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Discussion Starter · #1 ·
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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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 don´t know for sure.
 

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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 don´t 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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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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Discussion Starter · #7 ·
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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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 don´t 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.


r
 

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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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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 couldn´t succeed in private practice and he/she would allot you 10 minutes or be financially penalized.

I wouldn´t 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.
 

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Fact: if you don't have a U.S. address, you don't have to pay for the new "Obamacare" health insurance. Point being, that if you are an expatriate, you don't pay. Now, about those people who want to have it both ways, I have no comment.
 

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Fact: if you don't have a U.S. address, you don't have to pay for the new "Obamacare" health insurance. Point being, that if you are an expatriate, you don't pay. Now, about those people who want to have it both ways, I have no comment.
You may not have a U.S. address but if you choose to spend more than 35 days in the U.S. in a 12 month period you will be on the hook to pay.
 

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Discussion Starter · #14 ·
Friends:
While I appreciate the lively give and take, with accompanying illustrations of my hero, I was more interested in the one post which said as a Permanente or even a Temporada with no USA address (other than my mailbox in TX), we will not be subject to the ACA tax. I would appreciate more factual info.

As to the state of health care: USA vs. Mexico, I'll leave that to others. Fortunately, in my nine months here, I've not had an occasion to get deeply involved in that here. I do have a doctor who charges me $200p for a visit, had a dental cleaning for $150p, and am very happy.

Meds, while readily available without prescription have prven not to be the "bargain" I thought they'd be, the prices are, yes, cheaper, but the quantities at the prices are far less than the 90-day quantities we are used to in the USA, but it is less expensive but not that much. One med I have given up would be less expensive than my pre-insurance costs in the USA, but not by much. Named USA drugs here, that do not have Mexican produced counterparts are not such a great bargain. Fortunately the drug is not critical to my day-to-day health any longer! :)

As a side note: I carry only universal catastrophic health coverage for us ($900 USD/year) thru Best Doctors. It does have a $5K USD deductible, which we will cover from a de facto HSA in the USA, but I am relatively healthy and live, so far, a very "non-risk low key" life. Anecdotal: my friend tells me of his wife's stay in a hospital for a hip replacement cost, in toto, less than $6K USD. That is amazing!

So, more facts on ACA and stay healthy!
 

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With a little patience and web-searching, you can find the paragraph in a government site which clearly states that permanent expats are exempt from "Obamacare" . It is only applicable to residents of the U.S.

FHBoy asked the same question on the local Chapala web board and it was answered.:bolt:
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"Found this on one of the government sites: (HEALTHCARE.GOV.) Start the search with "exemptions for..............etc." you'll find the site.

"U.S. citizens living outside the U.S.

U.S. citizens living in a foreign country are not required to get health insurance 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."
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With a little patience and web-searching, you can find the paragraph in a government site which clearly states that permanent expats are exempt from "Obamacare" . It is only applicable to residents of the U.S.

FHBoy asked the same question on the local Chapala web board and it was answered.:bolt:
__________________________________________________________________________
"Found this on one of the government sites: (HEALTHCARE.GOV.) Start the search with "exemptions for..............etc." you'll find the site.

"U.S. citizens living outside the U.S.

U.S. citizens living in a foreign country are not required to get health insurance 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."
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Yes but they define living abroad as 330 days or more outside of the U.S. in a 12 month period. For example say you sell everything in the U.S. and move to Ajijic. No U.S. address. But you enjoy spending summers with your adult children in California. By the gov't's reckoning you must maintain acceptable insurance in the U.S. or be penalized.
 

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Please cite your source.

For those who are Permanent residents ........I have my doubts.
I googled Obamacare living overseas and got numerous hits. If you are, as they put it, a bona fide resident of another country that counts too. But you have to prove that, they don't just take your word. Or you can be out of the country for 330 days or more and they presume you meet the minimum standards with no further action required.
 

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I googled Obamacare living overseas and got numerous hits. If you are, as they put it, a bona fide resident of another country that counts too. But you have to prove that, they don't just take your word. Or you can be out of the country for 330 days or more and they presume you meet the minimum standards with no further action required.
Forum rules prohibit linking to other expat forums, so I'll just mention that there's a popular website with a forum for expats which focuses on the Yucatan and where there's been an excellent discussion, for the past year, regarding the Affordable Care Act and it's impact on expats. Google "Yucatan forums" or other such words and the website will probably be listed and you can then see the discussion. The moderator/owner of that site seems always to be well informed.
 

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As one who has had two very serious hospitalizations this year, in Guadalajara, and who is now in end-stage congestive heart failure, unable to do much beyond sit and suck oxygen, I can add to the praise for those who have cared for me, and who continue to do so. In fact, my cardiologist just called me yesterday to have my wife stop by and pick up a pile of samples, and to schedule an echocardiogram locally. He was also instrumental in my recent escape from the hospital at a reduced co-pay. The care in two separate hospitals this year was excellent and the nurses and others were always cheerful and attentive. I even enjoyed the food. I owe what little time I have left to my gastroenterologist and cardiologist; both of whom are genuinely nice guys, who really care about the well-being of their patients, even to the palliative care toward the end.
So, if I suddenly go silent, you will know what happened. Meanwhile, I am just increasingly fuzzy and making more typos than in the past.
 
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