Why Americans are Flocking to Asia

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firecat69
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Re: Why Americans are Flocking to Asia

Post by firecat69 » Sun Feb 17, 2019 9:16 pm

Now it has become a very useful discussion. So a couple of points . When I was deciding whether to retire in Thailand , one of the many considerations was Health Care but certainly just one of many. What I found was decent medical insurance was available but it became harder and harder to continue or get as you age. Since my family history says I may easily live into my 90's . I found it harder to find policies that would continue to cover me.

Maybe some of you have found a company that will cover you until you die and I'm sure many would like to hear about them . The other thing I did not like about most of the companies but not all was the rigamarole you had to get through to get certain procedures covered before you go to the hospital.

I have none of that BS. My primary doctor sets up an appointment with a specialist usually in a few days and I just hand them my Medicare Card. No prior approvals needed .

Not that long ago I needed to get some bone scans etc . The appointment in the Hospital was set up in 24 hours . I signed in and within 30 minutes started the various Bone Scans. If memory serves the charge was about $12,000 but Medicare only pays $2600 which the Hospital was happy to accept. My co-pay that they collected in advance was $131. Thank you Medicare. Now I have no idea what someone working Delta Airlines and covered by a generous Medical Insurance would pay . My guess is Delta's provider might have paid more than the $2600 Medicare deemed appropriate but maybe not.

Bottom Line Medicare like any Government Program is not perfect. I have no idea what I paid into Medicare during my 43 years of employment but somehow I would guess I have gotten it back many times over since my retirement 8 years ago.

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Gaybutton
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Re: Why Americans are Flocking to Asia

Post by Gaybutton » Sun Feb 17, 2019 10:10 pm

firecat69 wrote:decent medical insurance was available but it became harder and harder to continue or get as you age.
One of the reasons, among many, I like Cigna Global is because once you have their expat insurance it is for life. You don't lose the insurance due to your age.

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Re: Why Americans are Flocking to Asia

Post by fountainhall » Sun Feb 17, 2019 11:38 pm

Jun wrote:Where I live, the doctor sees the first 16 patients. So they queue outside, in the cold for up to an hour before the start. The doctor typically arrives 15 minutes late, despite driving a flash 500hp car. The patients may need to wait 2 or 3 more hours to see the doctor . . .
Your doctor sounds rather like my father. He was an old-fashioned country-style doctor who happened to live in a city. He would get up in the middle of the night to see patients - and that happened regularly - but his surgeries were out-dated, dingy and inefficient.

He retired shortly before he died. My brother then took over the practice and completely remodelled it. It was quickly computerised and an excellent appointments system introduced along with a good number of other innovations. It became far more efficient and patients genuinely seemed to like it (or at least the few I have spoken to over the years). That said, I have no doubt there are still a great many GPs in the UK who cling to old habits. Properly managed, in my view, that ought not to be the case. Civil servants and qangos clearly cannot.

On my annual visits back to the UK I have only had to visit a doctor twice. Both times were for minor issues and I went to a small private clinic in London near one of my clients. On both occasions I was seen by a doctor within 15 minutes. I cannot recall the cost of the consultation and the prescription because it was covered by my insurance. All I recall is being surprised that it seemed relatively inexpensive.
Gaybutton wrote:One of the reasons, among many, I like Cigna Global is because once you have their expat insurance it is for life. You don't lose the insurance due to your age.
If it's not too personal, may I ask when you took out the policy and how you discovered that particular company and policy? When I had to change policies some years ago, I was first steered towards a company and a policy which was only guaranteed until age 75. Thereafter the insurance company had the option to provide future cover or not. My view is that any agent pushing that kind of policy is pushing his clients towards potential financial disaster.

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Re: Why Americans are Flocking to Asia

Post by Jun » Mon Feb 18, 2019 12:17 am

gera wrote:To a natural question whether I would want to live in Singapore permanently, the answer is no ( but I could reconsider if my networth would be 100 times more than my current one).
If my net worth were a suitable multiple of the current level, I would certainly consider Singapore as a candidate place to reside.

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Re: Why Americans are Flocking to Asia

Post by Gaybutton » Mon Feb 18, 2019 4:48 am

fountainhall wrote:If it's not too personal, may I ask when you took out the policy and how you discovered that particular company and policy?
I've had the policy for several years. I checked into it after a friend told me about it when I was looking for insurance that would pay the hospital directly rather than having to pay up front and wait for a reimbursement.

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Re: Why Americans are Flocking to Asia

Post by fountainhall » Mon Feb 18, 2019 9:38 am

Thank you.

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Re: Why Americans are Flocking to Asia

Post by Dodger » Mon Feb 18, 2019 10:33 am

Self-Funded Health Plan (SFHP)

The essence of the concept is that I am liable for the risk associated with my own health costs and choose to carry the risk using my own assets and not take out insurance through a traditional insurance company. Self-funding involves a transfer of risk from myself to my own Self-Funded Health Plan (SFHP). There is no element of traditional insurance in this program.

Due to the limited finances in my SFHP as compared to a traditional insurance company, I could easily end up bankrupt if I were to incur a large number of high-dollar claims and/or catastrophic loss which exceeded the funds available in my SFHP. To mitigate this risk I have established a minimum baseline of funds needed in my SFHP, as well as selected a hospital in Thailand (Queen Sirikit Naval Hospital) which provides low-cost healthcare with a reasonable level of quality care where the funds needed to cover a large number of claims and/or catastrophic loss would not exceed the assets available in my SFHP account.

The SFHP is established with a base amount of 1 million THB. Monthly contributions of 6,000 THB are deposited into the SFHP the same as if installments were being made to a traditional insurance company. The purpose of this is to build the SFHP over time and offset the costs of any claims made during the current annual cycle.

Understanding that 6,000 THB/month can buy you an insurance policy in Thailand with pretty good coverage, once you are over age 65 (as I just passed) the rates for insurance can be increased significantly by the insurance company – or they can drop you all together. They want to insure young healthy people in Thailand not people over 65 and will do everything in their power to discourage you from renewing your policy – or just cancel it.

With my own insurance policy “SFHP” I don’t have to wait around for any approvals, assured a private room, can live to be 100 and my rates will never increase and my policy will never be canceled.

The downside is I will be relying on services at a low-cost government hospital which are adequate but almost certainly lacking the equipment and techniques supporting some of the latest technologies which can make a big difference if a catastrophic event were to occur. I guess that’s one of the consequences of choosing to retire in a third-world country but at least I’m in control of my own destiny.

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Re: Why Americans are Flocking to Asia

Post by Gaybutton » Mon Feb 18, 2019 10:36 am

fountainhall wrote:Thank you.
If it helps anything, a close friend, a true financial wizard and investigator, checked into Cigna Global - and I never even asked him to do it - and informed me it is an excellent company, excellent insurance policy, confirmed that once you have it, it's good for life, and said it is one of the few insurance companies that is truly good, honest, and doesn't give any nonsense about paying.

Dodger wrote:at least I’m in control of my own destiny.
Are you? If something catastrophic happens and the cost goes way beyond the money you've saved up, there goes being in control of your own destiny. My unsolicited advice is to do both - meaning continue to put money aside for self-coverage and get a good insurance policy while you're still young enough to get it. At age 65, as long as you don't have HIV, you can still get a relatively inexpensive policy with Cigna Global and keep the policy premium cost down by taking a high deductible. That's where the money you've saved up comes in. If you need to be hospitalized, wouldn't it make sense to use that money to pay the deductible?

Especially once you're past age 65, anything can happen at any time. Sooner or later it will. You know that. You could be perfectly fine one day and end up in the hospital the next day.

Do what you will, but I would re-think what you're doing. Nobody likes to pay for insurance policies, but when it comes to your health, I think it's worth it for the peace of mind and access to the best medical care. Just like the people who didn't listen and get a Thai bank account while it was still easy to get one - and now they regret it - if you wait too long to try to get a good medical insurance policy, then find you either can't get one or you can only get an expensive age restricted, you could too easily end up regretting it.

One last thought. What if something catastrophic happens to you and you're out of town somewhere, nowhere near Queen Sirikit Hospital? If you are forced to go into a typically expensive hospital, where does that money come from? To me, the price of a good medical insurance policy is well worth it for the peace of mind. I'd find some other way to save money if I were you. To me, relying on a relatively inexpensive hospital is the wrong way to do it.

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Re: Why Americans are Flocking to Asia

Post by fountainhall » Mon Feb 18, 2019 11:29 am

Some years ago I gave serious consideration to the self-insurance route. The policy I had had since my early 40s was fantastic and worldwide. But by age 55 the premium started rising, as I should have realised but did not. I then took the advice of members of this and other Boards and consulted an "expert". The policy recommended to me was certainly far more suited to my circumstances and the premium dropped to less than one third. But . . . after three years, the premium increased by 26%. The following year by 50%. 100% in two years was just madness. Letters to all involved only drew offers of sympathy - as though I had died!

So much for experts - and so much for my not having done my own research. Partly my fault - but lousy advice! That is the point when I very seriously considered self-insurance in Thailand with an annual travel policy from a company in London to cover my many trips outside the country. After a great deal of thought, I gave up that idea, largely for the reasons outlined by GB. I have no idea if I might eventually have a heart attack, prostate issues, be knocked over by a motorcy driver and have a brain haemorrhage. If all that happened over a short time, the result would be an empty health account - which then would have to be quickly topped up in case other nasties suddenly appear. The risk/benefit analysis had only one outcome.

I have been largely illness-free throughout my life - so far. I took out a policy with a different company with a substantial deductible which keeps the premiums low. Like Dodger I opened a separate account for the deductible and pay into that annually. It's not an ideal situation - I wish I had known about Cigna! But I consider it is the best available for my likely needs.

The other snag Dodger might face at his present age is the bloody Immigration Department. Given the intransigence it has shown over the retirement visa issue, IF it eventually decides retirees must have formal health insurance, obtaining even basic insurance after 65 becomes very, very difficult.

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Re: Why Americans are Flocking to Asia

Post by ceejay » Mon Feb 18, 2019 12:39 pm

A question for Dodger. You have put this money aside, but what arrangements do you have in place to make it accessible if you are too incapacitated to do so? That's a question worth considering, because some of the most likely situations where you will need large sums (stroke, heart attack, serious road accident for example) are also likely to leave you too incapacitated to go to the bank.

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