On Feb 28, 3:36 pm, "Elizabeth Richardson" <erich...[at]worldnet.att.netwrote:

- quote -

Thanks, Elizabeth.

Yes, absolutely. I committed to losing 40 lbs this year (almost half
way there) for just that reason

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On Feb 29, 5:07 am, "Elle" <honda.lion...[at]spamnocox.net> wrote:
- quote -


Thanks, Elle. I think that would be a last resort, as I am finding it
difficult to talk my wife into saving for a second home in Florida
where we wouldn't be near the kids 12 months a year

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On Feb 28, 2:59 pm, "rick++" <rick...[at]hotmail.com> wrote:

- quote -

Thanks, Rick. I love rules of thumb. It's a place to start, anyway.

Thanks!

Steve

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- quote -

Some consider it an advantage to have the widest choice of health care
providers. This isn't the case with an HMO.

But this is a digression from the original post, since the OP and spouse
are 41 and 40 years old; when they reach retirtement age there's little
likelihood that Medicare will work the same as it does now.

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On Mar 2, 12:05*pm, Avrum Lapin <avrum...[at]verizon.net> wrote:

- quote -

I can see that Medicare Supplemental insurance is going to be better
for someone moving to a different area of the country, but are there
some other advantages?

--
Ron

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On 2008-03-02 09:36:35 -0800, "rick++" <rick303[at]hotmail.com> said:

- quote -

That is quite true. What's more, I suspect that practically any country
in the world would welcome a super-rich immigrant, if not always a
moderately rich one, and find some way around the laws to let that
highly desirable person speed through the immigration process. But in
that case it would be largely a matter of expecting the wealthy
individual to boost the economy with outside money. Financial tests and
health tests for ordinary folks are designed to make sure those people
do not become a drain on scarce resources meant for the good taxpaying
citizens born there. But you are certainly right; if the OP is serious
about retiring outside the USA, it would be prudent to act early and
learn about qualification visas and such.


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In article
<724ba2f1-b262-4ea7-8cba-1ec9438a1438[at]72g2000hsu.googlegroups.com> ,
"stevedhoward[at]gmail.com" <stevedhoward[at]gmail.com> wrote:

- quote -


Just catching up on my mail but here is a different look

It is a good idea to think about medical expenses after age 65 but I
don¹t think that you should spend a lot of time modeling what they might
be especially if age 65 is far in the future. I suspect that Fidelity¹s
numbers are as good as any other set of numbers. Remember that
Fidelity¹s goal is to encourage you to save more for your retirement.

Medicare currently spends an average of $800/month on each Medicare
recipient. So that is one number

Medicare consists of Part A (hospitalization) which has no monthly
premium, Part B (doctors labs etc) which has a premium of $96.40 a month
and Part D (prescriptions ) which costs about $25/month. Long Term Care
is not covered by Medicare. Parts A, B and D come with deductibles and
co-pays. You can insure against the out of pocket costs of Parts A and
B for between $150 and $175/mo. For the worse case (really expensive
drugs and lots of then) your out of pocket prescription costs are
limited to about $4k for the first $5K of drugs and then 5% of the cost
above $5K if you have part D coverage. So if you are fully insured you
are looking at a maximum of $7600 in today¹s dollars. plus dentistry.
You can get cheaper overage through an HMO

Another data point - a self employed person aged 60 with a few
³controlled² pre-existing conditions will pay nearly $800/mo for a PPO
with an $1500 deductible and 30% co-pays. Add a few meds and some
dentistry and you are soon at $12K a year.

Will medical costs continue to escalate at their current rate (at some
point they will consume the entire GDP)? No. Like all other bubbles it
will crash. We all may want the best but I suspect that we will not give
up our cable TVs etc or be willing to pay higher taxes to cover costs.

As a Medicare counselor I have been surprised at the number of seniors
who will select an HMO over a conventional Medicare Supplement because
they will save $200/mo. (even if they can afford a supplement). The
ones who refuse an HMO are the Medicaid people because Medicaid will pay
for anything (you just have to find a provider who will accept MediCaid)
I suspect that more and more people are going to decide that another
round of Chemo or another surgery is just not worth it and they will opt
for hospice (fully paid for by Medicare Part A). If the government were
to freeze or cut payments the providers will find something else to do
with their time and costs would not rise as fast as the services would
not be available The only people who will want all that stuff are those
who will be on Medicaid which pays for darn near everything if your
income is < $600/mo and your assets are < $3K.

Note $ are for suburban southern California. May be higher in Beverly
Hills, New York City and Palm Beach.

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- quote -

Canada being an example.
The immigant qualification visa starts subtracting points when one
turns 50.
I am personally penalized 8 points on the age part and fall below the
visa cutoff :-(

http://www.cic.gc.ca/english/immigra...sess/index.asp

However there is a "rich immigrant" clause. You can buy a government
business investment for about $410K which matures in five years
with zero interest.

http://www.cic.gc.ca/english/immigra...tors/index.asp

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On 2008-02-29 02:07:29 -0800, "Elle" <honda.lioness[at]spamnocox.net> said:

- quote -

One point -- Do not assume that you can just pack up whenever you want
and move to any country of your choice. Many countries have
restrictions on immigration of various kinds, financial-wise and
health-wise, etc., just as is true in the USA. This is especially true
of nations where the living conditions, in addition to health plans,
are relatively more desirable. It is better to get the application
process started sooner rather than later, during the years when you are
in excellent health and in excellent financial shape, with lots of
dollars to take along with you to the new residence.

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On Feb 29, 3:49*pm, Douglas Johnson <p...[at]classtech.com> wrote:
- quote -

This discussion has gotten way off of the original poster's question,
which was
"If I want to ensure we are OK health care wise in retirement, is
$10K
per year (in todays dollars, inflated at 8% per year) out of pocket a
decent estimate to use when planning for costs?"

In answering that question with the information I easily found on the
internet, somehow I've been put in the position of defending the
information. I think the information deals reasonably with the OP's
question. I'm sure that both he and I are not nearly as interested in
what other people can afford to do as being as sure as we can that we
can afford the care we someday will need. So the discussion to that
end is just off-topic and I won't respond to in beyond this post.

- quote -

The cost in the Fidelity studies was to pay for the insurance and the
care that the insurance doesn't pay for. If you don't pay for the
insurance, then the health care cost won't be borne by the insurance
companies, and only a limited amount of it will be paid by the
government.

I've heard it said that some hospitals in my area are not treating
people in the emergency room without charging it to their credit card.
I don't know if that is true or not, but why shouldn't they deserve to
be compensated?

- quote -

That's probably because you had insurance that would pay most of the
bill.

- quote -

And I might vote for you!

Dave

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Dave Dodson <dave_and_darla[at]juno.com> wrote:


- quote -

Little of the current health care discussions talks about the elephant in the
room. That is that we want more health care than, as a nation, we can afford.
So we must ration it.

As you are suggesting, the normal capitalist mechanism for doing that is
pricing. But pricing isn't working. There are three obvious reasons:

1) Much of cost of health care is borne by third parties -- insurance companies
and the government. They negotiate prices, but have limited control over the
quantity of care that is bought.

2) Much of the optional health care ("buy less of it") is preventative (check
ups, blood pressure meds, vaccinations, etc.). This will lower costs over the
long term, but is the most likely to be deferred to the detriment of the long
term.

3) People that are faced with serious illness are not likely to be price
sensitive. My wife has had two bouts of life threatening illness. When I
walked into the ICU the first day, I thought "This is costing a fortune." My
second thought was "OK".

If I had a solution, I'd run for president.

-- Doug

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On Feb 29, 12:41*pm, Tad Borek <bore...[at]pacbell.net> wrote:
- quote -

But if you don't have enough money for a Lexus, you just don't buy
one. Instead, maybe you buy a Camry. The same thing will happen for
health care. If you don't have the funds to pay for it, then you will
buy something lower, i.e., less of it.

- quote -

As I said in my first post in this thread,
"According to a March 2006 study by Fidelity Investments, a retired
couple without employer-sponsored health insurance can expect to pay
$200,000 for out-of-pocket health care costs like premiums and co-
pays.

If you look at the Fidelity web page I referenced earlier, you will
see that most of the cost is for the insurance premiums, deductibles,
and co-pays. If the retiree is fortunate enough to have, e.g., a
former employer paying the premiums, that might cut the cost in half,
but still leaves whatever deductibles and co-pays are included in the
plan.

- quote -

People who don't have adequate savings will have to pay whatever
health care costs they incur out of pensions, Social Security, and so
forth. If you want to plan adequately, you can do so by allocating
$215,000 out of your retirement portfolio for medical expenses. If you
don't care about planning adequately, then don't allocate it. If you
really don't care about planning adequately, don't even bother to
accumulate it. If most people today haven't accumulated enough to pay
their projected health care costs, that just shows their opinion about
planning for their future, as we well know.

- quote -

I don't understand this diagram at all.

While actual medical costs may be weighted toward end-of-life
expenses, retirees on Medicare and a Medicare supplemental policy
probably are pretty well protected against out-of-pocket costs. E.g.,
my father died of cancer in the mid-nineties, after chemotherapy,
radiation therapy, and various hospitalizations. I wouldn't be
surprised that his last year's medical bills were mid-five-figures,
but his out-of-pocket expense was less than $2,000 for deductibles and
co-pays.

- quote -

Again, this is a planning issue. Failing to plan is planning to fail.

Dave

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Dave Dodson wrote:
- quote -

Lexii are a good example...not many people own them because they can't
afford them (or because they aren't German!) =) And they can only
increase prices by what the market will bear. It's as if Fidelity has
everyone in a Lexus, and says that Lexus can keep increasing prices 7% a
year (for 20 years, despite the fact that few can afford that even
today)...so look how much you need to save for car costs!

RE: "those with high insurance set pricing" - if that's true then it
suggests insurance covers these costs...so why does the average couple
still need $215k? The claim is that the average couple's out of pocket
lifetime cost, after all insurance, requires $215k - which few people
today have. Where is the money coming from for the bills of today's
retirees? Pricing for over-65 health care is limited by available $.

Another Fidelity assumption in the 11/07 paper was that the health-care
costs are evenly distributed through retirement. That's a valid point
for things like insurance premiums and prescription drugs and preventive
care. But IIRC if you're coming up with a figure for "average lifetime
health care cost, age 65 through death" it's heavily weighted for
terminal care, might look something like this:

$
$
$$
$ $$
$ $ $$$
$ $ $ $ $$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

From a time-value-of-money perspective that means a much smaller
initial savings is required...and the amount might be equal to "the
average equity in the median retiree home." So if a retiree today
squirrels away Fidelity's suggested $215k for health care and lives off
the rest...well, perhaps you live like a pauper, and leave behind an
excess estate. And I don't know what happens to the ~90%? who don't
retire with that kind of $ to begin with.

-Tad

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On Feb 29, 7:58*am, "HW \"Skip\" Weldon"
<skip5700removet...[at]hotmail.com> wrote:

- quote -

It's a delicate balancing act as to where to allocate limited funds, I
agree. And LTC is often not first on my financial planning list
either.

However, I fear the unknown cost of future healthcare and changes in
technology more than I do insurability. Healthcare costs are
unquestionably spiraling out of control. Where the market will level
out on this we can only speculate. In addition (and this is my big
concern) we have no idea what future technology advances will bring.
The ailments that killed us a decade ago, now only debilitate us.
People now live with diseases far longer, and cures haven't been
forthcoming. We haven't cured cancer, AIDS, heart disease, etc we only
enabled patients to live longer with these diseases. Any change in
average life expectancy, quality of life, and/or healthcare costs can
throw the underlying pricing assumptions of LTC way out of
equilibrium.

Future insurability is certainly a risk, but even the insurable may
find LTC premiums unaffordable in the future if trends continue on
thier current paths. A paid-up LTC policy mitigates that risk.

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On Feb 29, 10:19*am, "rick++" <rick...[at]hotmail.com> wrote:
- quote -

They don't create these "gotchas" out of thin air. There are no
exceptions that are not stated in the contract. The same is true for
the rate hikes. As it is probably known, I don't sympathise with those
that don't read what they are buying. LTC contracts are not written in
impossible to decifer legalese.

As Cal wisely mentioned, the premiums can also be paid in advance to
avoid the risk of rate increases.

- quote -

I mostly agree with this. The rich can often "self-insure". The poor
have no incentive to buy the coverage because medicaid will provide
support (I take personal issue with paying the medical bills of
others, but that's another topic). The people that most often find
they need LTC are the "average Joes". They have a low 6-figure nest
egg and a nice house to retire into, but couple of years in a decent
long term care facility can wipe out the things they spent their life
accumulating.

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- quote -

Even employer programs may not be great. I friends in our state's
program
which is outside of medicare. Their premiums doubled from
$190 to $380 per month the past three years. If they move over to
medicare, they are requie to pay all the Part B premiums which is
$400,
unless they had jobs for ten years in the social security system.

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On Feb 28, 5:21 pm, "Cal" <cal-les...[at]comcast.net> wrote:
- quote -

I've read lots of complains about LTC policies. More than half raise
premiums,
but this requires a special request to the state and the entire policy
group
is changed - not targeted individuals.
Second, many havent paid out as advertised. They find gotchas, or
stall knowing
ill policy-holder have difficulty fighting it.

These are probably good if you have significant assets to pretect for
immediate heirs
liek a spouse. If you have less than $100K, then they arent worth the
cost.
if you have more than a couple million, they might also not be worth
trouble
because you can afford it. You arent goign to be spending that money
on anything
else by the time you need LTC. I plan on the latter.

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"HW "Skip" Weldon"
- quote -

If they've done the right things in their lives, like staying fit, then they
are more likely to live longer lives. This lowers the cost of health care
throughout their lives, but longevity has its own "reward". A widow in her
90s, will likely need care, perhaps for several years. For most people,
that care has a high probability of costing far more than any accumulated
savings.

Elizabeth Richardson

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On Thu, 28 Feb 2008 16:11:25 -0600, "Elizabeth Richardson"
<erichktn[at]worldnet.att.net> wrote:


- quote -

Just to add spice to the excellent comments on this thread, here are
two admittedly contrarian thoughts on LTC insurance:

1. I've always considered LTC insurance to be like life insurance in
that if a person does the right things over their lifetime
(save/invest regularly, pay off/avoid debt, etc.), they outgrow their
need for both life and LTC insurance. (They'll be able to self-insure
with their assets.)

2. Buying life/LTC are also similar in that when buying either
coverage per unit costs of insurance are less at younger ages. But
when you adjust for a longer premium paying period at younger ages and
throw in time value of money, actuarially there's not much ultimate
cost difference between buying now or waiting.

So to me the principal reason to buy early is insurability. In that
instance I usually prefer that younger people (under 60) spend their
resources on good investments and avoiding debt. Around 60ish we'll
see how far they got, and decide on LTC insurance at that time. My
sense is that most who did things right won't need it. But there are
exceptions - for example, those over 60 who have not done things right
and those who want it primarily to insure inheritance for their
beneficiaries. And if they need it but can't qualify, then they also
are likely to have bigger problems than LTC insurance.






-HW "Skip" Weldon
Columbia, SC

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"Dave Dodson" <dave_and_darla[at]juno.com> wrote
- quote -

Whether those services labeled "health care" actually are
for the care of health is another issue, though. Time and
again, studies show that many medical procedures and courses
of treatments are known to be questionable and sometimes
detrimental, yet they continue to be prescribed.

If one wants to plan financially for health care costs, it
does pay to shop around and study on what the best bet is
for a course of treatment. Fortunately the resources for
doing this are better all the time. Not perfect, but better.

- quote -

I believe both patients and health care facilities are
increasingly revealed to be in the red. Hospitals are
shutting down in many areas, for one. Physicians are driven
out of practice in specialties such as Ob-Gyn. New med
school graduates haven't financial incentive to become
primary care physicians, so the shortage in this specialty
has been growing quickly in the last decade.

A little good news is that, yes, the market is working to
some extent, in that some of the healthiest and those
actually able to afford health insurance are refusing it.
This raises the costs for those less healthy and less able
to afford. Then more of those who are less healthy and
poorer drop their health insurance (or are dropped by their
insurers). They report to ERs etc. and are subsidized by
those who can afford to pay, one way or another. Spiraling
worsens. And so forth. Now, due to market action, health
care cost and access is a leading issue in U.S. politics.

I think there is a lot to some simple concepts like
"insurance won't work very well if only those in Category X
(tendency to be sick) have insurance." In auto insurance, I
thought it had become clear in many states that rates are
lower if all are required to have it. Until all are required
to have insurance, and even afterwards, I agree with E.
Richardson that preventive care must be a pillar of each
person's health cost planning. One does have control over
this. It may require some study, at times, to determine
which procedures actually are effective, but this study is a
good investment of time. Plus, as I have noted here before,
corporations like Safeway have provided much evidence that
requiring preventive medicine of its employees has a
dramatic effect on health costs.


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