US citizens living abroad are not required to purchase health insurance as outlined in the Affordable Care Act, often affectionately referred to as Obamacare.
The definition of “living abroad” is clear; nomads such as ourselves are limited to visiting the US for no more than 35 days every 12-months, else we are required to purchase minimum essential care insurance policies on a Health Exchange.
Were we actually in the US, we would do just that. But these policies provide no coverage for routine care Internationally, let alone across multiple States, which makes them effectively useless for our lifestyle. Thus the purpose of an exemption.
But limiting visits to the US to 35 days every 12 months seems awfully restrictive. If I wanted limitations in life, I would just get a job. So what is going to happen when we visit the US later this year for 2 to 3 months?
Optimizing Obamacare vs Minimizing Taxes presents a classic trade-off.
On the one hand, it would be nice to maximize Obamacare subsidies. Easy! Simply don’t generate a lot of income.
On the other hand, we want to minimize taxes. We do this by offsetting income with standard deductions and personal exemptions, and generating (a large amount of) income that has preferential tax treatment.
But for the ACA, there is no preferential tax treatment. There is no standard deduction, no personal exemptions.
In this post, I explore how to navigate this complex environment in order to optimize health insurance premiums, out of pocket medical expenses, and taxes. Can we find the balance?
In all likelihood, an early retiree in the United States is going to purchase ACA (Obamacare) compliant Health Insurance on the Federal or a State Health Insurance Marketplace.
Even though the ACA has provided common standards, Health Insurance is still a complex topic with numerous trade-offs. Coverage levels and premiums vary. Every insurance company has a different approach to cost sharing. Each State has a slightly different implementation, maybe a different website, and wildly different prices.
Subsidies may pay nearly all of your premium, or they may cover nothing. It isn’t always clear which will apply until after the fact. As a result, some will get an extra large tax bill at the end of the year, while others will pay too much each month. They may even provide a disincentive to earn a higher income.
But much like the Income Tax, those who understand the the system can optimize their income and investments. Knowledge is power. Optimizing Obamacare starts with understanding the system. Then we can make choices to minimize costs and maximize coverage.
“If you haven’t got your health, you haven’t got anything” – Count Rugen
Eat well. Exercise. Brush your teeth. Cultivate a positive outlook. Get plenty of rest. Everything in moderation (including moderation.)
Along with a regular medical exam, these preventative practices are the foundation of a strategy to live a long, healthful life.
We do a respectable job of taking care of ourselves. Vegetables are eaten in abundance. With no car, walking and biking helps us build both health and wealth. (Recently I’ve increased the intensity by strapping an 8 kg little boy to my chest.) We have no employer imposed requirements or deadlines, so distress is low and eustress is moderate.
We also practice awareness, paying attention to our bodies. I’m fairly certain that when I can easily bike 900 km up and down mountains that I’m unlikely to have cardiac problems.
But of course, sometimes things happen, which is where the regular medical exam comes in.
“Hello, Winnie? Yes, this is Dr. Luo. Your pap smear test results have come back, and we found some abnormal cell growth that needs to be evaluated immediately”
Two weeks ago I received this late night call from my maternity doctor. As part of my post delivery checkup we did a full health evaluation, and the results showed high grade lesions on my cervix (HSIL)
Do I have cervical cancer?! Google seemed to think so. The more I searched, the more panic set in. I just had a baby, I need to be here to take care of him
Modern Medicine, Traditional Care
“I think it is time,” Winnie said as she woke me
Adrenaline shot into my body, and I sprang into action like a headless chicken. Get dressed. Grab the bag of clothes we had prepared in advance. Fill a water bottle. Throw a bag of snacks into the backpack.
OK, we are all set to go to the hospital. What have I forgotten? There is something…. Oh, the wife!
We slowly walked the two blocks to the hospital, stopping every few minutes for the contractions to pass
My Mandarin isn’t very good, especially at 4 am, but I made out a few phrases… “…you walked here…?” “…probably too early…”
After a quick check the nurse sent us home with some clear instructions for when to return