I think I was wrong about the cost of my grandmother’s adult family home. Even though she only pays a little more than $1300 per month, she is assisted by Medicaid. My mom said that her roommate pays more than double that. However, it still sounds very cheap compared to assisted living and nursing homes. I found an article about Seattle adult family homes, and they said this: “The cost of care in adult family homes can be pretty low compared to other long-term care services, even when compared to home care. In Seattle, for instance, monthly costs range from $3,200 to $6,200 per month, with the average cost being around $4,650 per month.”
For a rather high cost of living area, that still beats the heck out of some of the other options!
@dstark, we stay on the top floor of a place called Mana Kai Maui. It is on the very southern edge of Kihei, right before the very expensive houses that lead to Wailea. It’s an ugly, 8 story 1970s box building, but it has a great beach right there, including whale watching from the balcony, snorkeling out the front door, and you can walk on the beach and beach path from there all the way to Polo Beach if you are walking in that direction. You can also walk for a couple of miles in the other direction, maybe to Charlie something or other park? Our “routine” is to get up and do the walk towards Wailea, including stopping in the office of the guy who has the best office on the island. (That would be the guy who makes lattes on the beach). The Mana Kai has a restaurant with a good happy hour including half price sushi. I know many people like the area up by Kaanapali, but we did both our first trip, and decided we like the area down by where we stay better. It’s not cheap, but we probably get a 2 br unit for less than people pay at Grand Wailea. (I really have no idea if that’s true). Now I’m ready to go… But won’t be there until next January.
We snuck into the Grand Wailea pool one time, and the kids liked it so much that I booked it for just a few nights during our next vacation to Maui. We were paying something like $10 for a lemonade, and $15 for a drink, it was so crazy expensive that we decided it was not worth staying there. Maybe if you bring in all your own food and alcohol, and get a good deal, but otherwise not worth it.
I agree with many on this thread about living arrangements, pricing, etc. Some higher cost areas for elder care can have lower cost care some distance from the city - I know this is true where we live. The drive to go visit could be worthwhile due to saving on the care.
@mstee with your dad and colon cancer, he may have been able to be ‘certified’ for hospice care earlier (they need to determine that someone is within 6 months of dying to qualify). As you said, any insurance/Medicare pays into Hospice for the cost of care. My mom didn’t get on Hospice care until shortly before death and would have qualified sooner - once sibling told me of her decline, I had them get her in for evaluation.
For some who are adventuresome, and not so tied with American roots, exploring other places to live. However most on this thread have nest egg and expenses figured out up to ‘unknown variables’ and want to stay where they have network of friends, medical care, life established.
There are risks with out of country - and the risks may or may not ‘bite’ someone living abroad - like Costa Rica. Brother who lives in CR needed to have gall bladder surgery - hospital had one surgeon; surgeon handled 9 cases that day - and no laproscopic surgery either - big mid-line incision and a year to heal. Thankfully no infection and his recovery was unremarkable.
Keeping company health insurance until 65 and getting on Medicare with a supplement is a great plan - however what about younger spouse, or if loss of it like @mstee ? H is hanging on to his job for dear life (and seems to have job security, as far as that goes these days), and thankfully I am only a few months younger than H. I sympathize @mstee - loss of health insurance during my chemo/stage III cancer would have been financially brutal. COBRA expenses safety for a while. Job market is tricky. Wow on west coast housing.
My parents, who had lived in the US, many places in South America and in Europe, retired to Ibiza in the mid 70s. They ultimately came back, to Florida (!), in large part because of medical care. If it were today, I think they’d have stayed in Spain, as the medical care available there has progressed many-fold.
I remember a conversation with a married couple, both physicians, who lived in Australia. Their take, oversimplified by me, was that if you wanted to be treated for a gunshot wound or other catastrophic trauma, you wanted to be in an urban US hospital, because the doctors there are so experienced. Long-term diabetes care in the US, not so much.
“Keeping company health insurance until 65 and getting on Medicare with a supplement is a great plan - however what about younger spouse, or if loss of it like @mstee ? H is hanging on to his job for dear life (and seems to have job security, as far as that goes these days), and thankfully I am only a few months younger than H. I sympathize @mstee - loss of health insurance during my chemo/stage III cancer would have been financially brutal. COBRA expenses safety for a while. Job market is tricky.”
And this is why we should all be thankful for ACA and hope for universal healthcare IMO. Let’s be honest - most of us are in our 50s and 60s. There is serious age-ism in corporate America and the reality is that it is much harder to keep our jobs at this age and to find a suitable replacement than at any other time during our lives. At least with ACA, you can fill the gap until becoming medicare eligible.
Thanks to all for your responses! My fear is that there are devastating illnesses that aren’t covered completely by medicare. I assume supplemental insurance is something you have to get pre-retirement - otherwise it’s a pre-existing condition that isn’t covered later or only at a prohibitive cost). At a certain income level, are you not better off setting up your own personal health emergency fund? That way if the unlikely health scare does not happen, you can buy a vacation home in Tahiti or take a six-month sail around the world or whatever. I would set it up so that I would start depleting it at around age 67 or 68 (assuming that average American lifespan remains at 78), since the likelihood of deadly illness is diminished the closer I get to a natural death. I would reduce the fund by 10% or so each year, spending it on retirement “fun.”
So basically, my “emergency health” fund would last 10 years. The starting amount is what I’m struggling with.
I am grateful that H was able to retire with medical insurance that will cover both of us all our lives. His former employer subsidizes 66% of the premiums, which really helps and the coverage so far has been excellent. We bought him MedicareB when he retired an it pays most copays.
Haven’t fully explored what coverage we have if H or I have cancer but am very glad to have insurance, would otherwise be worried about premiums.
You don’t have to worry about pre-existing conditions for medicare coverage. You can buy supplemental medicare coverage to fill in gaps in medicare coverage no matter what your health situation. You won’t pay extra for pre-existing conditions.
You don’t have to worry about pre-existing conditions before you start medicare either. ACA got rid of pre-existing conditions as a problem with getting health insurance.
As far as the size of a nest egg…nobody has a crystal ball. There are retirement calculators like this one where you can estimate future costs and income and see where you are.
@PragmaticMom, Yes. You can set up an emergency fund. Really you are saving more than you are likely to need. If you are able to save more, that’s great. It’s nice to have a cushion.
As an insulin-dependent diabetic, with all of the associated conditions that come along for the ride, and the husband of a woman who’s run 20+ marathons while trying to hold back the ravages of RA, I am thankful for the ACA’s refusal to allow pre-existing conditions to affect underwriting. Nothing political, but shame on anyone trying to get rid of ACA. Fine tune the marketplace if it makes you happy, but leave the fundamentals.
One of the main reasons DH won’t leave his current job is the medical coverage we get for me and would continue to get in retirement. He’d make a lot more elsewhere, but the insurance keeps us solvent.
@IxnayBob, the Australians were largely accurate. US healthcare is great at heroic saving of people from something traumatic (especially with the latest technology) and thus is often very interventionist in the final year, But, for basic living and preventive care, many countries provide better care on average. In last year’s survey, the US is ranked 37th in health care outcomes across the population. If you have cancer of the liver, there are many more surgeons in the US who can handle it beautifully than in Canada – and give you perhaps one more year of life – but for general health of the population, a lot of countries do it better. I was on the board of a Canadian private health care company and advise an insurer in the UK and the US press about the Canadian and UK systems is misleading.
@CountingDown, it is a shame that there is not full portability. At some point, companies will probably direct everyone to ObamaCare and then provide supplementary insurance as a perk. But that will take a while.
Won’t this require a change in the law? IIRC, companies are explicitly prohibited from getting rid of their on insurance and just offering money to buy insurance on the exchange.
The reason US ranks lower in health care outcome is we are FAT and have a lot of related medical issues; also don’t exercise. The bottom half of income households eat way too much starch and fats in their diet - and as a result you have a lot of poor people that do struggle with diabetes and other health issues.
I know I will stand out like an overweight/obese American that I am when in Europe this summer, but it is what it is. H is at his weight goal - he jogged 7 miles this morning. I have to do better.
The insurance paradigm is shifting in the US - and we all will be facing being denied some on health care choices in the future. It is happening a lot with drug formularies now on private insurance, for example; we now have to use mail in for any maintenance (3 month refill) medications or we have to pay for the total prescription cost. With testing limitations, you do need smart MDs to navigate the right care. My job as a RN is keeping my family healthy; I oversee and make sure H gets the right care - his MD and I concur so Mr Minimalist has to follow the plan.
Sometimes one has to fight for the right care. For example, due to the way hospitals are reimbursed for diagnoses, the hospital tried to kick my mom out too early after a major car accident. We knew she could not walk w/o assistance and that was reason enough for her remaining (she had facial surgeries and head injury from head on collision). One sis took a week off of work and I took a week off of work to help her when she did get discharged.
Life is more complicated, so the people aware and better able to navigate the paradigm changes will have better outcomes. “You don’t know what you don’t know.” Sometimes a situation requires a red flag action but if you don’t identify it as red flag you may miss the boat. A lame example is if you have a window for replacing certain insurance and you don’t, then something happens catastrophic. There are life and death situations that people don’t recognize require different actions for a better outcome.
Earnest questions: are there any countries where long-term care costs are lower than in the US when compered to the local incomes? And are there any countries with affordable medical costs for the devastating illnesses, biologics medicines etc. that aren’t covered by medicare? We love the US too much to retire anywhere else in the world. But we traveled to dozens of countries, and we always carried medical evacuation insurance, as I would never risk receiving local medical care in emergency. I’ve seen and heard of too many horror stories, including some that happened with my own travel peers.
Good questions, mycupoftea. Because when it comes down to it, when you are looking at your own family, overall health outcomes for the general population may not be the most important issue. Cuba may have lovely and equitable preventive health care for their population, but if something goes seriously wrong, where are you going to want to be? Also, if you’re not highly fluent in the primary language of the other country, I’d think you’d want to live somewhere where they commonly speak English. It’s hard enough to communicate to doctors who speak the same language!