Sometimes it’s not a matter of age; becoming an expat might come down to one question: Are you healthy enough?
Why I Wrote This Post
One of the most popular posts on my blog is Moving to Portugal as an Older, Single Woman. (And no, that’s NOT me in the picture.) I moved to Portugal when I was just shy of 63 years old. Not technically a senior citizen, but no spring chicken, either. I have a lot of people who ask me if they’re too old to leave the US—whether it’s to move to Portugal or some other country. And the answer, of course, is that depends. Because age really is just a number. However, it’s a particularly slide-y one: Some days I feel like a kid; other days I feel like I’m eighty years old. And I have no serious health issues.
It Ain’t the Years
It’s not a matter of old or young. Or, as Indiana Jones said, “It’s not the years honey, it’s the mileage.”
All of us reach age milestones at varying degrees of health. I can’t tell you how true the saying is, “If I had known I was going to live this long, I would have taken better care of myself.” On my walk the other day, I ended up in step with a gentleman who had a fast, steady pace going. While he only spoke Portuguese and we all know how well my Portuguese is going, I did manage to find out that he is 85 years old. He is tall, slender, but not sick-thin, and not at all bent over. (You know what I’m talking about.) At twenty years his junior, I was hustling to keep up.
I have pretty good health in spite of not taking care of myself and not eating my vegetables. So yeah, genetics come into play, too. When I moved to Portugal, I was on no medications with no major health issues. Since then, my doctor here recommended high blood pressure and cholesterol medications—fairly normal for someone my age. I took the blood pressure medication for several months before losing twelve pounds and starting an exercise routine. My blood pressure is under control without meds. The cholesterol… Well… I didn’t like the meds and I stopped taking them. My cholesterol is moderately high and I figure if I can lose another ten pounds or so, I might get it back into the normal range. If not, then I will start the meds. But I really don’t like to HAVE to take something. (Yes, I know, I should be on them now.)
So, becoming an expat is a matter of your health, and, when we get to the insurance part of this, partly about your age.
You Need Your Team
When you have a serious illness, you end up with a team of doctors, a hospital that you know, and a familiar routine. You go here for blood work; this doctor knows your entire health history; this hospital is better than the one across town. Moving to a new country means that you will need to assemble a new team of doctors who need to become familiar with you and your illness. Where you end up living might depend on the facilities that the local hospital has more than where you actually want to live.
On the other hand, if you’ve been in Portugal or the country of your choice for several years and you become seriously ill, you already have your GP, you know where to go for bloodwork and labs. You’ve probably had at least one visit to the local emergency room. You’ve been navigating the health care system at some level so you have a familiarity with it. You have a network of friends who can recommend doctors and clinics, where to go and who to see. You build your team where you are. (And yes, some people go back to their home country. They may have a better support system there or just be more comfortable returning.)
If you have a chronic illness, you will want to check to make sure you can receive the same (or better) treatment in your new country. If you can’t, it would probably be better to stay put, surrounded by the people who know how to handle your condition. Probably not what you want to hear, and yes, reality sucks. But you already know that.
Can You Even Get Health Insurance?
Pre-existing condition exclusions do exist in the private health care industry here. Usually, however, if you can show you’ve had continuous healthcare coverage prior to emigrating, you can get some form of healthcare coverage. You can may end up with a policy that excludes care for your pre-existing condition, usually for one year.
Once you have your temporary residency card, you can take advantage of the national healthcare program, but the general consensus in the expat community is that “if you didn’t pay in, you shouldn’t take out.” If you can’t get private health insurance, then yes, of course you will use the national health system. But in many countries, the system can be “backed up” and you may find longer wait times than you like.
As a side note, you will need private health care coverage as part of your visa application. There are companies that do this. They are usually somewhat akin to travel insurance or temporary insurance in that they charge a lot and don’t cover much. But that coverage is enough to get you through the visa process.
After a certain (ahem) age, it is more difficult to get private health coverage. For many providers in Portugal, that age is 70. (Medis Insurance has Vintage and Vintage Plus for those over 55. It covers you to the age of 75.) After the age of 70, there is really only one private health insurer, MGEN. It is limited healthcare coverage, with a 50% copay. At that point, I’d probably be using the national health services, too.
The insurance companies also work in conjunction with the national health service. For example, your private insurance may cover up to $100,000 worth of cancer treatments and then anything over that goes through national health. Compare that to the US where you basically have to go bankrupt before you can get government aid for health care.
What Happens to Your Medicare?
Here’s where things get a bit crappy. Once you turn 65, you can enroll in Medicare. Yay. But, since you’re in a foreign country, you can’t use it. You also start getting docked $170 or so per month for Medicare Part B. (And then you get to pay more money for whatever supplement package you decide to get.)
If you’re living out of the US and think you might move back, you probably want to pay or continue paying into Part B. For every year you don’t pay in, the cost of Part B goes up 10%. (There are some exceptions to this.) In ten years, the cost would double.
If you’re not going to move back, then you might choose (after careful consideration) to not pay into Part B. You have to opt out. Medicare automatically puts you in Part B and takes the money out of your Social Security check (if you’re receiving Social Security). You have to file a form with your local Social Security office and tell them you are opting out. I had sent in the form which of course got lost, resulting in a scramble a few days before the month I turned 65—because once they take that money out, they’re all “no givesies-backsies.” The US Embassy in Lisbon did a stellar job getting my paperwork over to the Gainesville, Florida office and making sure everything was filed correctly. (The staff at the US Embassy in Lisbon rocks!)
If you’re traveling back to the States, it is recommended that you get some form of travel insurance. Check your credit cards—some of them include travel insurance if you buy your airline tickets with the card.
My health insurance, including dental, is just under €200 a month. It’s the equivalent of a Blue Cross, Blue Shield silver plan. The dental plan actually covers stuff, unlike individual dental plans in the US. So, for a little more than what I’d be paying for Part B in the States, I have private health insurance. Add in the cost of a supplement, and I’m probably a little ahead. If I move back (doubtful) and opt for Part B, I will end up paying more than most people.
If You Have Enough Money, You Can Do Anything
Let’s face it, with enough money, you can be flown over to your new country on your private jet, along with your crew of private nurses, personal butler, cook/dietician, and dog walker. You can afford the best private healthcare no matter where you go, and you will most likely be able to call up your friend Duckie or Bingley or Thurston and ask for a referral to their private doctors. In fact, very wealthy people who can’t find a solution in the US often turn to other countries for help. Whether or not there is a solution, of course, depends on so many factors.
That is not an option for most of us, alas. You need to consider your health and that of any partners or family members who are coming with you to your new country. I see people with various chronic illnesses ask in expat groups if there is treatment available, and if so, what kind. That’s what these groups are for—connecting with people who have real world experience. Do take advantage of them. If you are shy about asking (and even if you’re not) use the search function in the group to see what has been discussed.
I would also recommend exploring your health care options when you make your initial visit(s) to your prospective new country. (They’re called exploratory visits for a reason!) Talk to people who are living in the area about their experiences with the health care system. You may discover that your local hospital’s emergency room closes on Sunday and you need to go several towns over. They can prepare you for the fact that modesty kind of goes out the window in many of the hospitals and labs. You might be pleasantly surprised to find out that the main hospital a few towns over has one of the leading cardiac programs in Europe.
Becoming an expat involves more than checking off all the requirements on your visa application. It’s more involved than knowing your world is going to change. Picking up your life and moving it across an ocean is a big deal that requires you take seemingly EVERYTHING into consideration. That includes your physical health and any support system it may require.
