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LTCI Watch: The world

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In my public school, “ethnic diversity” meant having some kids with Irish names in my class. An “international potluck dinner” meant that someone’s mom cooked spaghetti.

Today, immigration has changed the country. A typical street in New York may be more likely to have a Malaysian restaurant than it is to have a traditional German restaurant. Everyone knows that New York is a cosmopolitan place, but I also see plenty of Indian and Pakistan groceries when I go home to see my parents in Kansas City.

Some people have been e-mailing me lately to ask questions along the lines of, “How do I bring my parents here to State X in the United States from Country Y?”

Eventually, I will figure out the right people to ask. So far, it’s been difficult.

Of course: Many people here are furious about the idea of jealous moochers from overseas crowding into the United States to eat from the public trough here. I’m not talking about that.

I’m talking about nice, responsible, educated, solvent thirty-something and forty-something workers who come from markets with pretty good social welfare benefits that probably absorb about as many workers from the United States as we get from them: France, Germany, Hong Kong, Italy, the Netherlands, the United Kingdom, etc.

We already have tax treaties with those countries that somehow help people who split their careers between rich countries get payroll-tax-funded post-retirement income somewhere.

What we don’t have is a great way for healthy pre-retirees outside the United States to insure against the risk that they might want to move to the United States — the land of sky-high health care bills — and have acute care health insurance, in retirement, at a time when they might have health problems.

See also: 7 Tips for Elder Travelers

Example: Can a healthy 70-year-old who moves here from France and is not eligible for Medicare pay for a qualified health plan from an exchange, or for Medicare on a guaranteed-issue basis? Some of you might be able to recite the answers to those questions in your sleep, but I don’t think the answers are easy to find on the Web.

Even though the United States is actually close to developing country median in terms of what its spends on long-term care services, we also don’t seem to have a great way for trading older people who may eventually need long-term care (LTC) services with other countries.

Maybe someone could set up a somewhat creepy but useful exchange that would let people who had either private or public LTC arrangements in one country trade places with comparable people who had comparable LTC arrangements in another country. That way, each individual could move to be closer to migratory children in old age, without doing any severe strategy to the new country’s LTC costs. 

If and when interest rates rise and breathe bond yield life back into the private long-term care insurance (LTCI) market, a better way might simply be for LTCI issuers to make more of a point of offering multinational benefits.

For now, a simple, cheap way to proceed might be for someone who understands how all of this works to post a guide to whatever resources are and aren’t available. 

See also: The World Cup through LTCI eyes


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