Investment Workshop 49: Expat Insurance

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Today I’m going to talk about something I absolutely LOATH talking about: health insurance. Specifically, expat insurance.

Ugh, This Bullshit Again?

I know, I know. I don’t like it any more than you do, but it’s an issue that comes up over and over at Chautauqua, Fincon, and just our own exploding inboxes: If I retire, what the HELL do I do about health insurance?

It’s a question we keep getting over and over again, which is why we’ve written about it over and over again.

Here’s the frustrating part: Every time we write about it and say “here’s the current situation, do this,” Trump does something and everything we wrote gets completely invalidated a day later. I HATE writing about health insurance. It’s like being on a ferris wheel of stupidity.

So why am I writing about this now?

And the answer is: Mr. Money Mustache.

You may have heard of him. He writes about money. And early retirement. I hear he’s pretty good.

ANYHOO. Recently he, along with most of America, had to renew his health insurance and was shocked to discover his premiums doubled in price. Naturally annoyed, he reached out to us asking for advice, since we had talked at the last Chautauqua about how cheap and easy health coverage was as a nomadic person and he was curious as to how exactly it works. Ultimately, he decided that our nomadic lifestyle wouldn’t really work for him and just decided to pay the higher premiums, but our discussion generated some interesting ideas and I thought I would share those with you.

Why? WHY?

Why is this an issue, you ask?

In one word: Trump.

His executive order to end the cost-sharing subsidies that were a key pillar of Obamacare sent shockwaves through the health insurance market, and as a result has caused the cost of insurance to skyrocket. In Mr. Money Mustache’s case, the increase was 100%.

But here’s the fun part. The ending of those cost-sharing subsidies hurt the insurance companies. And that caused those insurance companies to increase their insurance premiums. But for whatever reason, Trump’s executive orders couldn’t change the mandate of Obamacare that the federal government would provide subsidies to make health insurance affordable to people earning below 400% of the Federal Poverty Level. So as a result, even though the price of health insurance increased under Trump’s changes, the Obamacare subsidies were forced to increase to cover the difference. As a result, under the new rules, early retirees like the ones who read this blog end up paying the exact same amount, but a bigger part of their insurance bill gets subsidized by the federal government.

But yet, Mr. Money Mustache’s premiums doubled! What gives?

Well, as it turns out, there ARE losers in this new Trumpian government when it comes to health insurance costs: Self-Employed People and Small Business Owners.

Because the primary customers of the Obamacare Exchanges are Self-Employed people and Small Business Owners, with early retirees like us as an unintended passenger. And if you’re an early retiree that makes too much from their investments to qualify for Medicaid, Obamacare and its associated subsidies is how you make health insurance work for your family.

Only problem is, if you’re self employed (like MMM) and make too much money (like MMM), you get hit with the premium increase due to Trump’s killing of the CSR yet don’t benefit from the associated increase in the federal Obamacare subsidies.

Great. What now?

Well, if you’re MMM, you just accept the higher premium. And that’s totally fine, TOTAL respect to MMM for his decision because it was the best for him and his family. He loves Colorado, and Colorado is where he shall stay.

But for us? What would we do?

Well, as it turns out, it’s not just a hypothetical. We had to make this decision as well.

In Canada (or at least in Ontario), if you leave the country for 2 years you are considered a non-resident. And with that, your gold-plated Canadian health insurance goes away. So we were faced with an uncomfortable decision. Stay in Canada for the health insurance, or keep traveling.

Naturally, we wanted to keep traveling.

So as part of our research, we looked into expat insurance, which is health insurance that covers you if you were to leave your home country and settle somewhere else. Would you like to know what we found?

Expat Insurance

This was what Cigna quoted for the two of us for a year of insurance coverage. For the purposes of this quote, I made up a date of birth, and pretended to be an American planning to live in Europe.

Click here to get your own quote:

So $2400-$3000 USD for a year of coverage. For comparison, MMM’s insurance plan was $12k per year! That’s 4x the cost for expat insurance! Here’s the catch though, these plans are for EXPATS. The reason that these plans are (relatively) cheap is because health care doesn’t cost the insane amount that it costs inside the US of A. These companies are depending on the fact that if their clients get sick, it won’t be in the US of A. That’s why there are limits in their policies for how much time they’re allowed to spend in the States.

Not convinced? I recently asked for a quote from another expat health insurance company and in the spirit of transparency, here’s the link:

And I would like to point out, these policies actually cover health care inside the US. But there are limits on how much time you can spend in the US. In fact, this policy has a rather weird clause stating:

As part of that commitment, IMG offers a Medical Concierge program, an unparalleled service that saves you on out-of-pocket medical expenses. We also offer a cash incentive and to waive 50% of your deductible for choosing to receive treatment from some of the best medical facilities outside the U.S.

So as it turns out, expat insurance companies will actually pay you to seek treatment outside of the US!

So What Should I Do?

I presented this all to MMM, but to be realistic, he’s not moving his family to Mexico any time soon to save on health insurance premiums. But it might be a good strategy for YOU, the early retiree that’s nomadic like us.

The truth is, health insurance is something that only Americans worry about. And that’s because your health care system is so insanely expensive that you can’t afford to NOT deal with it. That’s a unique problem that no other developed country in the world has to deal with.

So what should our readers do who want to to retire early? Well, a lot. But, in short:

  • Lower their income so they qualify for federal subsidies
  • If that doesn’t work, make enough money in side hustles so they can afford insurance
  • If that doesn’t work, evacuate and rely on expat insurance

Simple, right? Easy, right? And I’m sure this article will be in no way controversial, but in the off chance that it is, let us hear it in the comments! After all, it’s just health care. Who gets mad about that?

Continue onto the next article!

55 thoughts on “Investment Workshop 49: Expat Insurance”

  1. God bless Canadian socialized health care. It’s one of the reasons I think that I’ll always own a house here (in a cheap area with no mortgage)- once I retire and am able to travel more, it will still make it easy to spend 6 months a year here and never need to worry about this.

    1. We like to compare our (Canadian) healthcare favorably to our southern neighbors, and rightfully so. But it ain’t as good as most think. I hope you never needed much healthcare, but if/when you do, you might find some gaping holes in what you can get in Canada.

      Canadian healthcare is great if you need heart surgery or cancer treatments, but while the doctors and hospitals are covered, medications are not covered (and most people use lots of those as they grow old), nor are assertive devices or any preventative strategies such as physiotherapy etc. Waiting times are atrocious too.

      The underlying system we have is not all that different from the USA – our health providers are self-employed or large corporations (for profit or charitable), and they simply charge the patient a fee. It just so happen to be that each province provides (mandatory) insurance for it’s residents. But there are many holes in this insurance which is why our large employers provide good benefit packages similar to the USA.

      This system is in strike contrast to other universal systems where the hospitals, doctors and health practitioners are actually government institutions and employees.

      When a Canadian who is self employed (or FI and unemployed, anyone who doesn’t have a benefit package) grows older and needs medications, dental, optometry and other services you might find that there are many out of pocket expenses. You can still get those abroad for cheaper, no doubt, but I wonder how much health tourism you will be into when you are 70 years old and waiting in line for a hip replacement…

      So yes, we are way better off than our American neighbors, but it is not a good reason to be complacent about medical needs. Great to see this blog dedicate the time to educate us about options.

      1. No, it doesn’t cover everything, but I’ll still defend it. I’ve had 5 surgical procedures in my life. I grew up with a chronic illness (unrelated). I know people who have gone through years of cancer treatments. All of that was covered, and in no cases were there unreasonable wait times.

        1. I’m glad you had a good experience with our healthcare system, and you are correct – for the serious stuff we cover residents very well. You won’t end up with financial ruin for having a heart attack or needing cancer treatment.

          I was referring more to the predictable needs of ageing more than the acute needs of young/middle age. And yes, I do defend our current system (as compared to the USA) – but a young retiree with no benefits *must* consider increased health spending when getting older.

          This is a financial blog and the discussion was how to plan for lack of health insurance.
          My point is that a Canadian can not assume s/he will be taken care of for free as s/he get older. You must plan for health spending in your older years, despite having our “universal” healthcare.

          1. True that drug costs aren’t covered, but here in Ontario we’re piloting a socialized drug plan for people under 26. Plus there’s already coverage for people above 65. I suspect we’ll gradually see more and more coverage for prescription drugs in the future.

            That and expensive prescription drugs is not nearly as onerous as health care costs in the US. Unlike health care, you can ask for the price and shop around for drugs. I’ve seen prescription drugs being sold in other countries for a fraction of even what we can get them for in Canada.

            1. In planning for FI, this is my most controversial item and I live in Ontario! I’ve been debating on whether I should get health benefits with OHIP for a 3-person family. I’ve priced it to be about 200-300/month depending on package.
              Currently, we get it through my work benefits.

              My concern is about pre-existing conditions. Right now, my son has epilepsy and hopefully it goes away with age but his drug bills are about 120$/month. I can’t wait for OHIP+ for minors!

              For 65 and older, I heard most drugs are covered but in speaking with a friend whose 80 year old mom is in a nursing home, not all drugs are covered and does run some hundreds dollar a month. If you’re picky, you probably need to factor in long term care if you stay in Canada.

              In speaking to a friend (in his late 30s) who has cancer, drugs are covered but if you are interested in alternative form of medicine (like Chinese herbal) then you need to budget for that worst case scenario.

              As backup, I think there is a Trillium program that would cover catastrophic drug costs.

  2. hahahha…man…I never thought I’d say that one day but…Thanks God I’m not American !
    There are many good things in the US of A but health care system is not one of them.

  3. I’m early retired and living in the US and wouldn’t want to move out of the country for health insurance. I would think that’s a common sentiment.

      1. I want to live near my children/family/friends. I wouldn’t consider myself financially independent if I couldn’t live where I want to live.

        1. On the one hand I hear this and agree, but on the other hand…my family is on the coast and I’m in the midwest. I never see them anyway, so I might have well be in Costa Rica. Not a thing I’ve actually done yet, but I would definitely consider it.

          1. Right. I actually see my parents MORE now, because when I was working I would only see them for a quick meal every month. But now when I come back to visit I see them for weeks straight. The quality of time spent actually goes up, I found.

  4. Thanks for another write-up on health insurance for the neighbors south. It’s good to know there are some options, the silver expat plan price looks good. My plan is to have my income at the 100-130% fpl so that my ~$500 aca premium is fully subsidized. If ACA is going away, I will need to reduce my income to below 100% FPL for my state’s medicaid plan.

    Will do the world nomad insurance for the months I will be traveling.

    1. I really do think ACA will be around long term. We just saw an electoral wave on Tuesday go blue mostly because people are now voting with health care as their #1 priority. If that happens, the 2018 midterms will lock Trump out of taking any more steps to dismantle Obamacare, and then the next president will strengthen it.

      I hope so anyway…

  5. Thanks for this! Lots of FIRE bloggers say “If insurance becomes too expensive I can always move overseas” but you’re the first I’ve seen talking about it with real actionable information.

    It seems like Cigna wants to know where you’ll be living. Does this mean you change your insurance each time you move locations?

      1. Sorry, I wasn’t clear. I meant do you have to notify Cigna every time you change locations and get your policy rewritten, or are you able to just keep the same policy despite not “living” in the same country as you were when you signed up (France in your example)?

  6. Dear Wanderer,

    We spend 6 months a year in Ontario, Canada and 6 months in Mexico. Not so that we maintain our medical insurance standing but that’s an added bonus.

    We get extensive travel medical insurance for our drive down/back through the USA.

    While in Mexico, we don’t pay for any extra health care. Even if we needed major surgery, it would be less than/comparable with the premiums we would have to pay (for a family of four, my husband is over 60). If (and a big IF), one of us had to go back to Canada, we figure that an air vac would be around $10,000. We’ve already been going to Mexico for 12 years so we’ve already “saved” more than one trip and fortunately, we always have access to money to pay for this lifeline.

    Given the places that you visit, I can’t imagine that healthcare is that expensive. Is not having any healthcare something that you have considered (for any reason)?

    Besos Sarah.

    1. I wouldn’t bet on $10k for air ambulance. Full ICU support is closer to $50k. Also a surgery is one thing, but what if a prolonged stay or ICU stay after is involved? I wouldn’t risk it. Or at the very least, get some quotes from where you’re visiting.

      1. Dear MD M of 3,

        Thanks for the update on the cost of an air vac. I did look into insurance for our stay and one that included an airvac to Canada was $5,000. 10% sounds more than reasonable to me.

        Having said that, I’ve recently made an insurance claim (not for medical reasons) and it was one of the biggest nightmares of my life. I can’t go into it but honestly, movies are made of this (think Eric Brocovich but without the Hollywood ending). Having said that, the only situation where I could see myself using insurance coverage for anything would be for liability and I have that coverage.

        We have had two hospital visits while in Mexico. While they were both minor (stitches) and xrays (with medication) and didn’t require a followup, for whatever reason, the care (including meds) were free. They did ask us if we could afford to pay for the xrays and so we did. It cost $3USD.

        I don’t know what it would cost for an extended stay and/or if it was a serious injury, however, given your feedback, it is something that I will look into when I’m there next month.

        Besos Sarah.

        1. Checking would be prudent. Things to ask: if need be, do your air evacs only go to a bigger Mexican/local hospital or are they able to go further (Canada). Who accompanies on the transfer – intensive care doc with support staff or nurse alone? What equipment is available on board – ICU set up/full meds or just basic monitoring? There’s a chance they will say, if need to go outside Mexico you’ll need to find a US or Canadian carrier ($$$$).

          Absolutely human labour costs (consults, surgery, scopes) are low in developing countries, as are cheaper modalities (stitches, Xrays, even CTs etc). Some things are just unfortunately not – IV meds, specialized imaging, stents etc. There’s no way to discount those.

          The big thing is, as people get older, a seemingly small issue can quickly spiral into a very big issue. That’s why the insurance premiums are so high (the insurance companies will also pay the lower local fees for things that can be worked out locally). So someone needs an appendectomy, and in a young patient that would be a quick proceedure, maybe overnight in hospital, get discharged, all good after a couple hundred dollars. For someone over say 60, the surgery may be more difficult (older tissue), let’s say they can’t do it laporascopically, now bigger defect that more likely to get infected. But out in a few days. But also longer hospital stay, more time immobile predisposing to blood clots therefore risk of stroke etc. And the surgery itself is stressful on the body, the heart specifically, so may unmask an ischemic heart – heart attack in an older patient. Now patient needs ICU, cardiac monitoring, scans, stenting, bloodwork everyday etc. In ICU maybe they develop some fluid in the lungs, maybe pneumonia req further expensive antibiotics, then their kidneys stop working briefly so need dialysis for a few days. Slowly systems recover but now it’s been ?3 weeks of expensive intervention. Again, this is worse case scenario but that’s the thing, you don’t know.

          I’m not trying to scare you, just to give you a not unheard of scenario where a previously healthy person starts down a long path of recovery. As age goes up, yes insurance costs go up, but the risks and stakes also go up.

          1. Dear MD M of 3,

            Information is power and I’d prefer to make an informed decision. Thank you for helping.

            You raise another point that is part of our thought process but I didn’t mention. We are currently young-ish (my husband is 62, I am 45) and healthy. I know that can change quickly and when (not if) it does, we will make sure that we “plan for it”, as best as one can plan for life πŸ™‚

            Besos Sarah.

    2. Of course! But try selling that to the readers of this blog!

      Health care costs are something that consumes either citizens of third world countries, or the US. So that’s why I keep writing about it.

  7. Has MMM looked at getting insurance directly from the providers such as Blue Cross\Blue Shield? I have heard that it can be cheaper to do that rather than go through the exchanges (and thus pay the premium). I went through the exchanges last year as an independent consultant (and suffered my own increase back then btw) but my buddy who is also independent went directly. Cheaper for his situation…

      1. Sorry for my delay in responding. I wanted to get some facts with my experience for 2018. Yes, it is indeed cheaper in some cases to go directly to the carrier (i.e. Blue Cross). With this last open enrollment, the US government eliminated some of the subsidies to the insurance providers. To make up for that, some carriers increased their premiums especially in the Silver category. There is actually a whole NYT article about this. For me personally, the EXACT SAME PLAN from BC was $100 cheaper going directly than on the exchanges. This happened to some of my co-workers too. One family saved $400. I wish it was just a listing of all the plans and I think it started out with that intention but the funding of ACA is screwed up now. Anyone who can qualify for personal subsidies from the government should use ACA but if not, they need to shop around. I wish it was not so. Thank you for replying and for the blog! Keep it up!

  8. I am a bit surprised at the suggestion that healthcare is so cheap for Canadians. We pay much higher taxes than Americans and much of that goes to funding the β€˜free’ healthcare system. The private care and facilities are so much better in the US and that costs more too. And American salaries are higher. I am a Canadian living in Switzerland and our family enjoys lower taxes here too but we pay collectively 1200 USD per month for private healthcare which is mandated by the govt to buy. I think either way we all are, or have, paid for healthcare one way or another.

    1. Oh, we all do. As a Canadian, I’m acutely aware that’s it’s not free. But as a Canadian, or a Swiss, you will never go bankrupt because of a medical issue. As an American, that’s completely possible.

      1. That simply isn’t true. Medical issues are a leading cause of bankruptcy in Canada.$FILE/Redish-Sarra-Schabas-2006-ENG.pdf

        Fifteen percent of bankruptcies at 55 or older claim medical costs.

        There’s some other research I can’t lay my hands on at the moment that show the #1 predictor for bankruptcy over medical issues, in both the US and Canada, was financial health prior to the event. Basically, any financial shock is going to send some people into bankruptcy, whether they live in the US or Canada.

  9. How does this differ from World Nomads travel insurance? Why do you need Health Insurance abroad vs Travel Insurance with health coverage?

  10. MMM and his family could still use this insurance? Maybe? Can it apply to medical tourism? If not, well maybe medical tourism is the way to go.

    I currently live in Korea and started the process to fix up my teeth. I’M IN LOVE with National Health Insurance. Once hired and my ARC card processed, I was automatically enrolled in this system. A cleaning and x-rays is about $18 USD and I’ll be getting my first filling here tonight at the price of $46 USD. I easily paid way more than that in America, and that was when I had dental insurance. This may be the sole reason why I don’t return to live in America long term in the future. It’s great to see that I have insurance options for when I plan to travel around the world in 2020. Thanks for the great post!

    1. That’s the beauty of living outside the US. No other developed country in the world has to worry about health insurance costs. Yet that’s all I hear from Americans…

  11. Hello. I’m an European ER’d living in South America and planning to travel in SE Asia almost all of 2018. As I’m living in another country than the one I was born in, and that the local health plans were getting too expensive, I experienced a similar issue and decided to switch to an expat plan. The thing is that the price of most expat plans increases quickly once you add outpatient coverage. That was until I found the “Now health worldcare essential” plan with a maximum of 4500 USD outpatient coverage (optional), all with zero deductible. I did A LOT of research on expat plans and this is the best value for money I have found with respect to my personal situation. You may want to check it out. Note though that I (fortunately) never had to make use of it till now so I cannot tell about their level of service.

    1. Will check it out, thanks for the suggestion!

      That being said, outpatient care isn’t the expensive part. It’s if you get hit by a bus and need to be hospitalized.

  12. Interesting article. My wife and I are seriously considering moving to Mexico when we retire – just love the area and want to live somewhere where we’ll never get cold! I’d actually move today if I could somehow convince Mrs. MSW to go – although I think we’ve got enough to retire, we’re both also making very good money and she doesn’t want to part with that quite yet.

    Just had a few questions. Are the quotes above per person or per couple (ie for the both of you)? It’s a great deal either way, but even better if it’s both.

    Also, do you know how pre-existing conditions would work with type of insurance? Both of us have prior health conditions that are easily managed with relatively cheap medication (ie even if the insurance didn’t pay it), but I would be concerned about going down there and developing some condition for which I would not be covered. I’m not a big fan of the ACA, but the pre-existing condition elimination was one of the better things about it.

    Finally – did you say that this insurance would cover you if you went back to the USA infrequently? I was wondering how that would work – we’d still want to come back periodically and visit family for holidays’ etc, but would not want to go without insurance here – I’ve seen the healthcare system here up close, and as you said it is unbelievably screwed up and inefficient!!

    1. It’s per couple.

      It varies per plan. For the IMG one (the one with the big table), the cheapest bronze plan excludes treatment for pre-existing conditions, but as you go to the right (silver, gold, etc.) it starts to cover more and more pre-existing stuff. Go to their website and see what works for you.

      And yes the coverage works inside the US as well. You just can’t spend more than 6 months in the US. Again, read the fine print on each policy yourself before you buy anything!

  13. here in the u.s. you hear “health care” debated and discussed. i wish they would call it was it is: “health insurance.” these chiseling sidewinders in the insurance industry don’t provide care. stop by united health group or cigna with a gash on your forehead. nobody in the glass walled skyscraper could help you. they’re just barnacles.

  14. Healthcare in America is effing expensive! MMM is lucky to only pay 12K for his family.

    I am 53 and although we reached FI at age 49, I am still working until I reach 55 in order to qualify for company retiree medical. I can’t trust obamacare to be available in the future if I quit today.

    When my co-workers retired 8 years ago in 2009, retiree company medical was 7K a year per person. For every year of service (YOS) you can get either 2 or 3% depending on the age and YOS earned. For 25 YOS, the company can either cover 50% or 75% of the 7K or the annual price. Well, we were initially in the 3% group and thru the years we were changed to the 2% group. A few more years later, the retiree benefits was watered down again and now we get a fix amt of money that goes into an annuitity which generates a fixed amt for medical.

    Healthcare premiums increase every year.

    My wife was laid off in 2016 after 30 YOS and she gets 8K for medical every year and a pension. In 2016, the company medical is 11K a year minus 8K and it is 3K a year out of pocket. Obviously, the 3% medical group would had been the best. Imagine, after 30 YOS we would only pay 10% of an annual cost of healthcare? Most of our co-workers are 10 years older than us and they were grandfathered for the 3%. My wife is still fortunate to get 8K for medical.

    My wife’s boss was also laid off in 2016, his company retiree medical premium was 27K for his wife and 3 daughters! Now that is crazy expensive. He was fortunate to find a job and he elected to NOT take the retiree medical.

    In 2017, company retiree medical increased to 12.5K per person minus 8K and it is 4.5K for my wife.

    I have family members that are age 62 and they are paying 22K per couple! They cant wait to reach 65 to get Medicare. They don’t have pensions, 401Ks or retiree medical. Healthcare is their largest expense and that is why most ppl retire at 62 or older.

    Although I can walk out now and pay for my own medical, I prefer to endure another 22 more months to get 8K yearly for company medical and double my pension to 70K.

    Since healthcare is our major concern, we made sure that we budgeted 20K a year for healthcare and factor in 8% increases every year for the next 12 years until 65. In 12 years, that would be over 50K and that would be freaking crazy for healthcare.


  15. A note on ACA income thresholds. There are 2 levels of subsidy. First is premium subsidies for those making 400% of poverty. Second is cost sharing that reduces deductibles and copays (the $30 that goes to the Dr. that day) for those making 250% of poverty. Donald chose to cancel payments for the 2nd service, but the law requires insurance companies to keep paying out the service. They jacked up rates to pay for the difference.

    MMM is part of the group who make more than 400% of poverty. This is any high income person that buys their own insurance. If you are self employed, but don’t stack the benjamins like MMM, you will be OK.

  16. I have reached FI but I haven’t pulled the trigger on ER purely because of the health insurance issue. I have a chronic condition and see a specialist for my care. Unfortunately, none of the marketplace health plans where I live would cover the doctors I currently see. There are other doctors that cover my condition, but my current doctor is at a top national facility, so I am hesitant to have to change providers. It shouldn’t be this difficult…

  17. Wanderer,
    This expat insurance is an incredible thing! Thank you so much for this great information! My husband and I are in a similar situation to MMM in that we will be too high income in retirement to get any subsidies. We are also originally from Canada but have lived in Texas for twenty years and consider ourselves Texans and Canadians. My husband is retiring in April at age 53. He is a petroleum geologist and is totally burnt out. They are making him work 24/7. I am so happy for him to retire and enjoy life. I thought I would continue to work at least enough to keep health insurance for us but would reduce the number of shifts I take so we could travel more in retirement. This expat insurance would let us stay in the U.S. for maximum 6 months a year which is great with us as we can stay in Canada for part of the year visiting the family and I can even work a few shifts there. Plus we can travel around to visit other countries. As long as we stay out of the US for at least 6 months we will qualify. The rates are pretty good even for older people like us. Thank you so much for the information! This insurance would really give us more freedom in that I am not tied down to a part time US job to get insurance.

  18. Great article! A couple questions I hope you can shed some light on:

    1) I’m still a little confused about the country selection on Cigna – what’s to stop someone from choosing a country with a lower premium but not living there full time? For example, if I choose Thailand as my residence, the premium is $100/mo lower than if I choose Mexico – what if I wanted to spend only one month, or maybe none at all, in Thailand?

    2) Do these plans meet the Minimum Essential Coverage stipulations of the ACA? If so, that’s incredible! If not, what is one to do if they don’t qualify for the exemptions (e.g. you want to be in the U.S. for more than a couple of months per year)?

    Thanks again!

    1. Great questions, Brandon. Here are our answers:

      1) You can lie about it but when it comes time to submit a claim, you will have to submit all requested information and if they catch you in a lie, you’ll be denied claim. It’s the same with anything else. You can lie on your taxes, but if you get caught, you pay the consequences.

      2) No, it doesn’t. If you want to use expat insurance, you can’t live in the U.S for long periods of time.

  19. Thanks for the links to the expat websites. This article was written with the U.S. health care system as a basis for comments etc. Is there an article somewhere about health insurance for Ontario residents, who don’t want to have to live in Ontario for 5 months of the year to maintain that status?

    1. We are in the same boat as you. You can use expat insurance the same way we recommend for Americans (we’ve bought expat insurance from IMGlobal)

  20. Hi Guys! I love your site! This article is very helpful but, in this example, I would be concerned about the $3,000 deductible if my total annual budget was $40,000. Right? Also, I currently use Cigna Expat Insurance and they typically cover about 80% of the claim costs.

    I am concerned that if I were to retire and become really sick, these costs could spike and derail my budget plan. What do you think about that? Is there some way to quantify and manage that potential risk?

    1. if your total budget was 40 K, you get aca subsidy .

      anyone has experience making claims on expat insurance? for major health bill like hospital stay, surgery or ICU

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