# The Dream of Moving Abroad in Later Life, With Good Health Care



## MULTIZ321 (Feb 21, 2014)

The Dream of Moving Abroad in Later Life, With Good Health Care - by Tim Gray/ Your Money/ Retiring/ The New York Times.com

"FOR the well-traveled, the idea of retirement abroad can seem an idyll. You pick a place you’ve loved visiting, whether it’s the thrumming avenues of Paris or the sunny strands of Panama, and jet off for the perfect permanent vacation.

But the fantasy can become less carefree if you haven’t figured out in advance what to do about health insurance..."

Retiring to sunnier shores often sounds lovely, but the reality is that, depending on where you go, it can be tricky to get access to quality coverage.





Joseph S. Coyle and his wife, Sigun, retired to Paris, but he says their increasingly expensive insurance under a group plan has made them consider returning to the United States. Ed Alcock for The New York Times

Richard


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## Passepartout (Feb 22, 2014)

An interesting article about a subject that I've followed for years. A little background: I have never made a high income. I was single and childless- on purpose- for many years, finally succumbing to cupid's arrows ay age 50+. While I took care to live beneath my means and feather my nest I always knew it would be hard to live in this country in a way- and at an age- when I would want to retire. This led me to examine overseas living. I pretty much settled on the idea of living in Mexico, Costa Rica, Belize, or Thailand, and access to quality healthcare was a large consideration. As it turned out, I ended up married (happily- to a kindred spirit) and am not likely to be taking up permanent residence offshore- not that helps my itchy feet and wanderlust. (There is always a packed suitcase handy)

Anyway, one thing omitted in the linked article was tax implications. American Citizens- even living abroad- have to file, and pay, income taxes on their income. Even if it is entirely generated outside the USA, they have to file. This has resulted in a rash of people relinquishing their citizenship. American embassies abroad report that they have had to hire help to process applications from Americans who don't want to be Americans any more.

Many counties have quality health care available, or insurance for sale to ex-patriots who move to and bring assets to their counties. I can't blame either the ex-pats or the new resident countries from catering to this new market.

Jim


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## Conan (Feb 22, 2014)

Passepartout said:


> Anyway, one thing omitted in the linked article was tax implications. American Citizens- even living abroad- have to file, and pay, income taxes on their income. Even if it is entirely generated outside the USA, they have to file. This has resulted in a rash of people relinquishing their citizenship. American embassies abroad report that they have had to hire help to process applications from Americans who don't want to be Americans any more.



It's true Americans have to pay tax on their world-wide income, but the U.S. generally gives them a foreign tax credit that offsets their U.S. tax by income tax they pay in the foreign country. (There's also a specific exclusion for  income attributable to services performed within a foreign country.) Of course they have to file a Form 1040 like the rest of us.

That seems fair to me, even though it's a system that's unique to the U.S. In contrast, a Greek shipping tycoon or Russian billionaire can live in London (for up to 17 years) or New York and pay little or no income tax to their home country and also none to the U.K. or U.S.

Americans of modest means living abroad have been giving up citizenship lately because new reporting requirements have led many foreign banks to refuse to accept U.S. citizen customers.
http://www.npr.org/blogs/parallels/...more-americans-are-renouncing-u-s-citizenship


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## bogey21 (Feb 22, 2014)

I have a friend who has lived in San Miguel, Mexico for years.  He says the medical care is just as good as in the US and way less expensive.  I don't know if he has insurance or not.

George


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## Passepartout (Feb 22, 2014)

bogey21 said:


> I have a friend who has lived in San Miguel, Mexico for years.  He says the medical care is just as good as in the US and way less expensive.  I don't know if he has insurance or not.
> 
> George



Perhaps TUGger pammex will chime in here. I know she lives in Chapala and has had some serious health challenges taken care of in Mexico. There is a national health insurance plan that ex-pats can buy into, but don't know the rules of who, what age, how much and what limits it might have.

Jim


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## SMHarman (Feb 22, 2014)

Conan said:


> It's true Americans have to pay tax on their world-wide income, but the U.S. generally gives them a foreign tax credit that offsets their U.S. tax by income tax they pay in the foreign country. (There's also a specific exclusion for  income attributable to services performed within a foreign country.) Of course they have to file a Form 1040 like the rest of us.
> 
> That seems fair to me, even though it's a system that's unique to the U.S. In contrast, a Greek shipping tycoon or Russian billionaire can live in London (for up to 17 years) or New York and pay little or no income tax to their home country and also none to the U.K. or U.S.
> 
> ...



But what federal services do they get for for those taxes?  You pay taxes to share the costs of running the country you live in. 

Fbar reporting is hell on earth. Even us companies cannot give the information they require on the form. 

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## PStreet1 (Feb 22, 2014)

Where we live in Mexico, the national health service presents problems.  My housekeeper refuses to use it because it is impossible to see the doctor without devoting the entire day to the process:  if you arrive at opening, or even before, you may not see the doctor until late in the afternoon, and once, when her father was very ill and they had to use the national health service, they did not see the doctor that day and had to return the next.  She chose to pay a doctor, even though she is far from wealthy (she does, however, make a comfortable living).

On the other hand, an American friend went to the new emergency hospital in town and saw the doctor (who spoke English), had x-rays, and had a follow-up consultation at the hospital with the same doctor--and paid a total of $17.50.  They were highly pleased with the doctor/level of knowledge/facility, and of course, the price.  That hospital, however, can be used only for emergencies, and if the situation isn't an emergency, the person will be told to go elsewhere (unlike the U.S. where the emergency room must treat anyone who shows up).

We also have access to a "doctor corporation clinic/hospital," which many people are pleased with.  The charge to be a member is about $250.00 per couple per year.  That gains the members a discount on seeing the doctor, a low rate for house calls (yes, they still make them in Mexico), ambulance ride to the border if necessary to go to the U.S., and some other benefits.  The little clinic/hospital does excellent work--but staying there is, I'm told, NOTHING like being in a hospital in the U.S., and the difference is not a good one.  

I asked my doctor there what hospital I should go to if I had a problem, and he said "You should go to the U.S."
I said, "Well, if it were an emergency."
He replied, "If it were an emergency, you would have to go to the U.S.; if it weren't an emergency, why wouldn't you?"
I think that says a great deal about care in Mexico.

On my own, I've decided that the doctors and nurses are well educated and professional in Mexico.  If I need doctor care that does not involve technology, I'm very happy in Mexico.  If I need technology, it is necessary to go to the U.S.; they simply don't have much in the way of machines.

At any rate, those of us who live in or are in Mexico a lot tend to use both Mexican and U.S. doctors and services.  Some people buy some prescriptions in Mexico because they cost less; those same people buy some prescriptions in the U.S. because they cost less.

The health care answers aren't really simple to give, and of course, as we age, our needs change.


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## Conan (Feb 22, 2014)

SMHarman said:


> But what federal services do they get for for those taxes?  You pay taxes to share the costs of running the country you live in.
> 
> Fbar reporting is hell on earth. Even us companies cannot give the information they require on the form.



As someone whose grandparents were Jewish immigrants to the U.S. from Ukraine, I take a broad view of the value of the "federal services" I've received. I don't enjoy paying taxes and at times I've been very unhappy with our government, but I believe there's a moral dimension to renouncing U.S. citizenship.

The FBAR and 8938 forms are really not that bad.
http://bsaefiling.fincen.treas.gov/NoRegFBARFiler.html
http://www.irs.gov/uac/Form-8938,-Statement-of-Foreign-Financial-Assets

The foreign banks don't like the FATCA reporting, which is understandable if their business model up to a few years ago was to solicit wealthy US tax cheats and promise them anonymity. As you may know, UBS paid a fine of $780,000,000 to the U.S. in 2009 and entered into a deferred prosecution agreement for conspiring to defraud the IRS. And that's only one Swiss bank of many (all?) that engaged in the practice for many decades.
http://en.wikipedia.org/wiki/UBS#U.S._tax_evasion_controversy


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## persia (Feb 22, 2014)

It's really your choice, an employer overseas isn't going to report your income to the US, so it's a bit on the honor system.  I have two citizenships, Australia and the US, I typically don't report Aussie income to the IRS, nor do I report US income to the ATO.

Oh, and FACTA only applies to banks that do business in the US, stay with small local banks or credit unions and you'll be fine.


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## Ken555 (Feb 22, 2014)

Passepartout said:


> Anyway, one thing omitted in the linked article was tax implications. American Citizens- even living abroad- have to file, and pay, income taxes on their income. Even if it is entirely generated outside the USA, they have to file. This has resulted in a rash of people relinquishing their citizenship. American embassies abroad report that they have had to hire help to process applications from Americans who don't want to be Americans any more.




Absurd. There were reportedly 3,000 people who renounced their citizenship last year. If US embassies need to hire help to process paperwork for that small a group, you have to wonder how well staffed they are in the first place. 

3,000 doesn't qualify as a "rash of people" in my book. Let's keep perspective, eh?

http://en.wikipedia.org/wiki/Renunciation_of_citizenship#United_States


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