. You have to wait for the next open enrollment period. While we plan to get subsidized exchange coverage, if our income went up unexpectedly in retirement, we’d definitely do some price comparison shopping and include non-exchange plans in that research.

Related post: Protecting ourselves from higher health care expenses later in life with a big nest egg… for later

Catastrophic Coverage

Catastrophic coverage is insurance that only kicks in after a high dollar amount, and is meant to cover only the true catastrophes: serious illness or major injury. With this kind of insurance, you are on your own for routine and preventive care. Right now, only people under 30 are eligible to buy catastrophic plans, but in the pre-ACA past these were available to everyone. While we don’t love the idea of switching to a system that gives us a price disincentive from getting preventive check-ups, since we’d have to pay for those out of pocket above and beyond our insurance premiums, we’d definitely consider a plan that just covers the big stuff at a lower cost if the ACA goes away. We want to know that a serious illness or injury won’t wipe out our nest egg, and a catastrophic policy could still protect us in the case of, well, catastrophe.

Medical Tourism

If things get crazy with the ACA — let’s say every insurer drops out of the exchange so that no subsidized plans are available, but for some reason we can’t get a catastrophic plan — medical tourism is our next line of defense. Excellent and cheap health care is available in plenty of countries around the world, and we could make use of it if need be, especially since we plan to travel the world anyway. If we’re planning to visit, say, Thailand, then getting some dental care while we’re there is no big deal. Or if we need more extended treatment for something, we might post up for a while in-country. Several countries have built websites in English specifically focused on promoting medical tourism, like this one for India. The CDC has some cautions worth noting when considering medical tourism. And this option doesn’t address the individual mandate for health care coverage for U.S. residents — we might still be looking at having to buy health insurance of some sort, or having to suck it up and pay the tax penalty.

Full-Time Expat Living

Leaving the country is always on our radar as a potential future option, especially if the markets endure a sustained crash with rampant inflation and our dollars don’t stretch far enough in the U.S., or if health care costs just get totally out of control. We hope to stay put where we are, but think it’s smart to keep this option on the table in any case. While we would go back to work if things turn south in our planning within the first few years of retirement, but may not have that same luxury after we have several years away from the job market and have made our skills obsolete. As Go Curry Cracker also mapped out, living abroad exempts you from the ACA individual health care mandate, though there are limits then on how much time you can spend in the U.S. (roughly a month a year). Full-time expat living would be a huge adjustment, but we’d have the flexibility to choose a country with a low cost of living and high quality, affordable health care. (Probably tough to find that combo and great skiing, though!)

Medicaid… the Worst Case Scenario

We take comfort knowing that, if we truly start running out of money, we can get coverage through Medicaid. That’s not true for adults in every state (you can check your state’s eligibility levels here), since the states decided individually whether or not to expand their coverage to include low-income adults. And Medicaid varies widely in quality between states, based largely on how many doctors will accept it. So in some states you may technically have coverage, but be unable to find a clinic where you can actually use your insurance, while in other states, Medicaid is nearly indistinguishable from private health insurance. We think of it as our last health care safety net, but we’re sure glad it’s there.

How Are You Thinking About Health Care?

We’ve heard from aspiring early retirees who are taking more of a “wing it” approach to health care, and a few others who are obsessed with the details like we are. Where do you fall on the spectrum? Any health care options that you’re thinking about that aren’t on our list of possibilities, like health care ministries? How are you factoring health care expenses into your long-range budgets, knowing that so much is still unpredictable? Let’s discuss in the comments!


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77 replies »

  1. You can never know know for sure what the scenarios will be like. We still have s couple years left, but in the mean time we’re maxing out our HSA account. We’re convinced after reading Go Curry Cracker, Michael Kitces and Mr Groovy that maxing out the HSA is the way to go. Aside from that, we’ll be on an ACA plan for a while. We also may buy property abroad. Mrs is a dual citizen in Italy so if we live there a good chunk of time we may just use their Healthcare which I hear is quite good. Plans more defined as 2018 gets closer.

    • I think if you have access to an HSA, that’s definitely the way to go. We’re lucky in that we currently have low-deductible health insurance through work, but unlucky in that we don’t have an HSA as an available vehicle to sock away funds for retirement!

  2. Healthcare is our biggest concern in ER. Especially since we have two kids, and I don’t ever want to have to skimp on them health-wise. Honestly, I am hoping that I will find a teaching gig that I love, where maybe it is enough hours that I can qualify for healthcare (I like to think of it as a paid hobby or paid volunteer work). But, if anything causes me to leave the US, it will likely be healthcare… which is just sad.

    • With two kids also, it is our biggest concern. Just navigating the ACA website and trying to understand the cliffs is daunting.
      And we have briefly toyed with the notion of moving back to the UK for similar cost reasons…..but then a bunch of other UK living expenses skyrocket and it’s a zero sum game. Or worse. And US is home.

      • I *do* think it would be tempting to consider moving back if you come from a country that has a more progressive view of health care. But as you say, the U.S. is home! On some level, nothing replaces that. :-)

    • It IS sad that health care is what could force many of us to leave. It makes NO sense. And I love your teaching plan, using that to maybe get health care squared away for you guys!

  3. This is probably the scariest thing to start thinking about for me, it’s hard to accept that something this important could be out of your control.

    Glad there are a bunch of bloggers solving the problem before I need to worry about it ;)

    • I wish we were “solving the problem”! ;-) But glad it’s helpful in spurring your thinking — it really doesn’t have to be scary, it just takes some research and planning.

  4. Good article and I think medical tourism is interesting to look into and research. Might be a decent alternative as you say, but the biggest concern (which may not ultimately be a concern if I research more) would be the quality of care and trust in the medical professionals.

    But otherwise you folks are doing well controlling what you can in this scenario by staying healthy.

    The Green Swan

    • I think the concerns on medical tourism are important to address, but I also think we have this idea that only U.S. medical care is modern and effective, and that’s not true. It’s been a very eye-opening learning process for us!

  5. This aspect of early retirement overwhelms me because it will likely change. You have done a great job exploring and laying out the options. On medical tourism–Neil once got glasses while on a trip to Mexico. Exam, frames, and lenses were only $25!

    • What a great idea re: glasses! Mr. ONL’s in the market for new ones. :-) I never think of that stuff now, but we definitely need to shift our thinking, especially on vision and dental, which are unlikely to be covered, or at least not at high levels, once we have an ACA plan.

      • We currently get inexpensive ($15) glasses using discount websites rather than going through our insurance. This may not work if you have a bifocal prescription, but many web sites don’t even ask for a scan of script anymore, just the info off of it.

      • We have not been good about seeking that stuff out since we’ve had a decent vision benefit under our employer coverage. But $15 glasses — that’s way less than we’ve paid even after insurance! Thanks for the nudge to check that out! :-)

  6. Even though this might sound like we don’t care about our healthcare, we are taking more of the “wing it” approach at the moment. With the landscape nearly constantly changing, we’re not devoting that much time and effort at the moment because we understand that things will probably be different when the time comes to actually get healthcare anyway, and we’ll be doing the same research all over again. I’ve looked at the healthcare.gov web site once for about 20 minutes and got a good feel for our options. For now, that’s all I need.

    But like you, we will definitely look for subsidized healthcare coverage under the ACA. We are budgeting a couple hundred a person, but that is intentionally a high estimate. But nevertheless, it’s in our budget.

    Your note about possibly living abroad to save costs by stretching your dollar is another avenue that we are strongly considering if it comes to that. Costa Rica is on our radar as a possible spot, as is Thailand. We will cross that bridge when we come to it, of course, but the possibility still exists that we’ll look into something like that down the road if we need to.

    I love picking up asthma medication in Mexico for literally pennies compared to the United States. In fact, the U.S. *banned* the inhaler that I used to get because it “was damaging to the environment” or some such nonsense, requiring me to go to the time and expense of getting a prescription for an inhaler that costs about 20 times more.

    Sometimes, this country is just…fascinating. :)

    • I think as long as you’re budgeting a few hundred, and knowing the income you’re planning to have in retirement, you guys should be fine in the near term. The tough thing is that the premiums go up every year along with the out-of-pocket max. And per the good advice of the Accidental Retirees, we’re planning to budget for the OOP max each year… that’s the bigger X factor to us than the cost of the plans or how we get them, which will probably keep shifting.

      And yeah, inhalers! They got so expensive a few years back — first drug I ever knew of that had a generic version, but the generic went away. I was used to getting inhalers for like $8 and then all of a sudden they were over $100. What?!?!?!

  7. Healthcare coverage turned out to be a pretty easy thing to figure out for us. We just went on and individual health plan starting on 5/1 after 27 years on a company plan. Keep in mind many Americans are self-employed, I am by insurance for themselves every day. While it comes at a certain cost (non-subsidized), you have many more choices than you did working for a company to tailor a plan that works exactly for you. We have a high deductible HSA that is costing us about $900 per month for three (healthy) people. I wrote a short blog article in February that explored our choices in more detail.

    • You just might be the lone outlier. :-) And you get retiree health care in a few years, right? How I would love to have that option, but sadly that’s not in our cards. We don’t plan to overcomplicate the decision, either — we’re just going to sign up for a subsidized ACA plan once we know our quit date, but we like to know the options for the future in case things change!

      • I get company retiree health care coverage in 5 years when I turn 55. I’m told by some friends it is not that great of a deal, but at least it is guaranteed coverage.

      • A great deal compared to what? Even if it’s worse than employer coverage, it could still be better than private healthcare coverage on the open market! And hey, at least you know you have guaranteed options. :-)

      • Not a great deal relative to ACA. Some of the companies retirees are doing that instead. I don’t think that it will work for me, because I won’t get the subsidies.

  8. Medical insurance costs were the primary reason I didn’t retire sooner. Before the ACA disallowed pre-existing condition limitations, medical insurance was not available to either my husband or myself at anything even approaching affordable. My best case plan was to take his plan until he received Medicare (initial cost was $1800 per month for eighteen months, then $2700 per month for the eleven month extension due to his disability). When that ran out, he became eligible for Medicare ($104 part A, $141 part B, $57 part D), and I was on my own. I went with Costco and obtained a “gold” level policy at $800 per month. The first renewal, which was ten months later, his coverage for part A went to $122 per month, part B stays the same until August, and Part D went to $68 per month. My “gold” coverage went to $945 per month. These expenses are before one dollar is spent on actual health care, and when that happens (frequently around here), the co-pays really add up because providers split up services so everyone gets to send a bill (even for inpatient services). I recently spent three days in the hospital and, so far, I’ve received separate bills from two ER physicians, two labs, radiology, two ER’s, one anesthesiologist and one hospital, and there are more to come. Even with “gold” insurance, my out of pocket will likely exceed three thousand dollars. Fortunately we can afford it, but the experience brings to the forefront yet again what I’ve been preaching since before I even retired, back when I was contemplating how we would handle medical expenses. My sincere advice is this: get the best coverage you can afford if you have any kind of pre-existing condition that requires medical visits and/or prescriptions. If you skimp on coverage, budget for the maximum out of pocket during the year. Don’t fool yourself that you’ll luck out and not need it unless you have a solid bankroll behind you that you don’t mind spending on outrageously expensive, ineffective medical care. The bill for my hospital stay, with no procedures (just the room and care provided by the hospital staff, no doctors) was over $25,000 before any lab, radiology, medication, procesures or physicians, and that was for Thursday night through Saturday morning. If you can fly by the seat of your pants and not planning for medical expenses works for you, that’s great. I wouldn’t dream of it. I budget $1200 for premiums and $550 out of pocket every month, without fail. Sad to say 2016 YTD we’ve already exceeded those numbers and I’ll likely hit maximum out of pocket ($6250) long before year end.

    • Your cautionary tales (and actual dollar amounts!) have really motivated us to make sure we’re thinking through our health care options. And seeing those numbers definitely gave us sticker shock! For us in our 30s, the premiums quoted are significantly lower, and of course we’re also hoping to stay within the subsidized range, which should make a HUGE difference. But I couldn’t agree with you more on the big point: budget for the out-of-pocket maximum every year. That is 100% part of our plan! And sorry to hear about your hospitalization! I hope that you’re feeling better. :-)

      • Much better, thank you. I couldn’t keep solid food down! Very odd ailment turned out to be an irritated esophagus. If I’d known that I could have saved $3000 and a lot of time and hassle…who knew? They are presuming a food or environmental allergy was the cause. One of those “it could only happen to me” things, I guess. At this rate I’ll reach maximum out of pocket by September 😄, so it’s not all bad!

      • I’m glad you’re feeling better! I feel like every illness I hear about these days is wacky, so it’s not just you! And hitting the OOP max — I’d be thinking about every other test I could cram in this year! Ha!

  9. UGH. You know how much I hate this discussion… and I even work in healthcare research a lot of the time! My conclusion is always: I wish we lived in Sweden! :)

    • I KNOW. It’s crazy how much of my brain space this question occupies, and how little it occupies in countries that have actually figured this out. :-(

      • A lot of my job is spent researching how other countries are better at managing costs and providing better care for (insert any condition here). It just leads me to constant research-based awareness of how terrible we are at healthcare stuff!

      • Again, I KNOW. And we can’t even discuss it intelligently. People say they really want to keep their private plans, and I’m always like, “REALLY?! Have you ever actually had to resolve an issue with an insurance company? You think THAT is the model of efficiency??” Okay, off the soapbox. :-)

  10. Health insurance is one of the benefits of my inability to completely retire early. My current plan is to try to work out something with my employer for 30 to 40 hours of work every month, which can be done remotely. If they go for it, I would use that income to fund our health insurance through one of my company’s plans, cover living expenses beyond our investments/rental property/side hustles, and/or continue adding to the 401K. There are a lot of variables, but that phase of the plan won’t start for another six years, so we’ll see what happens before then.

    • If you’re getting company-subsidized health coverage in semi-retirement, then that sounds like a great deal! If you’re not getting that subsidy, it’s worth looking at exchange options, because in our experience company insurance is super expensive if the employer isn’t covering a good portion. Food for future thought! :-)

  11. This was a very well thought out and well written post. That said, I think the fact that it has to be written is evidence of how insane and overly complicated that our tax code is. Make no mistake, health insurance and the ACA is a tax planning decision every bit as much as a health or even financial risk decision which is what it should be. We are currently in the “wing it” camp. Like you, I have read the ROG post and others on the topic. However, I find it pretty wasteful spending too much time trying to navigate this extremely complicated system which could potentially be completely different in only a year when we’ll actually need it.

    • Absolutely! Our tax code is a mess, and this is yet another great example of that. Not to relitigate the subsidy question, but the fact that millionaires can qualify for large subsidies on ACA coverage is completely wacko… but we’ll also be taking advantage of this, and so can’t really complain. It does seem like health insurance questions combine the worst of the tax code with the rampant rising costs of health care… not a good combo! Despite the possibility that the ACA could change, we’ve still put together a plan that we’ll share one of these days for at least our near term early retirement. Essentially we’re trying to structure our income to qualify for as big a subsidy as possible under the current system — and when and if that system changes, then we’ll make a new plan!

  12. Healthcare is something we will have to figure out sooner or later. For now we are taking a wing-it approach, but soon will have to dive into more research.

    As someone who has used both the Canadian and American systems, what frustrates me most about the latter is the complexity, confusion, and lack of simplicity.

    ACA plans sound good, and maybe Medicare (though I have no experience), but both of them seem less than optimal if you do simple things like spend a lot of time travelling within the country, as least in my first glance.

    • Our sense is that most ACA plans (not including Medicaid — different story) are pretty flexible, and act just like “regular” health insurance. So you can still use them for travel within the country. And Medicare is universally accepted, so if that stays similar to how it is now, we’ll be golden when we get to age 65 (haha — the only area of life in which we want to hurry up and get older!). But yeah, the American system is for sure overly complicated and confusing… and perhaps perennially changing as well!

  13. I’m really grateful to you and the other bloggers who have explored this topic in-depth. Healthcare is the one big unknown when retiring early and it’s a concern of mine. Since I still have about 10 years before “retiring” I haven’t spent too much time digging into it — so much could change that it’s difficult to plan. But I look forward to hearing more about people handle this during that time so keep us posted on your plans!

    • So much can still change in 10 years, as you know. As long as you budget for some significant healthcare expenses, you should be able to adapt to whatever new system is in place by the time you pull the plug. And we’ll definitely keep you posted on what we do! :-)

  14. Oh man, healthcare is a beast to figure out! If we weren’t so attached to the good old USA, we would probably just move to Malayasia or Indonesia where we have some good friends, and then we could go pay for Western Style healthcare in Singapore if necessary. Alas, we’re stuck with poor options while Rob finishes school.

    Right now, insurance is so closely tied to employment (it was before anyway, but with ACA, the tie is codified in tax law) that its difficult to find reasonable alternatives at this time. Maybe that can be your first early retirement project ;)

    • No pressure… Just solve America’s health insurance crisis. On it. :-) I agree – it’s super crazy that we link health coverage so closely to employment, and to taxes. And glad to know we are not the only ones thinking about getting healthcare abroad!

  15. A non mountain picture! Surprising change.

    I will figure this on out when time is ripe. The basic system in Belgium is not too shabby. Combined with an employer insurance, most people are covered for the worst.
    We took already one measure: we enrolled in a health savings plan where we did medical acceptance a few years back. We are in…! We promised to ave each month a small amount and get a poor return in exchange.

    • We’ve had a few non-mountain pictures in here. :-) And you already know that I’m super jealous of the healthcare options you all have in Belgium! Healthcare-related bankruptcies are not really a thing anywhere except in the US.

  16. I found it interesting how you brought up the possibility of utilizing medical tourism if the need be, especially since you named India as a reference. My brother-in-law is a surgeon working in a Boston hospital and he claims that doctors from India are some of the best that he’s come across. Now obviously I have no way of personally backing this up, I just thought I would pass this little bit of knowledge along. Personally, I’m not sure how I feel about getting healthcare abroad.

    It will be interesting to see what happens to Obamacare in the long term. They designed Obamacare to come out in stages and some theorize that it won’t survive. But who knows what the future will bring. – Mrs. FE

    • I have heard exactly the same thing, from sources I trust. I think it’s a western bias to think that we can only get good health care here! And yeah, no idea what the future holds for Obamacare. But we sure hope there is some option to help early retirees keep health-insurance, even if it’s not Obamacare.

  17. Great to be thinking long term, but I would expect there to be many changes with ACA over the years. Having a HSA and taking care of your health, preventatively as much as possible is a good way to go.

    • Oh, how we wish we had access to an HSA. We are lucky to have really good employer coverage right now, but the flipside is no HSA to save for the future. :-(

  18. Have you guys look into the Colorado Cares single payer initiative? I haven’t yet, but am curious how something like this would affect us.

    • We try not to get into state-specific stuff here. :-) It sure seems like a single payer initiative would at least help keep costs more stable than the skyrocketing prices with private insurance!

  19. This is a big worry for me (even though I’m nowhere near this potentiality), because these parameters are going to continue shifting. Taking care of myself physically and mentally is my current investment in my future health.

    • That is a great place to be. Keep focusing on your own health, and you certainly will have fewer health expenses over the long run!

  20. For two adults planning early retirement in our early 40’s, we are budgeting $1000/mo for health care insurance. Right now Obamacare runs $300-400/mo but I expect it to increase to $900+/mo once we enter our late 50’s and early 60’s.

    I agree with the medical tourism idea for non-emergency and elective procedures, but I think the most expensive medical procedures handle emergencies (heart attack, stroke, auto accidents, etc.) or chronic diseases (cancer, dialysis, etc.). For these it is imperative to have decent health insurance.

    This doesn’t even cover long term disability insurance, which early retirees should research but not necessarily purchase.

    • That’s smart you’re budgeting so much for health care. We’ve definitely had readers comment here on what their premiums look like in their 50s and 60s… it’s not pretty. But it does strengthen our resolve in any case to stay in as low of an income bracket as we possibly can, to keep those costs down! And couldn’t agree with you more on keeping health insurance to deal with those expensive emergency or chronic issues! And on long-term disability coverage. We probably over-insure ourselves, but I’d always rather that than the alternative!

  21. Health care does seem to be an ever moving target and really no one knows what will be available in a few years. Just yesterday though I went to our states ACA website to calculate the maximum amount of income we could earn before hitting the cliff. Likely we will be working a little during our retirement so we would need to be diligent about keeping our income below that level. The good thing is that this cliff is actually higher than our annual expense needs so hopefully, assuming nothing major changes in the next few years, we will be able to make it work. But if all else fails, like you mentioned here, we could also go the expat route if my husband was willing to give up his side business. Maybe Canada would be a good option for the two of you as there is plenty of good skiing there!

    • That’s so smart that you’re planning ahead to look at income level limitations in retirement. We’re doing much the same thing, shaping our retirement income around the particular subsidy cliff that we’re targeting. And of course it could all change! And yeah, haha, maybe Canada will be our best bet! :-)

  22. I’m not gonna lie, being in the military our entire adult lives we’ve never had to think much about health care. I do hear coworkers discussing it sometime. Seems complicated.

    • Haha — “complicated” is a good way to put it! Honestly, I’d be fine with it being complicated if we didn’t also have to constantly reassess our options. I’d love if it was something like choosing an investment strategy, and we could just do the homework, pick one, and then move on to think about other things. But at least for the foreseeable future, we’ll have to spend mental energy not only making the decision but then continuing to survey the landscape. Boo! :-)

  23. Hey, I’m Australian. My advice is move to Australia. It’s a lot warmer than Canada and Europe, plus we speak English and have kangaroos – what’s not to like? :)

    Australia currently has a system (called Medicare) that will pay for 100% of all basic and/or necessary medical things: Dr visits, testing, a lot of crucial medical things. But for non-crucial things you will have to put in money yourself (private health insurance will pay for a lot, but you’ll still have to pay for some, on a case by case basis – it’s complicated, most Australians don’t understand, it’s only because we are doing IVF that we have fully learned.)

    My wife Jasmin has done a 2 part explanation of private health insurance if you’d like to read it / want links :)


    • You had me at kangaroos. :-) We’re in! But seriously, does Australia actually let people move there without a job lined up? Canada and the EU nations make it awfully tough to just move in, and while I’m sure there’s a deal available for Commonwealth citizens, we wouldn’t qualify. (I’m sure this is something I could quickly answer with Google, but I’m asking you in case you might know!) ;-) We’ve never seriously considered Australia because we just assumed the hoops to enter would be crazy, so we’ve only ever thought about going expat in the countries a little more desperate for U.S. dollars.

      • I’m not an expert on all the different visas. Depending on your assets, you can get in on an investment visa. You could set up your own business, I think that’s one. You could find yourself a nice Australian to marry..lol.

        It isn’t impossible, I myself am an immigrated Australian :)


      • Haha — didn’t mean to put you on the spot. But this is all good to keep in mind in the future, if the U.S. makes things untenable for us. But we sure hope to be able to stay put! Hope you’re having a great day. :-)

  24. I’ve been talking with an insurance broker and accountant to see how we can navigate the healthcare landscape via our business. I imagine I’ll write about it once I have a better handle on the situation, but it looks promising, especially for those who plan to make money via a blog or freelancing after FIRE. :)

    • Oh, that sounds so interesting! We’re definitely curious about how structuring things as a business could help our retirement finances, so please share what you learn!

  25. Yikes, relying solely on a catastrophic plan or medical tourism sound like not-ideal options. I appreciate that you’re trying to make a comprehensive list though. I’m curious which country/countries you’ve thought about for the ex-pat option.

    • You know it totally keeps me up at night to think about having to rely on those things. I completely HOPE we get to buy and keep ACA coverage, even if it’s less subsidized in the future than it is now (honestly, I’m okay with that — it still doesn’t totally sit right with me to get tax handouts given how much money we have saved). But yeah, had to be comprehensive for the list. :-) We’ve mostly looked at Mexico, Costa Rica and India for health care, all based on recs from friends. But in truth we haven’t explored it in real detail because we don’t plan to rely on that. But we’ve heard enough to know that the western-centric view that other countries have sub-par health care is just not true. That’s a comfort for when we’re doing extended travel, whether or not we have ACA coverage! :-)

  26. I hear medical tourism is the way to go. As long as you heavily research it and go somewhere legit, you’d save thousands. It’s a shame they make healthcare in America crazy expensive. You look at the itemized bill when you go in? They charge something crazy like $10 for a band aid or something.

    • Definitely agree with you that it’s a great option to know about. Though, it’s much harder to predict the need for emergency care, and that tends to be the most expensive stuff. But if we need something like a knee replacement down the road and it would be a huge out-of-pocket cost in the US? We would definitely go overseas without hesitation!

  27. I saw an article about another large healthcare company dropping out of Obamacare (not sure if using appropriate verb, but I think you get it), and I thought of you. I was going to write an email asking “what are you going to do now if such and such companies drop out?” and I didn’t have to. I just had to re-read this post where you map it all out. Thanks for being thorough. It helps me get an understanding of my options!