Long (we never say old) friends moved to Italy for a good deal of the year. This Grandma is not one to move abroad for long periods of time to be away from grandchildren. For another, I am so happy that America allowed our family sanctuary and citizenship, that I am not interested in living anywhere else in the world. Year after year, however, I hear of their wonderful time in Italy.
First, of course, is how they manage away from their grandchildren for such a long period of time. Their grandchildren come to Italy, I hear, even spending the summer. How wonderful! We know that the best education is giving our grandchildren new experiences. Spending time abroad is just perfect.
Second, I wondered how they manage with health care. I never asked, but forwarded the February 21, 2014, New York Times article, “The Dream of Moving Abroad in Later Life, With Good Health Care, by Tim Grayfeb, to my long friend.
The article about health care abroad concerned me:
The best policies, those offering the broadest coverage and giving access to the best hospitals, can be jarringly costly. More affordable alternatives can come with exceptions that may surprise people accustomed to the comprehensive coverage offered through many United States employers. Many countries offer high-quality care – France is a prominent example – but retirees won’t be able to access it without insurance or paying out of pocket. And in almost all cases, Medicare doesn’t pay for health care provided outside of the United States.
“Health insurance really is a primary consideration when retiring overseas,” said Brendan Sharkey, director of individual products for HTH, which sells and administers GeoBlue international health insurance. “People may want sunshine and affordable living, but they’ll also want to make sure they’ll be covered adequately.” That means not just buying a policy, but also assessing the quality of health care in the country where they plan to settle.
“If you’ve had two heart attacks, you have to ask yourself if it makes sense to retire in Nicaragua, where the underlying quality of care just isn’t there,” Mr. Sharkey said. More practical alternatives might be Panama or Thailand – warm, affordable countries known for better-quality care, he said.
For health insurers, age equals risk – senescence brings sickness. So older people can expect to pay up for international health insurance, especially as they reach their middle to late 70s. “It’s the same everywhere in the world – the older you get, the more expensive the premiums,” said Steve Nelson, product development manager at Medibroker, an insurance brokerage in North Shields, England.
At Cigna, international health premiums can range from a couple of hundred dollars a month for the most basic plan to several thousand for a comprehensive one, said James T. O’Brien, head of the Americas region for Cigna’s global individual plans.
“Our product is designed to take all comers – we’ve made it modular and flexible,” Mr. O’Brien said. Cigna offers three levels of inpatient coverage, with total annual limits of $1 million, $2 million or $3 million. A customer can then choose among several deductibles, ranging up to $10,000 a year, and can add coverage for such things as outpatient care, medical evacuation and vision and dental services.
Anyone shopping around should understand that insurers individually assess applicants for international medical policies, Mr. O’Brien added. Coverage isn’t automatic, as it is with Medicare. The insurer reviews an applicant’s health, typically either through a questionnaire, an examination of medical history or both. The insurer then decides whether to offer coverage, what the premium will be and whether to exclude any conditions.
Cigna imposes no age limits on its plans, but some insurers won’t cover people who have crossed an age threshold. Allianz Worldwide Care, for example, won’t accept applications from people past their 76th birthday, said Alexander Bender, a senior manager for client relations, based in Dublin. Once Allianz does enroll people, it guarantees lifelong coverage as long as they pay their premiums, he said. HTH sets a similar limit for its longer-term GeoBlue policies.
Age also can bring ailments that complicate coverage. “The older you are, the more underlying conditions you may have,” said Mr. Sharkey. “Once somebody starts having multiple conditions – maybe high blood pressure, obesity and high cholesterol – it becomes difficult to cover them in one of our long-term plans.”
Like many insurers, HTH offers policies that can cover either short or long stays abroad. The short-term ones are intended for travelers and snowbirds, while the long-term ones are for full-time foreign residents. “For longer-term coverage, there are medical conditions that are an automatic decline – if you’re a pacemaker recipient, if you’re diabetic and insulin-dependent, if you’re undergoing cancer treatment,” said Mr. Sharkey.
Another consideration is whether you want coverage in the United States. Some international health insurers won’t cover domestic care, and others charge more for it. Allianz, for example, offers policies that provide coverage that is worldwide or worldwide minus the United States. Allianz singles out this country, sometimes even doubling its policy premiums, because health care costs more here than elsewhere, Mr. Bender said.
First, my friend pointed out that America is no longer highly rated in health care if you look at international ratings. This Grandma did. Italy is number two in health care according to World Health Organization Ratings listed in Wikipedia. See Wikipedia.
America is listed at 37! More interesting, America was listed as number 1 for medical expenditure per capita. I am surprised that the New York Times article did not mention this.
My long friend said that she has been very fortunate in Italy–that the quality of care is good. She said even her guests are covered without asking for insurance information. They cover everybody even their guests without asking for insurance information, according to my long friend. She said her dentists are in Florence and are MD dentists trained at University of Pennsylvania. I guess even the best doctors are considering relocating outside of the U.S.!
I do have other long friends who went to Bangkok, Thailand, for health care purposefully. The type of health care needed was better there than here and much cheaper, according to these long friends. Travel abroad for health care is becoming more common as the web connects the world with reports on new medical discoveries.
But for now, this Grandma believes what the article says:
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.
And there are locations around the world that are not expensive to make a part time or full time home in retirement. Research into health care is an important step, even though it is hard for us Boomers to admit it. But don’t be put off by the threats that health care will suffer. Investigate for yourself. The internet has many websites on health care around the world and on health insurance for expats.
That is if you want to be an expat. I like traveling the world but I like returning to America best of all. Maybe a few weeks to a month with grandchildren in Europe would be heaven – if the parents of our grandchildren would let us take them! A summer abroad with grandchildren would be pure
Joy,
Mema
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