24 October, 2013

Some Straight Skinny

OK, here's number 901. I might have to say something when it hits 909 - you know, the Beatles said they're "traveling on that line." Well, we'll see when it gets there.

So, what's new? Like a lot of folks I got hung up watching the children in Congress play. I, and I assume, a fair number of other expats and folks who'd like to be expats might also be wondering about the state of affordable health care.

In our particular case, we used to have international health care. Several of us living down here had it through the same company. Dianna and I kept our state health insurance initially when I retired and we moved down here. It wasn't long till we asked ourselves, "Why?" The insurance through the Washington State Health Care Authority or whatever it's name is, cost us about nine hundred dollars (that's $900.00 US +/-) each month. It didn't take a rocket scientist to realize we were going to go broke keeping that.

Friends of ours, Mae and Craig, turned us on to the international health insurance, which, even with a couple of riders on our policies, would cost us about three months worth of the state insurance for a year of coverage. Roughly $1200 a year. So, it took about 3 micro-seconds to make that decision. I cancelled our state insurance, which was no good down here anyway, since you had to be in the states and preferably in Washington State to use it.

We bought the international insurance with a $5,000.00 US deductible for each of us, since we were looking at it as catastrophic insurance only. We went along like that for about five years, happy as clams. Then we got a letter advising us that they were cancelling us. Everyone else we knew, also got just about the exact same letter.

The timing just really couldn't have been better in our case. We'd been thinking about cancelling it anyway, as we had become used to, and familiar with healthcare and its costs down here, so not having insurance didn't strike us as that big of a deal. So when our policy ran out, we didn't even think twice about it.

But, getting back to Congress and Affordable Health Care (notice the caps?) That's the official name of it, not just that it is or might be affordable health care. So, the reason we were interested in it was that there was a lot of confusing misinformation about it.

Since we lived outside of the US, and we were happy with the health care here (in Belize and Chetumal/Merida, Mexico) we didn't see any reason for us to purchase the Affordable Health Care. That was the only reason we didn't want to get it. We never felt that it was the harbinger of the collapse of American civilization or anything like that. But, like I said, there was a lot of bum dope out there about it.

In fact, other friends of ours, Owen and Sandy, up in Olympia, had written a letter to  our Congress person, Representative Denny Heck (D) asking if someone living outside the country would be required to purchase the insurance. Here's his answer:
Thank you for contacting the office of Congressman Denny Heck regarding responsibilities for the individual mandate under the The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).  It appears that U. S. citizens living abroad will have to maintain coverage.  Here is the IRS information on the subject:

I have also attached a Congressional Research Service (CRS) report which provided additional information.  I hope this is helpful.

Congressman Heck appreciates you contacting him; please do not hesitate to do so again should you need assistance with a federal agency or policy.
That struck me as being wrong as we had heard other rumors as relating to being out of the country X-number of days would exempt you from having to get the insurance. Turns out, one of the documents cited in his letter says that if you're out of the country for 330 days you're exempt. So much for Congress knowing much about bills they've passed - even if he is a nice guy and a Democrat.

I stewed over that for a few days and having heard so much then about how broken the website was for Affordable Health Care, and having been a Webmaster in my former life, I wanted to see just how badly it was broken. So, I jumped onto my trusty laptop and brought up the page. Incidentally, I did that right when Congress shut down the Federal government, so my expectations were not very high.

I arrived at the Website's home page in good order and was looking around. I noticed there was a box saying they had a chat feature and that I could chat with someone about the Health Care bit. I thought, "No way." Fully expecting to get an error message or at least a message saying something like, 'due to the shutdown, this was unavailable. Imaging my surprise when this happened:
Surprise. It must be staffed by essential personnel. I got someone who gave me the straight skinny. I was amazed that someone actually was there to chat.

Here's the transcript of our conversation.

[06:28:51 am]: Thanks for contacting Health Insurance Marketplace Live Chat. Please wait while we connect you to someone who can help.
[06:30:27 am]: Please be patient while we're helping other people.
[06:31:04 am]: Welcome! You're now connected to Health Insurance Marketplace Live Chat.

Thanks for contacting us. My name is Katlynn. To protect your privacy, please don't provide any personal information, like Social Security Number, or any other sensitive medical or personal information.
[06:31:14 am]: David
[06:32:44 am]: Katlynn
How can I help you?
[06:32:58 am]: David
My wife and I live in Belize, Central America. We live here full-time and have since 2007. Are we exempt from the requirements to purchase insurance?
[06:33:25 am]: Katlynn
Thank you for your question today. It will take me just a moment to review and respond to your question.
[06:33:37 am]: David
[06:35:22 am]: Katlynn
If you are a U.S. citizen living in a foreign country, you are not required to get health coverage under the Affordable Care Act. If you're uninsured and living abroad, you don't have to pay the fee that other uninsured U.S. citizens may have to pay.
[06:36:45 am]: David
Ok. Thanks very much. Can I get a transcript of our conversation?
[06:38:35 am]: Katlynn
You are welcome, I cannot provide a transcript. I apologize, you can print this conversation. You can read the text of the health care law in full or section by section by visiting The section-by-section version of the health care law is also available at
[06:39:18 am]: David
I was able to print the conversation. Thanks again.
Well, there you have it. Not only was there a real live body there answering chats, but I got the clearest answer from her that I've heard anyone give.

The rule is, from the document cited in Congressman Heck's letter, if you live out of the country for at least 330 days in the year, you are exempt from the requirement. Now, I don't know about someone just moving down here. I would suspect that you'd be liable for the insurance for that year since you would most likely be here less than 330 days, but the next year and thereafter, you'd be in the clear. Of course, all this assumes you're ok with the local health care, and just like we always say, Belize is not for everyone. The same probably goes for the health care here too.

But, back to our congress issue once again. Owen sent my answer to Denny Heck's office. Here's their reply:
Thank you for following up with Congressman Heck's office regarding exemptions from the Affordable Care Act for U.S. Citizens living abroad.

According to the Internal Revenue Service, U.S. citizens who live abroad are subject to the individual shared responsibility provision (i.e. there is not an exemption for Americans living abroad). However, U.S. Citizens who live abroad for a year (or at least 330 days within a 12 month period) are treated as having minimum essential coverage for the year (or period). They need take no further action to comply with the individual shared responsibility provision.

We hope that this clarifies any questions you have regarding the Affordable Care Act and U.S. Citizens living abroad. Please do not hesitate to contact Congressman Heck's office in the future should you have additional questions.


Beth Schimke
Constituent Services
Office of Congressman Denny Heck
Written just like as if they had actually come up with the answer all by themselves. Well, at least we're all on the same page now.

So, there you have it. Answering those questions about affordable health care and the Affordable Health Care Act. That's enough for now. Gotta save some to be able to get up to 909.


JRinSC said...

Hi Dave,

The easiest way to opt out of the ACA is to manage to live long enough to reach 65 when it no longer applies to you. In a way I'm glad I'm 66 -- now for me the ACA is not an issue!

Thanks for your info though -- I am sure a lot of people that are thinking of the expat experience would be wondering about what you just cleared up.

Thanks for #901


Dave Rider said...

Hi Julian,

I hit the magic 65 this coming year myself. But then, I have to learn all about Medicare and all its parts and supplemental insurance and stuff like that. What joy.


Mr. Pancho said...

So good to hear from you and boy did you make #901 a real gem! I'm 46 and have Belize in my sights within the next 5 years (Lord willing). I was wondering about that so thank you, thank you!!
Hope all is well with you and the Mrs in beautiful downtown paradiseville.


Unknown said...

I'm so glad you've covered a topic I've often wondered about. For the mean time, the ACA is going to save my unemployed self about $200/month. Like many U.S. health insurance policies, my present insurance does not provide out of country coverage (I envy the Canadian system, but we are constantly conditioned to quiver at the thought of socialist boogiemen as we drive on our socialist highways {;>). When traveling abroad, I purchase medical evacuation insurance to the U.S. should the need arise.
An incident in my travels to Roatan, Honduras leaves me to wonder if I might be money ahead by just seeking local medical treatment. On the second day of a ten day Roatan visit, my friend slipped off the top of a submarine and fell six feet to impact the dock before falling an additional four feet into the water. He soldered on, uncomplaining, for the reminder of our stay, but passed out just before a taxi arrived for the return airport trip. He insisted catching the flight home and driving himself to the U.S. hospital to discover broken ribs, a punctured lung and a $40,000 medical bill (he was not insured). In his case I believe he would have been money ahead by seeking local treatment. What an insured person would have to pay (~$9,000?) in the U.S. verses unknown Roatan medical charges is too convoluted to reliably judge the insured person's money saving path.
There is talk of Belize developing a medical tourism industry, I hope I don't have to put it to the test during my next visit. I'd be interested to hear what you learn about Medicare, etc when residing outside of the U.S.

Don Squier

Dave Rider said...

Hi Don,
I hear you. Compared to the $900/Mo we would have been paying, if we were still living up north, the ACA would have been a Godsend.

It all depends on your comfort level with foreign health care (and how much one has bought into the hype that US health care in general is numero uno).

Medicare is unavailable outside of the US (and I've heard, a couple of areas of Canada/Mexico right near the borders). We might buy into it only if there's a chance we would need to go back to the US for treatment, which, I think is becoming less and less likely.

Belize's medical tourism is developing. In a lot of cases, it's already here, it's just the governmental tourism folks have yet to catch up with the advertising, etc.

I think a good portion of my opthamologist, Dr. Hoy's business is Gringo's coming down and spending a few days of their vacation getting reasonably priced state-of-the-art eye surgery.

Same with my dentist, Dra. Glenda Major. We had a friend of ours stay with us for a month while he had a bridge reconstructed and some other dental work done.

Thanks for the nice comment.


Dave Rider said...

Hey Julian,

About that 'magic 65'... Must be OldTimer's disease hitting me. I don't turn 65 for another year and a half, not next year!

It'll come fast enough without me rushing it!


Dave Rider said...

Hi Rodney,

Thanks for the nice comment. I really appreciate it. Everything is well with us (knock on wood) and we're still loving life being retired in Paradise.


Dave Rider said...

I wonder what happened? Sandy L's comment seems to have disappeared right after I approved it for posting. I'll reproduce as much of it as I have. Luckily, I printed the comments out before hitting any buttons, so I think I've got most of it - which is something I've never done before. Weird.