Affordable Care Act and Expats

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Affordable Care Act and Expats


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Old 24th September 2013, 08:11 PM
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Question Affordable Care Act and Expats

If we can leave behind all the politics of this, there is a good question to be asked:

How does the ACA affect those USA citizens living abroad as expats who are not yet old enough for Medicare (yes, some of us are that young). We are, after all, USA citizens.

I would appreciate links and citations, rather than opinions.

I left the USA as a Maryland resident and now wonder if we would be required to sign up for USA based health insurance through an exchange or face the tax penalty under the law.

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Old 24th September 2013, 08:17 PM
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Originally Posted by FHBOY View Post
If we can leave behind all the politics of this, there is a good question to be asked:

How does the ACA affect those USA citizens living abroad as expats who are not yet old enough for Medicare (yes, some of us are that young). We are, after all, USA citizens.

I would appreciate links and citations, rather than opinions.

I left the USA as a Maryland resident and now wonder if we would be required to sign up for USA based health insurance through an exchange or face the tax penalty under the law.
The tax penalty for 2014 for not having heath insurance is about $60.00 US and not until 2016 will it be $600.00 US. We have a couple of years more to get medicare. I have a Calif. residence so I am presuming it will apply to me. No US residence and I presume it will not apply. I donīt know for sure.

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Old 24th September 2013, 08:51 PM
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The tax penalty for 2014 for not having heath insurance is about $60.00 US and not until 2016 will it be $600.00 US. We have a couple of years more to get medicare. I have a Calif. residence so I am presuming it will apply to me. No US residence and I presume it will not apply. I donīt know for sure.
It's $95 per person in the household in 2014, will be $695 per person in 2016. I believe there was a recent thread and the question was do you have to be a legal resident in another country for 330 out of the 365 days in a calendar year or do you just have to be out of the country 330 days to avoid carrying insurance or paying the penalty?

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Old 24th September 2013, 09:31 PM
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Just send a copy of your Residente Permanente card; that should do it.

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Old 24th September 2013, 09:54 PM
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BBCWatcher (whose posts are generally thoughtful and well-reasoned) has provided a detailed description of the ACA over on the USA forum. On the question of non-residents, the post says:

"If you are not a resident of any of the 50 U.S. states or of the District of Columbia then you are not subject to the new health insurance requirements in the PPACA. (For purposes of determining whether or not you will owe a penalty if you do not have adequate health insurance, the IRS will generally look at whether or not you could qualify for the Foreign Earned Income Exclusion -- regardless of whether you actually take the FEIE. Residents of Puerto Rico, the U.S. Virgin Islands, Guam, and other parts of the U.S. outside the 50 states and D.C. are not subject to the PPACA.)"

This certainly sounds like a reasonable approach by the IRS, and it sounds as if the key is actual legal residency elsewhere. Still, there's no specific citation given. If I run across anything more definitive, I'll stop back here and let you know.

One small thing: you mention Medicare for the over-65 set, but insofar as I am aware, original Medicare doesn't cover anyone living abroad (although there may be some private supplemental plans that do). I believe there have been rumblings about doing pilot programs in Canada and Mexico, but I don't know that they have come to anything as yet (alas!).

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Old 24th September 2013, 10:00 PM
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Questions and Answers on the Individual Shared Responsibility Provision Read paragraph 12.
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Old 24th September 2013, 10:51 PM
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One small thing: you mention Medicare for the over-65 set, but insofar as I am aware, original Medicare doesn't cover anyone living abroad (although there may be some private supplemental plans that do). I believe there have been rumblings about doing pilot programs in Canada and Mexico, but I don't know that they have come to anything as yet (alas!).
My bad, I was referring to when we go back to the USA and need (God forbid) medical care, not when we are living as expats. I know that Medicare is NG in Mexico, and the issue there is whether or not to opt for Medicare coverage as a full time expat (a totally different topic).

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Old 25th September 2013, 12:26 AM
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We are now respecitvely 71 and 67 having been retired in Mexico since 2001 and fully eligible for Medicare . We have elected to dissasociate ourselves from Medicare in every sense and fullly insure for major medical coverage through an international insurance company but here is the kicker. Even if that insurance company screws us to the wall and refuses any major medical claims we may put forth in the future, we would a thousand times rather opt for major medical treatment in Mexico than the U.S. for two reasons and maybe more:
* Here we will be treated as human beings in private accomodations by, in our experience, over the past 13 years compassionate and highly competent physicians and hospital staff at a mere fraction of the cost we would incur in the United States.
* Here, we donīt have to sign up with disgruntled doctors and staff treating us as worms in a coffee can. When we sought the care of physicians under our HMO Kaiser Permanente in Northern California in the 1990s, we never saw the same physician two times in a row and were nothing more than numbers on a chart immediately forgotten. A disgraceful system treating the poor and middle class as cockroaches disturbing the tranquliity of the household.

Down here over the past decade plus, I have received the best medical and dental treatment of my life at a fraction of the cost imposed in San Francsco. Choose your arena but if that is the United States, bring a fat wallet and a cynical state of mind.


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Old 25th September 2013, 01:45 AM
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That some disgruntled persons fled or were ejected from the USA , or any other country of their origin, and then who freely choose to disassociate themselves from the benefits they either earned or were entitled to in their home country ... is fine with me. Let the country they fled to, fear in hand, welcome and care for them. Freedom of choice. It's wonderful. Isn't it?
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Old 25th September 2013, 02:23 AM
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That some disgruntled persons fled or were ejected from the USA , or any other country of their origin, and then who freely choose to disassociate themselves from the benefits they either earned or were entitled to in their home country ... is fine with me. Let the country they fled to, fear in hand, welcome and care for them. Freedom of choice. It's wonderful. Isn't it?



I have no idea to whom you are referring, Longford, but since that snotty remark followed my post, let me tell you that my wife and I are citizens of the United States and France respectively, permanent residents of Mexico, have lived here as retirees for 13 years full-time, and will soon be Mexican citizens and we pay our own way here for all things including medical care, housing, food and transportation , peso for peso. We leech off of no one ever but are damned pleased that we can enjoy the protection of the Mexican medical establishment which is reasonably priced and much superior in practice in places such as Guadalajara to places such as San Francisco where we lived for 40 years and, no doubt, Chicago. The medical establishment in the United States is a disgrace. In France, on the other hand, if one has had a career working there, total medical costs are free and the medical care is excellent. In Mexico, it is not necessarily free but iinexpensive and a hell of a lot more efficacious and more civilly administered than in the dreaded U.S. system. Down here you actually can find a doctor who remembers who the hell you are and may even recall your infirmities. At that HMO in San Francisco there were two things you could depend on. You woulld be assigned the next two-bit doctor available who couldnīt succeed in private practice and he/she would allot you 10 minutes or be financially penalized.

I wouldnīt move back to the U.S. if they threw free medical care at me and promised me a cherry snowcone as I reposed there in that dormitory room with 300 other ward inhabitants waiting to kick the bucket.


Last edited by Hound Dog; 25th September 2013 at 02:36 AM.
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