Health Care

April 16, 2016

International Retirement Migration

I just finished listening to an NPR (National Public Radio in the US) report on retirees in Cotacachi, a rural town in northern Ecuador. (http://latinousa.org/2015/10/09/rural-ecuador-americas-new-retirement-spot/) The report talks about the arrival of American expats to this small Ecuadorian town which has a very low cost of living, great views and an easy way of life. It also talks about one of the great engines of expat ingress to Ecuador, International Living, an online magazine which markets all sorts of services to expats, such as real estate, attorneys, local experts, etc., as well as its own premium services, seminars and webinars. To read International Living is to be convinced that fairy tales come true, even at $1000-1300 a month.

International Living is the top hit every time on Google when looking up retirement abroad, and they are the go to bad boys of unreasonable expectations. The report on NPR mentions them several times, for good reason. But they have tapped into a market, they didn’t create it whole cloth. They have probably single handedly  doubled the number of American expats in Ecuador, but if you think about it, it takes a lot to convince a person to leave their home country and their lives and move to a strange country where they speak a different language.

Why We Leave

Why would people want to leave their homes and families and everything that is familiar to them, to go to a new country, any new country? 

The main reason for the current retiree diaspora is financial. Most of us older people are now, or soon will be, living on fixed incomes that are no match for the US cost of living. We live in the richest country on earth, but we can’t afford it. It is that simple. When you take into account what is required in the US: housing, food and clothing, medical care, transportation and other basic needs, there just isn’t enough in the pension. According to a 2006 Princeton University Working Paper by Thomas Methvin, “As the Migration Policy Institute attests, “The skyrocketing cost of medical and nursing care paired with increasing life expectancies have led to growing doubts that Medicare, Social Security, and private retirement plans will be sufficient for a decent retirement living for all but the most fortunate of retirees” (Migration Policy Institute 2006).

The second reason is lifestyle. This is in large part related to finances. If you can paste together an existence in the US on your pension, it will be a rather spartan one-maybe one your puritan ancestors would approve of? Probably in the US, if you are on an average SS retirement, you will continue to work to supplement your pension. From the same study mentioned above:

“Migrants leave, even from the so-called “core” [developed nations], because they are embedded with lifestyle expectations that they cannot fulfill given their present living conditions, much like those who may leave the periphery [developing nations]. This happens for example when retired migrants living in the “core” make a calculated association between differentials in the cost-of-living in so-called “periphery” regions, causing them to seek locations that allow them to stretch their resources and attain (or come closer to) such a lifestyle.”

So, let me explain that a bit. In one dominant explanation of immigration, it is argued that people migrate to the developed nations (the “core”) because of the penetration of advanced consumer lifestyle ideas and desires into the developing nations (periphery) and people migrate in search of the better life they believe they can have, or at least give their children, in the most modern nations. In other words, they are driven by the desire for a consumer lifestyle. I think it is fairly clear that this is often the case (with many economic migrants, but of course not the case with refugees).

When it comes to the migration of retirees from the developed nations to developing nations, it is ironically the same operation in reverse. We in the rich countries all grow up with consumer desires mostly driven by media. We want a good, comfortable life-style and actually feel quite entitled to it. Many retirees feel cheated when they realize they can’t play golf and lay about at the beach in their retirement. We want our own homes and to be independent. Moving in with the grown children and watching the grand-babies is neither desirable nor an option. So just as the migrants from the developing nation are seeking a good life-style, so are the retirement migrants moving to the developing nations.

A reason quite related to the above is disenchantment with the American way of life. I have found that a lot of retirees I’ve met abroad, or whose blog articles I’ve read, feel alienated by contemporary American culture and society. This critique comes from the right and the left, as if you could divide the expat retirees along the lines of Sanders and Trump. There is a general malaise, even if it is interpreted differently. Again, it would seem that those migrating out of developed countries are driven by similar forces as those who are immigrating into them- the American (or western, or developed) way of life.

The promises of the life of leisure in the perfect climate with all the amenities obviously overstates the possibilities. Just as the immigrant who arrives in Europe or North America experience some painful realities, so do the expat retirees. But we are driven by similar, and somewhat eternal forces. Humans are migrants. Why this is still a mystery and a controversy defies logic.  Now is a new era of migration, and retirees are now being recognized as being part of the new diaspora.

 

 

 

 

March 18, 2016

Assessment: Retirement in Colombia on a Pension

That is what this trip is about, assessing retirement options, though I do have to remind myself at times. So, after 6 weeks here and time in the two major cities and some small towns, I do have a few conclusions.

No real obstacles present themselves, to start with. The weather in the mountain regions (most of Colombian cities are in the mountain regions) stays well within the temperate range year round. Colombia is fairly well developed, and with rare exception you can find what you need. Airfares from the States are quite reasonable, and frequent from the cities. There are plenty of expats and a lot of them are doing interesting things, like producing hand-crafted foods, beers and wines, and raising organic produce.

One could easily find some work to do here. The government has an initiative to become bilingual, the second language being English, but it has a very long way to go. The good thing about that is that teaching jobs should be relatively easy to come by. In fact, the society seems to be on a general positive trajectory and I can see lots of opportunities to earn some extra money, from beer brewing to running hostels and restaurants. The town I am currently in, a very small but touristic town (mostly Colombians and international backpackers) is in desperate need of a few good restaurants.

People are generally friendly and helpful. The cities have world class museums and entertainment, as well as excellent restaurants. There is no shortage of outdoor stuff to do, in fact this is a superb country for every sort of sport.

Health care is getting very good here. Medical and dental tourism is developing, and there is a national health care system. I had the splendid opportunity to check out the emergency care in Bogota in a public hospital, which is the very minimal quality care you can expect. I got taken care of by an excellent doctor for the equivalent of $20, including an ambulance (free), the hospital visit, prescriptions and the taxi home. I wrote a detailed report here.

A retirement visa is relatively easy to come by in Colombia. The visa is based on your provable pension as a multiple of the minimum wage. The current necessary income is less than $700 a month.

Retirement visa (TP-7) – for the foreigner who receives a retirement income such as a pension from a public or private company or the government (Social Security). The requirement is a minimum of three times the minimum wage in Colombia. The minimum wage in 2016 is 689,454 pesos per month, so the minimum retirement income is only $629 per month at an exchange rate of 3,290 pesos. (source)

On the other hand, and there must be an other hand, there are some, well, considerations.

The peso has strengthened slightly since I’ve been here, but it seems the baseline is rock bottom 1800 pesos to the US$. Today it is close to its high at 3150 to the dollar (3400 is the recent high).  Things are ridiculously cheap at the moment (lunch from $2-3 US, and that is the major meal of the day). I stayed in good places in Medellin and Villa de Leyva for $10-11 a night for a private room with shared bath, kitchen and very quiet location. If the exchange rate strengthens to its highest rate, prices would nearly double. This is the reality. Two years ago the rate was at less than 2000 to the dollar. You should be cautious about retiring here if you are banking on the current exchange rates.

While the government may have a goal of bilingualism, it is a distant dream. I’m amazed at how few people have any grasp of English at all. Of course, I am equally aghast at the number of foreign tourists arrive here with no Spanish. In this little village in the midst of the countryside, I see people sit down and start prattling at the waitstaff in English, and seem put out when they aren’t understood. This is not a retirement scene like you can find in Mexico or Spain. I cannot imagine retiring to anywhere in Colombia without learning the language, and arriving with at least basic survival skills in Spanish.

While it is close by plane to the United States, unlike Mexico, the country feels far away. It is certainly part of its charm, but your friends probably won’t be jumping on a flight down very often. You will need to build a social circle here amongst the other foreigners and the Colombians. For the long term this is great for a lot of people, but I think it will also be an adjustment for many.

I think for me the biggest stumbling block is the exchange rates. The cost of living may remain relatively stable for people living on pesos, if you are getting an American pensions in US dollars, it could get rocky.

March 6, 2016

Emergency Room Bogota: Health Care in Columbia

Nothing makes you long for “home” like getting ill while traveling. I’ve been sick in many countries, almost to a one with food borne illnesses. It is a miserable time, exacerbated by needing to encounter an unknown medical system in a developing country. Last night I got an immersion course in Colombia’s health care system.

The last time I needed urgent care I was in Bangkok, and for me it was about like being home. I knew the health care system, and I had a hospital that I had been using for many years for my basic medical needs. When I got food poisoning there and was doubled-up with pain, at 2 in the morning, I got myself a taxi and was to the emergency room in 20 minutes.

This time was different. Being in Colombia for about a month, I knew nothing about the healthcare system except what I had read and heard. It is essentially a socialized system, but one that is fragile and inefficient. Delivering adequate healthcare to a large, and largely poor, clientele, would be a challenge anywhere, but here there is an inadequate tax base and too much corruption. The system covers everyone. I don’t think it is intended to cover foreigners, but effectively, it does.

This was research I didn’t intend to do. On Friday afternoon I had a large meal at a fairly well known restaurant. It is in fact the nicest restaurant I’ve been to in Colombia. The meal was mediocre, maybe because it was at the end of the afternoon meal time. By 8:30 I was good and sick. I got worse through the evening, and by the middle of the night I asked the owner of the hostel for help. He made some phone calls, and then said I needed to go by ambulance to a clinic. This seemed a bit extreme on one hand, on the other, taking a taxi in my condition in the middle of the night is a bit risky.

The ambulance arrived about 50 minutes later. The hostel owner helped me to the ambulance and the driver asked him for money. There is a sign in the ambulance that says that you do not pay for an ambulance, and he didn’t. My vitals were taken, and then we sat in the ambulance for about 1/2 hour for some unknown reason. Finally we took off, me weakly on a gurney in the back, not strapped in at all.

45 minutes later we arrived at a very modern clinic. I was wheeled in and planted next to a wall across from the admitting desk. The attendant from the ambulance stayed with me and was my only contact. The rest of the people of the clinic aggressively ignored me. After over an hour, the ambulance attendant said he was taking me to the hospital. They loaded me up again in the ambulance and drove for 45 minutes to the public hospital. Wheeled in, and planted again next to a wall, I went through the same experience. Other patients walked in to the emergency room or were brought in by ambulance, and seemed to be in excruciating pain, falling on the floor and crying for help. They also got little attention. I clearly wasn’t being discriminated against, or for, as a foreigner. We were in this together, and suffered the same indignities and level of service.

A couple of hours later, by now 8 AM, things started moving a bit. I was told I would get an IV. I said I wanted to see a doctor first. A crowded under-served old emergency room is not a place to be unmindful about things like needles. Around 9 AM I saw a doctor. I think all of us were waiting all night for the morning doctor to come on shift. Wisely they had treated the worst patients first, so I was about 4th in line. The doctor was young and competent, and spoke a modicum of English. With my less than a modicum of Spanish, we managed. I got examined, diagnosed and got prescriptions in about 20 minutes. All smartly and efficiently. When it was my time with the doctor, I had all the time I needed and did not feel pressured or rushed.

I had meanwhile called my friend/former hostel host from Villa de Leyva and he advised me a bit. He offered to have a friend come and help me and take me back to my hostel after I was done at the hospital. He said I was in a very bad neighborhood and I should not go on the streets. Instead of putting his friends out, I had the hospital call a taxi for me. 45 minutes later I was on the road home.

I’m feeling better today. The meds are doing their job and I’ve been making up for lost sleep and the stress of the illness.

Conclusion about my healthcare in Colombia:

I was treated as well as anyone else here, which is marginally adequate but I was treated. If I were to show up at a hospital in the US as a foreigner, getting treated at all would require a ton of paperwork and a lot of money upfront. I could easily be turned away.

My out of pocket expenses?

  • $12 to the hospital (the hostel owner was outraged-he said I should not have been charged at all)
  • Nothing for the ambulance. Remember, the attendant stayed with me for hours, in addition to the total at least 2 hours ride
  • $3 for 3 prescriptions
  • $6 for the return taxi, only because we had to drive around to find and ATM and drugstore

Yes, in a developing country, socialized medicine is a struggle, but one based on the principle that health care is a human right. The drunkest, most belligerent, ancient toothless old man got respectful care, and poor mothers with small children were able to walk in and get care, after waiting a long time.

Yesterday morning I would have given anything for a nice bright efficient US clinic. But even with insurance it would have cost me a lot of money, money that the drunk and the poor mother don’t have. Even with Obamacare there are still “deductibles” and out of pocket expenses. Now in retrospect, even just a day later, I am grateful for the care I got and for the experience of the system. It was a sobering experience, but a useful one.

 

 

 

 

 

 

January 19, 2016

Next Stop: Medellin

(The featured image is from http://daringplanet.com/stupid-go-medellin-colombia/)

Damn! You sure intend to terrify your friends and family this time, I’m thinking. I haven’t told them yet, because I don’t want to deal with the response. But this is not the Narco’s Medellin. Times have changed, Medellin is now known as a sophisticated, peaceful and very modern city, with superb public transportation and other amenities. But, after years of reading of Pablo Escobar and the state of narco war in Colombia, and now with the new TV series that makes all of that fresh again, the old reputation prevails.

Why start at Medellin? A decision had to be made. The time had come, and in all of my readings, Colombia kept popping up. I’ll admit that the current exchange rate makes it inviting, as does the climate. Probably weighing in heavily was the ease of travel from the States, specifically Miami, but also Houston. Nonstop 3.5 hour cheap flights many times a day. I would get there eventually, why not immediately? Besides, Medellin, Colombia meets the requirements of my list:

Family and friends. Medellin is very close, via air, to the United States, and it is a cheap flight. Convenient for friends and family.

Affordability. I’ve chosen the cheapest city in the US, Harlingen, Texas, as a point of comparison for cost of living on numbeo.com. “You would need around … (1,325.44$) in Medellin to maintain the same standard of life that you can have  … in Harlingen, TX…” Amazingly close to may $1300 mark. Shockingly, Medellin, according to Numbeo, is cheaper than Phnom Penh or Siem Reap, Cambodia!  

Legal Status. “You have to receive 3 times minimum salary in monthly bases to qualify for the retirement / pension visa. $644,350 pesos is 2015 minimum salary, so you must gain $1,933,050 pesos per month. Thats 805 USD with an exchange rate of 2,400 pesos per dollar.” (According to http://www.colombiaretirementvisa.com) Today’s exchange rate is 3,221.16. That translates to $584 US. The Pensionado visa must be renewed annually for 5  years, at the end of which you can get permanent residency.

People. It’s hard to generalize about the people of an entire country, especially one as diverse as Colombia. I have read that the people of Medellin are warm and friendly, but those of Bogotá are more reserved. Time on the ground will answer this one.

Language. Colombians speak Spanish, of course, and I understand that Colombian Spanish is preferred for newscasters for its clarity. I hope!

Culture. Latin American culture blends indigenous, Hispanic and African, so it is a lively stew. What is distinctive about Medellin? As one of the great cities of Latin America, Medellin has the urban high cultural elements one might expect in Mexico City or Buenos Aires. Well, that might be too high an expectation, but it seems to be a cosmopolitan city with elements from graffiti to museums and performances.

Climate. It calls itself the City of Eternal Spring. Sitting near the equator, the weather is pretty constant, and pretty constantly in the 70s and 80s (F). It is warmer than Cuenca and Mexico City, but certainly not as hot as places at lower altitudes in the country.

Beauty. I’ve seen the photos. I can’t wait.

Access to  medical care. Both Colombia and Ecuador have national health schemes that expats may participate in. “If you live in Medellín, it is possible to have access to world-class health care in several hospitals in Medellín at a much lower cost than is found in hospitals and clinics in the U.S., Canada or Europe.  Each of these hospitals and clinics in Medellín also has some of their staff that speaks English.”(http://www.firstamericanrealtymedellin.com/hospitals-in-medellin/)

Terrain. Most of Medellin is a valley floor, and relatively flat. Some of it is steep hills.

Food! Being a Latin American urban capital, I fully expect the food to be varied and pretty great. Medellin is now earning a rather foodie reputation. (http://edition.cnn.com/2015/12/15/travel/medellin-food-destination/)

Coffee. Colombia. No need to elaborate.

Amenities. It’s a big city, but in a developing country. All the modern amenities will be here, but don’t expect LA standards. Internet probably won’t be as fast, for example. For me, having lived in Asia for many years, I’m rather inured to inconveniences. I used a bucket and pitcher to take (cold) showers in Bangladesh, so I have a rather lower bar than many.

Tranquility. Aha! Being a big city in Latin America, I would expect peace and quiet to vary a lot by neighborhood. The is another “we’ll see”.

Medellin may help me sort out whether I am more of a city mouse or a country mouse. I love the energy of cities. Being embedded in a neighborhood with cafés and little shops, with life all around me appeals to me. I loved that about Ho Chi Minh City and Chittagong. The frisson of the unexpected mixed with the familiar keeps me motivated. I have always been torn about city or country (by which I mean a village or small town). I can probably do both for a while.

I would love to have questions from my readers and I’ll do my best to research the answers.

 

 

 

January 11, 2016

Best Places to Retire Chart

I slagged on International Living recently because of its hype and its eager promotion of dubious products, but it often does have some useful information if you can get past the promos. Here is a chart that outlines the best places to retire based on a number of variables.

Global-Retirement-Index

From International Living website

Read across the top to find the ones that concern you, don’t just look at the aggregate best score. I find that some of the variables aren’t a concern to me, or aren’t equally ranked with the others, and some other variables aren’t included. I notice that language isn’t included, and that is very important to me, for example.

If it weren’t for health care, climate and language (not in their variables) I would strongly favor Cambodia.

Mexico measures high on most everything, but the financial requirements are relatively high (I’ve covered this elsewhere, but as an example, you can retire in most of the other countries on a pension of $1200 US or less, and it is over $1500 and some measurable assets for Mexico).

Ecuador looks good for most everything, and my only serious hesitations are political stability and the fact that the currency is the US dollar. Ecuador continues to be a strong contender.

Air fares and travel costs are also not on the graph.The countries in Asia may be better choices for Australians due to their close proximity. On the other hand, North Americans will find Latin America close and convenient, and cheap for return travel. For example, you can fly from Medellin to Miami return for less that $350 US. A return flight from most any place in Asia is $1200 on a good day. On a pension that is a huge difference.

The above chart is a great starting point for checking out the options. Please send me any question you have on the topic and I’ll be glad to research it for you.

 

January 8, 2016

It Ain’t Easy

“Retiring abroad is easier and more affordable than ever before. These days it really is possible to spend your days relaxing beneath palm fronds on a Caribbean beach, enjoying farm-fresh produce in a mountain haven with year-round spring weather, or wandering the storied streets of a historic and cultured European city…or all of the above.” International Living

The Internet bubbles over with advice for how to retire and live a happy life forever under the palm trees, being waited on by attentive hired help, eating, drinking, and playing cards with your fellow happy-as-hell expats.

A lot of online companies get rich hyping seminars, “webinars” and even what appear to be pyramid schemes, especially regarding real-estate.

Then there is the reality. Or, the realities.

The first reality is that most people reading my blog, not all, for sure, will fall into the bracket of those who will not be able to retire the way we think we should in our home countries. It is just true that the expectations we have come to have for how we want to live, how we should be able to live, may not be realistic.

“A global survey of people’s attitudes to retirement savings shows while Australians expect to spend 23 years in retirement, their money will run out after only just 10 years, leaving them on the age pension.” source

“The latest National Retirement Risk Index from the Center for Retirement Research (CRR) at Boston College says that more than half (53 percent) of households risk falling more than 10 percent short of the retirement income they’ll need to maintain their standard of living. More than 40 percent of retirees are also at risk of running out of money for daily needs, out-of-pocket spending on health care or long-term care, according to the Employee Benefit Research Institute (EBRI).” source

So we come to consider the alternatives. What if we could meet our expectations elsewhere, where the sun always shines and the cost of living is half of what it is at home? We fantasize, and there are lots of snake oil salesmen willing to feed those fantasies.

The other reality is that moving to another country as an older adult is, well, to put it mildly, a challenge. The majority of us live close to where we were born. If we are Americans, that life generally was rather parochial. Americans tend to be monolingual, for example. It is not unusual to hear someone say that there is no real reason to travel, because we have it all in the States. If we aren’t parochial, we certainly are naive. I read recently where American expats without legal status were being deported from Mexico; one 70 year old didn’t know she needed a visa to live there.

Here are some considerations if you are thinking about moving abroad:

  • Family. I think this can be a deal breaker for some of us. If you have a close family or have family members who depend on you, or upon whom you depend, it is rather difficult to tear up roots. It isn’t insurmountable, but it should at least go into your calculation about where you retire. For North Americans, Mexico and Central America, and even South America can be possibilities, as well as the Caribbean. But know that Sunday dinners will be had without you. For Australians, there are places nearby, such as Bali or Malaysia.
  • Language. This is easier for North Americans, because Latin Americans speak Spanish, which is incomparably easier to learn than Indonesian. If you learn the basics of the language before moving some place, it will help a lot with the transition.
  • Friends and Social Life. If having a large group of friends and an active social life soon after arriving, then you have to choose your location accordingly. Be frank with yourself about how dependent a person you are. I found in my years in Asia that there were a lot of long nights of self-doubt for lack of a close group of like-minded people. I consider myself a very independent person who has spent many years living abroad in many countries.
  • Legal Matters. Where to begin? With a lawyer, probably. You need to know how to get your money and pension from your home country, how to get legal where you are going, and how to deal with legal matters when you get there, especially when it comes to contracts and real estate.
  • Health Care. This is crucial. There are a number of countries that are offering medical tourism and promoting their health care systems. But it isn’t free. Does your insurance from home cover you abroad? Certainly Medicare does not, at all. Can you get insurance where you are going (there are countries where this is possible, and some where it is dubious). If you live close to your home country and are able to travel there for your pensioners’ insurance that’s good for most things. If you have retired someplace and are permanently committed there, you will need to be able to rely on the local health care system. This ruled out Siem Reap, Cambodia for me, as I would want to go to Bangkok, Thailand for health care.
  • Food. Yes, this is an important consideration. Buying imported foods in developing countries will bust your budget. You love Thai food. Really? 3 times a day? Noodles or rice for breakfast? Rice and something else for lunch? Rice and (hopefully) something else for dinner? Most of it quite spicy?
  • Transportation. I can say unequivocally that I will be depending on public transport where I live. Can you live without a car? If not, can you afford a care where you are going, and insurance, and do you want to drive on the roads there? For most Americans, cars are a part of their identity. Factor this in to your thinking.

I’m sure I’m missing something. I would never advise against retiring abroad; it is a good solution for a lot of us. But do so with a very sober assessment of yourself and your circumstances. I have no regrets about having expatriated many years ago; it suits me. But I am no longer really of my country. When I go back, it isn’t my home. Life has gone on without me. This is yet another reality.

 

 

November 24, 2015

Latin America

map_samerica

http://www.gilgordon.com/resources/samerica.htm

It’s huge, and covers a continent and then some. I’ll be traveling around Latin America next year and checking out potential retirement spots. Fortunately in the 21st century a lot of the leg work can be done online. This I’ve been doing for the last couple of years.

I have criteria I’ve been rather loosely applying as I’ve been researching. Concern for affordable health insurance and health care has risen on my list, but the basics remain the same, and the bottom line is being able to live on my Social Security of $1300 a month (plus whatever extra income I can generate).

Here is my current short list:

Mexico

mexico

 http://www.trllavk.tk/map-of-mexico/

Mexico meets a lot of my criteria. Unfortunately, there are rather high financial requirements for a permanent visa, and legal status is required for the national health plan. There are other plusses and minuses, and I’ll be spending time there and filing a full report.

Guatemala

mapcentralamerica

http://www.infoplease.com/atlas/centralamerica.html

Guatemala has risen on my personal list because the visa financial requirements are quite doable, there is good quality affordable health care, and it’s close to Mexico and the US.. Antigua and Lake Atitlan seem to be two favorite spots due to their climate and beauty. Guatemala City may be getting better, but it has a reputation for danger.I plan to spend some time in Guatemala.

Nicaragua

This is another country with low entrance and residency barriers. The health care is reportedly good and affordable. The cost of living is cheap, and they are some beautiful locations. It hasn’t risen to a must visit yet, but I am paying attention.

Panama

Panama offers the best package for retirees. The communities that meet my criteria in terms of climate and size tend to be more expensive than Nicaragua, Guatemala and Mexico. The medical care is reputed to be excellent. Panama City is a cosmopolitan city, with a challenging climate. Like Nicaragua, I am still researching Panama, and it does have a lot to offer.

Columbia

colomb

http://www.infoplease.com/atlas/country/colombia.html

I met someone recently who convinced me that Columbia would be an excellent choice. The visa requirements are quite reasonable. There is very good health care and a national health plan. The cost of living is low, there are great beaches and old colonial towns and cities. Medellin gets good reviews, though it is a big city and I am not convinced that it is as safe as it is lauded these days. I do plan to visit and check it out.

Ecuador

ecuador

http://www.infoplease.com/atlas/country/ecuador.html

There are many publications these days that rate potential expat retirement locations. The income requirements for a visa are quite reasonable. Cuenca Ecuador often tops these lists. In the mountains, it has a springlike climate. There are a lot of expats living in this colonial city. Health care is both excellent and affordable, with a national health plan available to legal residents for about $80 a month. Personally, I am not so keen on the “lots of expats” part of it, and will probably be more interested in places where there is a smaller presence of us. I’ll be checking out Ecuador and will be reporting back.

Next time I’ll go through the map and talk about what places I’ve ruled out and why. Maybe something will move up to my short list, and something else may fall off. I can’t wait to get started!

November 10, 2015

The Reality of Mexico for Retirement: Visa

Mexico has been at the top of my retirement list for a long time. I’ve spent a lot of time there, and have been learning the language a bit at a time. I love the colonial mountain towns best, with their markets and plazas, with cathedrals anchoring one end and bars at the other, with lots of celebrating in between.

Joanne Bretzer Photo

Joanne Bretzer Photo

The culture of Mexico has both remained in and returned to the southwest of the United States, or the formerly north west of Mexico. Those of us who have lived in that part of the States can feel a bit at home in Mexico. It has always felt a bit like home to me.

But now the facts don’t fit the dream. High on my list of requirements are  health insurance and, of course, legal residency. Here is the problem:

Visa: The following is from the International Living website:

Temporary Residency Visa

The most common type of temporary resident visa for expats is as a retiree. To get it, you have to show that you can support yourself in Mexico on funds you’ve earned (or are earning) elsewhere. The minimum monthly requirement is about $1,553 in net income for an individual (as shown on your last six months of bank statements), plus about $520 a month for each dependent. Alternatively, you can provide bank account or investment statements for the last 12 months that show an average balance of at least $25,880. A third way is to show that you own a property in Mexico that has a value of at least about $207,046.

Permanent Residency Visa

You must show higher income requirements for a permanent resident visa. You can show investments with an average monthly balance over 12 months of about $103,523. Or you can show a monthly net income or pension over the last six months of at least $2,588.

Bottom Line

These requirements preclude anyone who is getting the average Social Security of a monthly $1300, unless you have good investment income. Now, being Mexico, there are ways around these requirements. You may either stay in Mexico on tourist visas and make visa runs, or try to work around the requirements with a lawyer.

This is a serious consideration for those of limited resources. It is fine to consider doing visa runs for a while, but do you want to when you’re 85? This also raises questions about insurance. If you want to be part of the national health plan, you will need legal residency.

November 8, 2015

Health Care as an Expat: Insurance or No Insurance?

bum

This is the sort of room I stayed in last fall at Bumrungrad Hospital when I got food poisoning in Bangkok. There was another bed and another guest in the room (an old Thai woman whose family never left her side), but I had space and a sofa for the guests who didn’t come to see me.

I arrived at 1:00 AM after getting sick in my hotel room and hailing a taxi for the hospital. I was taken to the emergency room where I was pretty promptly seen by a doctor (the promptness may have been facilitated by my screaming in abdominal pain). I was given morphine and that stopped the screams quite nicely. Then I was examined and taken to a room like the one above. I did have insurance from my job in Bangladesh, and regularly visit Bumrungrad for medical stuff when I live in SE Asia, so check in was quite straight forward.

I was there for two nights and attended to pretty constantly. My check out bill was less that $100 US. Of course, without insurance it would have been much higher.

So, what is it like if you have no insurance?

Here is information about real costs at Bumrungrad from their website:

https://www.bumrungrad.com/en/realcost-thailand-surgery/final-bill-estimate-surgery-cost-pricing?Pid=7305&RealCostPid=450

Procedure:
Total Knee Replacement
REALCOST estimates are based on the actual invoices patients paid upon leaving our hospital. They include surgical fees, doctor’s fees, medicine, lab tests, room fees… the total bill for the incident of care.
 
 
BASED ON DATA: January 2014 – December 2014
CURRENCY: USD US Dollar
Median: THB 479,452 (USD 13,382)
Low: THB 451,417 (USD 12,599)
Only about 1 in 4 cases
cost less than this.
High: THB 535,786 (USD 14,954)
Only about 1 in 4 cases
cost more than this.
Here is a comparison of costs in different countries: (http://www.kneereplacementcosts.com)
Country Price (estimates)
Total Replacement Partial Replacement
U.S. $35,000 $17,000
Thailand $15,000 $7,000
Costa Rica $12,000 $6,000
Mexico $9,000 $5,000
India $7,000 $4,000
 No Insurance, or “going naked”:
Going without insurance. to my thinking, is only feasible if you have a reasonably good pension, and/or good investment income. On $1300 a month and a very modest savings, this is not an option for me. I’m fine now, but I’m not 85. We all should know that our health care costs will really go up as we get older.
I’m currently researching countries where there are good affordable health care programs available to expats. So far I’ve been looking at countries in Latin America, and some have great programs. In Columbia and Ecuador, you can get national health insurance and good health care for $100 a month or less. In Nicaragua you can join a hospital cooperative and get good care for a reasonable cost. This week I’ll be doing my homework, as I get my knees checked out in Melbourne, Australia. This is the reason for good insurance – I am sure I am in for some shocking numbers on my knee problems, and will probably appropriately postpone work till I am settled somewhere with insurance.
October 17, 2015

The Sorting Hat, Part 2

multi

I’m in the process of deciding where to unpack my suitcases and hang up my art. For the last 3 weeks I’ve been traveling in Mexico as both a vacation with a friend and a bit of scouting. As I ride buses and trains and ponder the upcoming years, I have been compiling a list of both needs and preferences for a home-base.

Here is the check-list so far:

  1. Family and friends. My family is mostly in the US, and my friends are all over the world. Where are they likely to come see me, and how easy will it be for me to travel to them? I’ll make new friends, of course, but on this trip I’ve been visiting old friends and family, and I’m reminded about how much I have missed them.
  2. Affordability. I have to be able to live on my $1300 a month from Social Security, so it is a prime consideration.
  3. Legal Status. Each country has a variety of requirements to obtain legal status. It may be fine to make a regular visa run when you are in your 6os, but it will become much more difficult with age. Proper legal status is important for me. In Thailand the current military government is making it difficult on expats and some are having to leave. Having to leave a place you’ve made home when you are old is traumatic.
  4. People. The most important thing of all is a mix of people with the probability of friendships and companionship. Finding a core group of people with shared values and interests is necessary.
  5. Language. For a gringo relocating to a Latin American country, this may not be a huge hurdle. Spanish is actually easy to acquire, and most people from the US know way more or it than they may think. Asian languages are much more difficult, and aside from some food names, little of these languages has entered the American vocabulary. That is a very clear distinction to consider.
  6. Culture. This can mean a lot of different things, but for me it means a variety of peoples, not high art. In Durango a couple of weeks ago, I was in the main plaza on a Friday night. At one end, down a pedestrian street, young people gathered at bars and live pop, techno and hip-hop music competed. In the main plaza there were mariachi bands and guitarists, and at the far other end, outside a colonial church, there was a free opera performance. In Creel, a town in Copper Canyon, the town square filled with Raramuri, the local indigenous people, while the young Mexicanos cruised the streets in their cars. For me, that is culture.
  7. Climate. I am coming to realize that, after 13 years of sweating in Asia, I’m ready for someplace cooler, but not cold! More than that, a comfortable climate now feels like a necessity. I’m currently in Mazatlan, and I dread going out in the sweltering heat and humidity.
  8. Beauty. I learned a long time ago that I’m not really happy in a place that lacks physical beauty. Beauty is subjective, of course, but for me it means elements of natural and human-created soulfulness.
  9. Access to  medical care. Yes, after beauty and climate comes medical care. My priorities are not always so pragmatic. Access to medical care includes proximity and affordability.
  10. Terrain. A consideration these days for me is having a flat enough terrain to get around on foot. I don’t want to have a car. I had a place in mind in Mexico, and had even bought some land there, and now I realize that I couldn’t navigate the hills and the cobbled and stone streets now, let alone 10 years from now.
  11. Food! When I go to markets as I travel, I find that some of them make me want to stop right there and get a kitchen. I prefer to cook my own food most of the time, and I love a lot of different cuisines, but there must be availability of fresh, local varied ingredients.
  12. Coffee. Not a deal breaker, but it does matter. When I lived in Bangladesh I had to bring coffee from neighboring Nepal or Thailand. There was some canned and instant stuff in the stores, but I tried to make sure I never ran out of fresh beans.
  13. Amenities. Internet, electricity, and the basic necessities. I’m not too fussed by not having access to big box stores, or even variety stores.
  14. Tranquility. One thing I noticed while spending time in one Mexican village was that there was noise at all times of the day and night. It wasn’t just when the fireworks factory exploded in the middle of siesta, but rather often at unpredictable times. Another town, considerably larger, was much more tranquil at night and during siesta.

That is the operational list at the moment. More things may come up. If you think of something, please respond. I’d love to hear suggestions.