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Old 12-07-2016, 02:07 PM   #21
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Greetings,
Be very, very careful with a "pre-existing conditions" clause. A close relation was refused medical remuneration for a medical problem not in the least related to her "pre-existing" condition. This was pre AHA.
Thanks RTF, we will be asking specifically what each global medical company has in place before choosing one. We don't really have any pre-existing conditions that would be costly issues, but we want to be fully informed. I really hope they remain history in the US for when we return.
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Old 12-07-2016, 04:38 PM   #22
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Greetings,
Be very, very careful with a "pre-existing conditions" clause. A close relation was refused medical coverage due to a "pre existing condition". She had suffered a sports injury to a ligament and had undergone a lengthy regime of physiotherapy which, at the time, had been covered by her employer but after leaving that employer and applying for her own coverage, was deemed too great a medical risk in spite of the fact she was willing to not include ligament injury or similar in the new policy.
This was pre AHA.
Yes, not legal today. We can't know tomorrow.

Now, in getting a global plan that has a pre-existing condition clause, I'd be very tempted to also continue my US plan for some period of time. One key is the definition of pre-existing. If it's defined as something for which you'd received treatment in the previous year then you can clearly know what that is. However, if it's open ended definition and pre-existing includes things you knew nothing about, then it's dangerous.

I've followed the trends in pre-existing clauses on group plans in the last 27 years or so, and there were times they were horrible. We eliminated them for new hired sometime a couple of decades ago and also for those who had qualifying events.

There are many parts of the AHA that haven't been widely discussed and are only known by those who have benefited by them. Eliminating pre-existing condition exclusions is one of those parts.
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Old 12-07-2016, 06:09 PM   #23
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Was not able to fully research the tax home issue. The 330 days comes from the tax law that exempts $75,000 in non US income from those working and living abroad. If I were to guess Obamacare just referenced the code sectiom. If that is the case you may be required to have a tax home (pay taxes) outside of US.

I have been told that touching down in the PR or the US Virgins restarts my 60 day coverage under medicare supplemental plan F.

Your choice on not carrying US coverage. That is a two fold risk. If you require major medical work were will you go and what will be coverage. Also it is reasonable to assume Obama care as we know it will be gone in a few years. Then what.
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Old 12-07-2016, 06:19 PM   #24
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Your choice on not carrying US coverage. That is a two fold risk. If you require major medical work were will you go and what will be coverage. Also it is reasonable to assume Obama care as we know it will be gone in a few years. Then what.
Her choice is to have a global plan including rather than excluding US coverage. That would allow US treatment. As to changes in laws of any type, it's hard to know. However, once a benefit has been provided such as no pre-existing exclusions, taking it away is very difficult and, while one can't be sure, I'd think highly unlikely.

We maintain and US policy and a Global Policy which excludes the US, but then we spend the majority of our time in the US.
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Old 12-08-2016, 05:56 AM   #25
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There are two different views of what medical insurance provides. The first is to even out the cost over the year of routine medical expenses. Thus the premium pays for wellness visits, medicines, routine treatment and other items costing less than $5,000 US for a year (arbitrary number). This function is more important at lower income levels.

The second function is more of an insurance function. The major expense. An expense unlikely to happy to any one person but which does happen to someone every day. These expenses can range into hundreds of thousands, if not millions of dollars.

Before Obamacare many Americans purchased ultra high deductible plans assuming that they could cover any expense under e.g. $20,000. However, if they needed an organ transplant the insurance would cover the million dollar plus cost.

Travel plans have a cap on their coverage. The needed medical procedures may exceed that cap. Also some travel plans require you to be outside of the US for a certain period of time each year. Unsure of what happens if you are in a US hospital and can't leave as far as eligibility to renew coverage.

As my comments indicate medical insurance for traveling Americans is much more complicated now then it use to be. (Remember immediately prior to Obamacare my wife and I had worldwide coverage, $1,000 deductible, and a five million dollar cap for $335 per month each.)
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Old 12-08-2016, 08:34 AM   #26
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Thanks everyone, lots of great advice out there. We are looking to get Global Medical (different from Travel Insurance), which has the option to include or exclude US coverage, as BandB mentioned, so we will definitely opt to include US coverage. With that, we can get medical treatment no matter where we are in the world, and up to 90 days treatment in the US. I am unsure what happens if we are unable to leave after 90 days, so I will be asking that question of the broker next.

2 of the 3 Global Medical companies offer unlimited coverage (GeoBlue and CignaGlobal) - no cap per year. You pay more, of course, but for catastrophic events, it would be worth it, we will likely choose one of those plans.

I will keep you posted to any details I find out about pre-existing condition clauses, and catastrophic care in the US that goes beyond 90 days.

Cheers,
Fran
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Old 12-08-2016, 08:50 AM   #27
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And never forget, if you need emergency care outside of the US, the provider may not accept whatever insurance you have. They may have never heard of Aetna, or IMG, or insurance, for that matter. A hospital in Colombia, for instance, will not be interested in submitting claims to some foreign insurance company. They may demand cash. Yes, your insurance will reimburse you at the end, but that won't get you in the door.

There are companies that cover this hole. My employer uses iSOS. I'm not pushing iSOS, they have competitors. But iSOS has a network of care providers around the world who will accept iSOS (and speak English). And if the provider doesn't accept iSOS, supposedly iSOS will show up with cash (never had to test this). And some big insurance companies also have international networks, but it doesn't help if you're where they're not.
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