Expats and the Affordable Care Act

"A Doctor Explains: What the Affordable Care Act Means for Expats

By Timothy J. Garrett, MD, MBA

October 1, 2013 saw the beginning of the enrollment period for health coverage under the Affordable Care Act (ACA). Along with the news about glitches with the health care website came lots of questions for expats: Do expats have to enroll? Will there be penalties for expats who do not enroll? Even if expats are not required to enroll, is there a benefit to enrolling?

Here are three things that every expat should know in regards to the ACA:

1. U.S. citizens who are bona fide residents of a foreign country are not required to have health insurance as mandated by the ACA.In general, U.S. citizens living outside of the United States for at least 330 days in a given year and who meet the IRS requirements to be a bona fide resident of another country are exempt from the ACA. (You’ll find the full list of requirements for bona fide residence in Form 2555 on the IRS website.)
2. U.S. citizens living outside of the United States but who are not bona fide residents of a foreign country arerequired to have health insurance or face fines.
   If you:
   a) have told your country of residence that you are not a resident of that country
   and
   b) are not required to pay income tax in your country of residence,
   then you are not a bona fide resident of that country. 
   If you don’t meet these stipulations—or any of the other listed IRS requirements—and you do not purchase health insurance, then you could face fines in 2014 of $285 per family (US$95 for individuals)—or 1% of your income, whichever is the greater amount... That amount will rise to a whopping $2,085 per family (US$695 for individuals) or 2.5% of your income by 2016.
   To avoid these fines, it’s in your best interest to purchase at least minimum essential coverage.
   Good news if you are entitled to Medicare, however: Medicare qualifies as minimum essential coverage. If you’re eligible for Medicare, you won’t be at risk of fines.
3. It could make sense for you to have minimum essential coverage under the ACA even if you are a bona fide resident of another country.
   Many expats are fortunate to live in an area with high-quality, affordable, and easily accessible health care. Those who are bona fide residents don’t have to pay for health coverage in the U.S. But even if you are a bona fide resident of a foreign country, having extra cover in the U.S. could help you to secure your own peace of mind.
   If, for any reason, you think that you or your family might have health issues that will require treatment in the United States, it’s worth thinking about purchasing a low-premium/high-deductible U.S. plan that’s coupled with a medical evacuation policy. There are several medical evacuation companies that will provide evacuation from almost any location in the world to the U.S. hospital of your choice for a reasonable membership fee.

Next steps:

The most important things you can do next are to determine whether or not you are a bona fide resident of a foreign country...and then to carefully consider your personal needs and requirements for health care.

Then, if you find you’re required under the ACA to obtain health insurance or that your circumstances make U.S. health insurance a wise choice, the next step is to shop around for the insurance plan or medical evacuation membership that best fits your needs and budget. A trusted insurance advisor who is well versed in the intricacies of the ACA can help you find the exact U.S. coverage you need."

via International Living postcard

THE MUFFIN IMPERATIVE

When the world seems to be heading for the doldrum-pits (isn't it always?), it's sometimes good to focus on the smaller problems, especially the self-indulgent ones, which are the best kind, to wit:

Like any expat, I have my food rants, relating generally to the cuisinal higher reaches comprising cakes, pies, cookies, ice cream and such ecstatics-- the rarefied air of indulgence. This morning I take a slight tangent, to address the no-less-important muffin situation.

English muffins, which someone in America once told me were in fact of American origin, actually originated in England, where they are now known as "American Muffins." (Expat breakfasts are often confusing.) Here in Japan, the natives too have their own version of such muffins, which for purposes of international muffin clarity I shall refer to as Japanese-American-English muffins, starting with the package that I hold in my hands.

As Asia advances through its cultural juncture with the wider world, we here in the J-boonies have been seeing a finer and finer gradation of imported products (I still remember the surprise I felt a few years ago, upon seeing olive oil(!) on the supermarket shelf in the larger village up the road). So it was inevitable that sooner or later English muffins would reach all the way out here to where I live, but like so many derived and adapted cultural imports from around the world, these local Japanese-American-English muffins are but a distant far-eastern cousin of the American-English muffin, being smaller in diameter, thinner, nonchewy, vaguely sweet, vapidly pneumatic and generally less substantial, i.e., nearly all the things - apart from shape and name - that a decent American-English muffin should not be.

There are 4 muffins in this package of - in a typical Japanese twist - "pumpkin" English muffins, so until I get them finished I must occasionally abide before the toaster and ponder related matters of international complexity, like a diplomat making his own breakfast. As I stand there keeping an eye on a couple of orange-ish (fork-split, of course) disks, my foot-tapping mind ponders the inscrutable pumpkin factor, runs through a quick comparison of Japanese/American/British tastes, the smaller portions here in the Land of Wa, the minimalist flavor requirements, the broad variety of subtlety therein (but pumpkin?), the importance of appearance and unobtrusiveness in matters of flavor and texture, the sad lack of... Bing! My muffin is ready.

WHERE THE INTREPID HERO LIVES

Up at dawn this morning, leaning over the loft railing in zombie mode as I gazed out the high upper windows at the just-rising sun piercing the dark lake with eye-watering shafts of light and silhouetting the islands that lay strewn like dark gems across the gray silk surface calm as only the dawn can be calm, the mountainside and opalescent jade mosaic of recently planted rice paddies terracing up the slope, each terrace a polished green facet of the greater light, I was suddenly foreign to this place, an old feeling, but an aspect of myself I'd thought no longer pertained; still, there it was, probably residue from the American dream I had last night; and I saw that actually this was one of those exotic places they use in magazine travel ads in the Occident, with the body of water and terracing rice paddies, or in the classic movies that take place in the far east, or in novels where the intrepid hero lives in an inscrutable culture in a house with high ceilings and ceiling fan and loft on a mountainside above a major body of water with islands on it and emerald terraced fields all around, and it is his island of tranquility, it is where he comes to unwind and plan his next operation that will save the world, it is where the exotic travel ads say (at maybe just about the level of my knees as I stood there) "Come taste the good life," and then fresh from the trip, back in the city they tell their friends in the crowded restaurant what a fantastic exotic unforgettable trip it was, beauty you wouldn't believe, and the culture, and I live here, and went downstairs to shave.