Avoiding ObamaCare

                                Avoiding ObamaCare!

Many people are dreading the 2014 implementation of the "Affordable Care Act."    Not us expats.

The law states US citizens living outside the US for 330 days during any twelve month period are considered compliant to this law by doing nothing except non-residence. Also true of those living in US territories.

The rule is similar to the IRS reg that exempts our US earned income from income taxes (but not social security tax).

Your passport stamps indicate the time outside the US.  One minute in the US qualifies as one day.

If you do not qualify for an exemption in 2014, the individual penalty is the greater of $95 or one percent of income for the year (maximum of 3 times individual penalty).  However the penalty rises very sharply after 2014.

Additionally, major care will have to be delayed or rationed increasingly as we age. Adding 30 million people to coverage with no plan to increase MD's must reduce available care.

A recent article cited the present 90% recovery rate for US prostate cancer due to our rapid delivery of care.  That compares with the 53% recovery rate under government care in England (12-18 month waiting time).  Bureaucrats move slowly.

You may also consider internationalizing your medical care to obtain rapid, high quality and inexpensive care in Latin America or Asia. Come to Ecuador, Panama, Brazil, Mexico, Costa Rica to find many doctors trained in the US and Europe who speak English. Care in Asia may be found in Singapore, India, Taiwan, Thailand, etc.

Visit my post under "Medical Tourism" or a few ideas on routine care savings.

MRI

                                       M.R.I.

My recurring back pain called me into another excursion into the world of Ecuadoran medical practice. My lumbar discomfort found occasions to get my serious attention periodically during my adult life. Most recently, a 737 narrow body flight in the center seat followed by a 500 kilometer drive triggered a couple days in bed and temporary use of a hiking pole for support. Ouch!

My previous rayo -X (rayo equies) revealed some problems and physical therapy provided little lasting relief. A previous bone density scan did not clarify the issues. Earlier this year, two US trained chiropractors added to my temporary relief. Maybe an MRI will shed definitive light on the issue. Medical costs, at a fraction of US billing, certainly are not a deterrence, as they were in NC.

Following a friend’s referral (and my Santa Inez insurance), I scheduled a visit with Dr.Romulo Idrovo (09-808 5691). What pleasant experience! Dr Idrovo spoke excellent English, was quite friendly, and completed my visit with the common "Here is my personal phone number - call anytime."

After a couple days on a temporary prescription, I called the kind doctor. In two hours I was in his office. He walked me downstairs to schedule my MRI for the next morning.

My MRI lumbar results were available in half an hour. What was the cost? A mere $250!

Earphones buffered the loud banging, humming and screeching of the MRI tunnel. How do you pass twenty minutes unmoving in a tight conical enclosure? The gentle fan blew fresh air over me, dispelling my fear of developing claustrophobia. So, I prayed for my friends and reflected on God's faithfulness in my life's difficulties.

The differing medical perspectives of chiropractic, X-ray technology, P T, and magnetic imaging remind me of the blind men as they examine the elephant. One, holding a leg, describes a huge heavy beast; another, holding the tail, describes an unusual canine; while the third, with the trunk, considers a reptile.

The chiropractor, noting hip dislocation combined with a sciatic problem, disputed the exercises recommended by the PT. The exercises were excellent, except that they aggravated the hip dislocation. Inflammation must be reduced before any exercise regimen. The MRI will reveal problems with marrow and ligaments, adding another dimension.

My Saturday morning appointment with De Idrovo was brief and to the point: serious inflamation around bone marrow required a spinal injection of anti-imflamatory. The inflamation may have been longstanding and prevented further healing.

Within four hours I was in the operating room of Santa Inez for a 15 minute procedure, then half an hour in recovery room. What may have taken a month in the US was completed three days. Total cost for three doctors, hospital procedure, MRI and prescription was $545. My Santa Inez insurance should cover 85% of it. (See postings on health insurance)

Now, I must be vigilent for my back. All this is not a permanent cure. No more moving pianos or middle row seats. But what a relief...
                                Rejoicing,
                                                  Gary

                          

Medical Tourism

            Medical Tourism
   Or… how to enjoy a free trip to Ecuador 

Our first trip to the Andes included Quito and Cuenca in June 2010. We fell in love with Cuenca’s charming people, old world architecture and gentle climate. We had learned to reimburse our travel costs during previous trips to Montevideo, Uruguay. Bloggers were also a prolific source of information.

Like many self employed folks we saved premiums by having a $5,000 deductible on our U S Blue Cross coverage and using a HSA for tax deductible reimbursements. So we were out-of-pocket on most medical, dental and vision expenses. Now let’s see how many interesting experiments we can complete in a few days.

                                              Ecuador Cost          USA approx.        
 1 .Vision exams-both of us           $20 x 2 = $40                          $  150 

2. Bi-focal lenses –Gary only                          54                               150

3. Specialist office visit                  $ 25 x 2 = 50                               400

4. Bone density Scan-GE                   40 x 2 = 80  Just like at home  240

5. Ultra Sound – neck                                      36                              150

6. Lab CBC, calcium, parathyroid, Vit D         52     All is well          200+

7. Meds                                              11 x 2 = 22                                80

8. Massage – ahhh                            15 X 2 = 30   Discount for 2     130

9. Manicure (why not?)                      5 x 2 = 10                                 30

10.Haircut – Gary (a risk?)                               5    Looks great!         15

                Totals                $ 329  Saving covers airfare  $1,545  

We met some very interesting and friendly locals.  And delighted in many delicioso meals. 

 And we learned of their culture. Yes, you could enjoy similar savings in many countries in Latin America or Asia.

       Don’t just be a tourist… Be medical (and cultural) tourist!     

                                                                            Rejoicing,   Gary