IMDonehere,

It is in the financial interests of the British government to pay Spanish providers to meet the health care needs of UK pensioners in Spain, since the cost of medical care in Spain is probably 2/3 or less than what it is in the UK. While it may be the case the UK pensioners contribute to the local Spanish economy and pay real estate or income taxes, it's not clear the Spanish economy gains enough to offset the high costs of providing medical in the last 20 years of life, and the financial blow to the UK of so many pensioners in need of serious medical care returning to the UK make it more in the UK's interest than the Spanish interest to keep the pensioners in Spain.

Nonconformist,

Some version of that seems to be where the negotiations presently sit, but with the twist that British pensioners will probably be required to buy into a separate British health insurance scheme, rather than having UK taxpayers at large foot the entire bill for health care of nationals living abroad. But nobody really know what the present British government is doing. It seems to be imagining all kinds of options that the EU is telling them no longer exist if they are unwilling to actually be in the EU.

By the way, a great many UK pensioners have retired to Catalonia, and while it is far from clear that the independence movement there will succeed, what the status of UK pensioners would be in an independent Catalonia -- in particular who pays for their health care -- seems even more unclear than the present situation regarding Brexit.

Massimop. I am waiting to see what Brexit does to all these UK citizens living in EU countries. We know a lot that live in Spain.

My one freind is attached to the US Embassy and she went on and on about their healthcare. She has to pay for scrips but was amazed at the price. Her husband has heart problems and she can't get over how well they are treated and the care they have received. She doesn't want to leave ever now.

My SIL contacted a number of Spanish healthcare companies and she will not be covered. The Spanish consulate will not accept healthcare with exclusions.

End of story.

Thanks for everyone's help.

I'm so sorry that she hit what looks to be a dead end.

Just for my own knowledge, how is a pre-existing condition defined? If someone has high cholesterol, would that be a pre-existing condition that would predispose someone for cardiac problems? Happily, I've never been a situation where any conditions disqualified me for insurance, but I do wonder...after a certain age, don't most people have some kind of "condition" that might necessitate medical care in the future?

Thanks Eks.

Yes, medicine for high cholesterol is one of the pre-existing conditions as it considered chronic.

IMD - So sorry your SIL's dream was shattered.

Than you Bedar. She is quite unhappy.

ekscrunchy, I do consulting to and deal with various insurers in the US and of course the term "pre-existing condition" can be anything that you are already being treated for or have had an occurrence of. This can range from fairly routine and minor (as you noted, many older folks may take statins or high blood pressure medication or a thyroid hormone) to more serious. Diabetes is more serious, as well as having has cancer, asthma, a heart attack or stent put it, let alone Crohns disease or something like that, an immune deficiency, AIDs, epilepsy, serious mental health issues, anorexia, lupus, arthritis, MS, a stroke, Parkinsons, etc.

In the US right now, you cannot be denied coverage due to that nor charged more due to the ACA, but in the old days you could, but most insurers I know would not refuse to write insurance policies just because someone was taking a statin, if they had never had a heart attack or stent put in, etc. In fact, I have never heard of an insurer doing that if that were the only problem you have (back in the old days), denying coverage just because you were taking a statin.

I do not think that was the issue here given what IMDonehere has said, that she was denied insurance just because of that.

Unfortunately, the pre-existing condition coverage mandated by the ACA does not apply to people over 65. While you cannot be refused for Medicare, if you wnat a Medigap supplement plan and do not sign up in the initial period, you can be denied coverage. Not sure whether this is also true for Medicare Advantage, but would expect so.

It is a real pain when things do get to a false stop. No movement what so ever.
I also do not understand what Brexit has to do with this situation.
None of those who have commented about various tax and health care rules presently live in Spain thus they do not understand fully what is going on.
I am not willing to go into all the ins and outs, but in the past Spain was not applying it's own regulations regarding movement of people. Now they are "harder" and keeping more inline with that.
I have been doing some looking around for you (SIL) a lot of forums about moving to Spain are aimed at other Europeans.
This one is not necessarily so and I found this argument about health care.
It does not help this situation, but it suggests the situation is not so easy.
http://www.expat.com/forum/viewtopic.php?id=589321
There has been an up take in Americans wanting to live in Europe since that election. There must be some way of taking that step.

So as it stands now, can the SIL not live in Spain legally even if she agrees to pay her own medical costs, either with private Spanish doctors or by leaving the country and seeking care elsewhere?

How do these rich celebrity types move from country to country even when they are elderly? Or even non-celebrity but very rich people??

If Dustin Hoffman wants to pick up and move to Spain, for example, would he be prohibited from doing so legally if he had a pre-existing condition, or is there a work-around if one has lots of cash?

What percentage of persons over 65 have NO pre-existing conditions? My guess is that the percentage would be in the single digits, no? I know I sound very uneducated about all this but this thread has been an eye opener for me..
I think many Americans (me, included) labor(ed) under a fantasy that they can just pick up and move to Europe if and when they can afford to do so, without any limitations...

You need to prove you have health insurance that will pay your foreign medical bills if you want permission to stay long term in a country with a publicly-funded health system. You cannot obtain a visa to enter and stay without documented proof of a valid insurance policy.

Some countries allow long-term residents to buy into the national health service, paying yearly premiums. You can also buy private insurance in America that will cover you abroad no matter how old you are and no matter how many pre-existing conditions you have, but the premiums/monthly payments get higher and higher the older you are, and if you want pre-existing conditions covered, you must pay for it. (Obamacare will not pay for foreign care -- which is actually not cost-effective for the American taxpayer).

I don't know how much money Dustin Hoffman has, but it's possible paying $2,500 per month in health insurance premiums would not be a dealbreaker for him if he wanted to live in Spain long-term. So yes, there is a "work-around" if you have enough money.

Just to add: Most people do not have pre-existing conditions that would require premiums of $2500 per month. The OP posted this his SIL was quoted that amount by an insurance company, but if you read the link that ribieraacra posted, you will see discussion of cost of private insurance premiums for those with pre-existing conditions was about $3000 per year, which is less than $300 per month.

Some people would not find those premiums unaffordable. In fact, many Americans, before reaching age 65 paid several thousand a year for health insurance. So even if they are not Dustin Hoffman they might not find it unaffordable to continue to pay that amount for health insurance, especially if they move to a country where prescription drugs are cheaper along with other out-of-pocket expenses for dental care & basic needs.

Clarification, so no one is misled:

The cost of a private insurance plan for an individual with a pre-existing condition is determined by individual insurers, so I am not saying that anybody can get private insurance for $3000 per year. What I was trying to say is that some people would do a cost-benefit analysis of the per diem cost of private health insurance and make their own calculus about whether living abroad was worth the premium.

$3000 per year is less than $300 per month and thus less than $10 per day. Some people would find that both affordable and attractive if living in Europe is their dream.

However, one also needs to be clear about the costs of tax obligations & other expenses one might not face living in the US. In the end, it's very much a question of trade-offs. Some people can find a way to make the trade-offs work within a budget (i.e., they offset the higher costs of health care & taxes by living with cheaper rent & other economizing in shopping, etc) while other people just pay the extra costs as an investment in personal happiness, safety, etc.

@massimop - I would be interested to know where you found an annual policy for travel/living abroad for $3,000. Last time I looked into it BUPA wanted $12,000 and that was several years ago.

I got that figure from the link that ribierasacra posted a few posts above yours

My SIL was quoted by one Spanish insurance company a healthcare policy between $2,500 to $3,000 a month.

Yes, you mentioned that above. Every individual case is different depending on age, overall health issues & destination.

Missionaries and academics often go abroad for longer periods of time than tourist travel insurance will cover and they purchase private health insurance (probably most often from US-based insurance companies like Blue Shield, etc.) Whether it's possible for individual travelers to obtain such coverage at prices they can afford -- again, that depends on the individual's circumstances

How to live in Spain when not an European
https://www.spanishpropertyinsight.c...dency-permits/
https://www.barcelona-sothebysrealty...den-visa-spain
http://www.exteriores.gob.es/Consula...aDuracion.aspx
https://www.expatica.com/es/visas-an...2354.html#long

I have been told to suggest to you morgan-price.com, and sanitas. It seems it doesn't matter just to get the visa, and after she is here for a year she can apply and pay for the public system where everything is covered.

Thank you.

One of the companies that rejected her was Sanitas.

She had gotten all the necessary documents approved by the Spanish Consulate in NYC but it was the last one, the medical that stopped her.

Just so I understand this very disappointing situation, which is the situation:

She cannot get medical insurance due to her pre-existing condition, or she cannot/does not want, to buy insurance at the high price it will cost.

Is she looking to be covered in both the US and Spain, or just in Spain? I ask cause I ran through some basic details for myself on a site I found online, and could find insurance at $1,000 per month if I wanted coverage only in Spain, not in both the US and Spain... if I wanted coverage in both countries, it would cost me double. There did not appear to be any pre-existing disqualification but of course, I only went so far..

I'm sure she has covered all this in great detail but again, I am curious....hope you don't mind rehashing this..

She cannot get medical insurance due to her pre-existing condition, or she cannot/does not want, to buy insurance at the high price it will cost.
___________

She cannot get coverage in Spain for a reasonable rate.



I think she would keep her Medicare in place in the US plus the supplemental in the event of a catastrophic illness.

Neither the Spanish insurance company application nor the accompanying literature, mentioned the exclusion regarding a pre-existing condition, which is why she invested so much time and money in the venture.

<i> Since the US taxes its citizens on worldwide income regardless of residency (unlike almost every other country in the world), if she plans to live in Spain for good she might be better off renouncing her US citizensip. </i>

Unless you have significant income outside the US, there's no advantage to renouncing your US citizenship for tax purposes. The US has lower individual tax rates that any European country that I know of. Also, if you've already paid tax in Spain on your income, you can deduct the amount you paid from the amount you would owe in the US, which would usually wipe out the US liability.

For someone whose income, for example US pensions and investments, is mostly based in the US, it would be much more advantageous to pay the US tax rather than any European tax. I'm taxed on my pension in the US, and then Italy makes me pay additional tax to bring my total tax liability up to Italian levels. I don't know if Spain also does this, but the tax bite can be substantial even for modest pensions. (My US Social Security is <b>entirely</b> taxed in Italy, due to some nefarious tax treaty between the two countries.) If a pensioner is thinking of living abroad, these are things that should be thoroughly researched.

As far as Medicare, I have the Part A which everyone has, and voluntarily pay the Part B, because if I ever had to return to the US in my doddering years, the cost of joining Part B at a later age would be much higher. The Social Security Supplemental insurance, as well as the drug insurance, is managed by the individual states, so you can't even get those unless you're a US resident. I've been told that if I ever have to return to the US, I can pay the same rates for those as someone who joined at normal retirement age, if I can prove that I had equivalent coverage in the meantime. I sincerely hope that the Italian National health service is considered equivalent coverage.

The issue is not the amount of tax. The issue is the paperwork.

Gestorias take care of any Spanish paperwork. A BIG issue is the amount of tax ! And then there is the issue of US paperwork and taxes. It all drives my ex nuts, but he can't move back to the US because he doesn't have Medicare. BTW, taxation on global assets is on the books in Spain also. And, if one owns property there, s/he is obliged to file forms on global assets. Right now there's no tax on those, but who knows about the future.

There are very few (if any) countries that do not tax residents regardless of citizenship. If you are residing in a European country for more than half the year, you owe taxes to that country.

The "nefarioous" tax treaty most (if not all) European countries have with the US guarantees you will not be double taxed on the same income/assets. Therefore, if you pay what you owe to the European government of the European country where you reside most of the year, the US will deduct that amount from whatever you might owe the US. Since European taxes are generally higher than US taxes, the end result is typically that no taxes are paid at all to the US.

If any resident of Europe -- native born or expat -- has investments in the US they must file detailed paperwork declaring those assets to the country where they are paying taxes. The financial advantages of holding US investments are enormous (and have been for many years), so is the receipt of Social Security, and just in general the benefits of being a US citizen with a US passport are enormous -- especially if you are thinking of living inside a European Union that might not exist in the near future -- so renouncing US citizens and giving up all one's US assets to avoid paperwork is probably not a good idea -- but ask a lawyer if you find it tempting! Don't go by what you read on the internet.

"There are very few (if any) countries that do not tax residents regardless of citizenship"

Right. But do they tax/require tax forms to be filed by their citizens regardless of residence? That is the problem with the US.

"in general the benefits of being a US citizen with a US passport are enormous"

In general, as a traveler, I have found my UK passport more advantageous. The visas are usually cheaper, if required at all.

Forgot to add that until Brexit my UK passport also gives me the right to live and work in the other EU countries.

On the tax and paperwork issue:

http://www.democratsabroad.org/alexp...ation_campaign

-- "The US is the only developed nation that taxes its citizens on income earned while they live abroad."

https://republicansoverseas.com/tax-...sign-petition/
http://republicansoverseas.com/wp-co...Jan-6-2017.pdf

http://www.fodors.com/community/euro...mment-10110034

"Forgot to add that until Brexit my UK passport also gives me the right to live and work in the other EU countries."

That maybe so but you still have to comply with the country of adoption laws.
You will still need health cover to live in Spain. You have a certain about of time to run around to organise your registration paperwork too.
It is not as if you can up leave and live with no worries.
https://www.gov.uk/guidance/residenc...ments-in-spain

.
Personally I don't see that filing a Federal US form is that onerous. Typically it is more onerous to fill in the forms required by the European country of residence to declare US-held assets, and that is required of anyone holding US assets, no matter their passport.

I'm sure having a UK passport is of great value, but as Brexit shows, if you are thinking of living in Europe, giving up one's US passport for a European passport might mean that in the near future some of the benefits you previously had with a European passport have vanished overnight. That could also happen for US passport holders but the chances are much less.

I am not familiar with Spain's policies. U.S. friends who applied for and now hold French, UK and Italian passports were not required to relinquish their U.S. passports. My husband is British, the U.S. did not require him to surrender his UK passport when he became a naturalized U.S. citizen. He continues to renew it when expiry comes up.

I know that if you plan never to return to the States you can formally apply to no longer be required to file annual income tax forms for the U.S. We did not choose this route when we lived in France for seven years. We didn't find filing both U.S. income taxes and French taxes very difficult, I handled the French and my husband the U.S. France and the U.S. have a reciprocal agreement in place which helps avoid double taxation. It probably helped that we are not in the 7-figure income bracket, far from it.

Do not relinquish your U.S. passport without careful thought. And even if Spanish citizenship is granted, some payment may well be due for healthcare.

I agree with all of the above. Because the US is the primary global power, with a robust legal system and foreign service, the protections of a US passport for global travelers are significant. Plus, you can vote in US Federal elections -- not an insignificant power in itself.

In recent years, anti-terrorism laws and crackdowns on tax cheating in several Euroepan countries have resulted in stricter requirements for handling money and reporting money. This paperwork is inescapable in most European countries no matter your income bracket if you have any US based income.

By far the most complicated tax & relocation paperwork I ever faced was moving from New York to California earlier in my life. California may have since simplified its tax system, but at the time, it was blitheringly complicated to figure out how to stay on the right side of the law and yet not overpay.

But bottom line is that both health insurance and tax requirements are not only crucial "details" to understanding relocating to another country, they are frequenly in flux and subject to new rules and regulations, so you need information beyond what can generally be found on the internet or message board forums, even expat ones (they can be tremendous sources of misniformation because too many people think their personal experience is a universal one impervious to change over time. That's not reality.)

thursdaysd,

Having read the links you posted, I don't seer where US citizens residing in Europe would reduce their tax bill or their paperwork burden with the changes being proposed. It's possible that US citizens living in South America or Southeast rAsia would see a great benefit by paying the local tax rate, but I can't see how a US citizen living in a European country with higher taxes than US taxes (generally the case) would come out ahead -- and if they keeping money or other financial assets in the US, they would still need to file the paperwork making all their US financial transactions transparent to their country of residence.

What would benefit US citizens over 65 who live abroad is making Medicare "portable", extending the coverage to cover the costs of foreign medical care. This would also save the American taxpayer money.

For those of us who think health care is a human right, implementing Medicare for All and then making it possible to use the coverage in foreign countries is the goal. Lots of people will fight against it, but so what else is new?

I never said that they would reduce their tax bill. The US citizens who actually live in Europe and have to deal with the paperwork are very clear that it is burdensome and often expensive. Getting it wrong is massively expensive. I see no reason to dispute them.

I entirely agree about Medicare, but I have no expectation that it will happen.

" the protections of a US passport for global travelers are significant. Plus, you can vote in US Federal elections -- not an insignificant power in itself."

You are joking, of course.

thursdaysd,

I actually live in Europe and so did (or does) Cathinjoetown & both us of are US citizens who said we don't find filing US tax forms burdensome. Maybe other US citizens do, but I don't think that invalidates our point of view. I am not disputing it is burdensome to them. But obviously it's not burdensome to everybody.

Even if you didn't say it would reduce their tax bill, the clear implication of the campaign for "Residenccy Based Taxation" is to reduce some expats tax bills. The biggest paperwork & expense burden for me is filing taxes in a European country, not to the US. The European tax forms are more complicated & the paying the accountaint is more than what I pay my US accountant because the European accountant spends more hours, more times a year than the US accountant does working for me. Relieving me of the burden of filing a US tax form would still leave me with the more onerous & expensive requirement of filing in Europe (as long as I live here)/

No, I am not joking about the global power of the US and the power of the individual vote of the US. You leave the impression you are fairly clueless about the present politics of the world, and what the risks are.

So look, it's been suggested in this thread that US citizens renounce their citizensship if they move abroad, that this is to their advantage. It jsut underscores the need for people not to rely advice over the internet before making major changes in their lives. As stated several times, think very carefully before doing these things, and don't use message forums as a source for advice.

Of course one should vote. But if you think that the power of one vote is significant you are delusional. I used to file tax returns in the UK. It took me about five minutes. The US forms are infinitely more time consuming and infinitely more complicated.

And of course one should consider carefully before taking any major step. That should go without saying.

This has little to do with the original question and I am out of here.

Later someone told me that -sanitas would not take pre-existing condition customers.. sorry. try morgan-price and then after a year she gets on thee public system SUPER INEXPENSIVE ( I think under 100E/month if she is over 65. Most medicines almost free.. no co-pay.

I know a ex-vet here who has parkinsons an dI think his caretaker told me about morgan-price.