US ExPats questions..

Hello my husband and I are recently retired.  We are thinking of living abroad and Cabarete is one of our top choices as we are windsurfers and scuba divers.  I am trying to estimate a budget and am unfamiliar with the big ticket items...  I should mention I am 62 and hubby is 66.  We have been to Cabarete several times but it has been a number of years ago.

What is the best medical insurance for expats and the average cost/month for good coverage for a middle age couple? I did check out the Cigna Link but they seemed very high..

Do you just walk into any hospital and clinic and show your international medical insurance card?
Is medical evacuation insurance available? Recommendations?
Do most US citizens keep their Medicare and fly back to the US for routine appointments?
Any federal employee ExPat's out there? Did you give up your federal medical coverage?
If we were to purchase a home vs renting cost of hurricane or house insurance if it is available?
Do they have building codes for new construction to withstand hurricanes like in the US?

Sorry for all the questions. Any general guidance is appreciated..

Welcome to the forums. 

Insurance: for you it's available locally, cost of good coverage with dental is about US 55 a month. There is only one option for your husband and the coverage is not good.

Yes you can get travel medical evacuation coverage. I will post a link tomorrow.

Cabarete has never been hit by a hurricane so it's a good place to be.  House and contents insurance is available and is priced based on the building construction and contents value.  It's not overly expensive.

Construction here is predominantly cement block so withstands pretty well anything that has hit that area.

I hope this helps.

Cigna is very high and keeps getting higher the older you get. I moved on to local cover with a return to UK if things got nad.

I will skip the other medical insurance questions leaving for others.

There are building codes but verification of on site work quality is another matter. But the positive is that most construction is block and concrete so assuming you aren't in a flood risk zone, windstorm effects will be likely from any breach and water ingress. More important is earthquake cover. You would be in a high risk zone and codes here were updated in 2012 after Haiti quake findings. Most builders follow the reinforcement/ construction requirements well.

Here is the link for Travel Medevac -  go to the link and walk through the process of quoting for what you need!  Its fairly simple. This is an American company with years and years of experience. I was here a few months ago when they flew in to transport a woman in Santo Domingo.  The price was US $55,000 without insurance!

Thank you for your replies.   As you mentioned for myself it is not difficult but for my husband the International plans are very expensive with huge deductibles.  Another alternative I guess would be to use Travel Insurance for an extended time and the evacuation insurance mentioned.

We would also like some information about the quality of care for major events. If someone had a stroke or heart attack is the local Cabarete hospital equipped to quickly care for you, stabilize you and then medevac you elsewhere. Time is of the essence for these situations. Are there any medical personnel nurses, doctors on the forum that could elaborate on treatment capabilities of the local hospital? Or past experience. Thanks so much..

Not to blow smoke on your parade, but why would you ever think about moving to a 3rd world country if you have health concerns?  Take the time to think this through and maybe consider the snowbird option.  Otherwise just take your chances and what is meant to be will be.  Always  look forward...

The decent hospital is within 20 minutes.  They are quite capable but may not be up to newest standards of care.  Yes they can stabilize you depending on your condition.

Correct me if I am wrong: there are currently no major health issues. You are simy looking at the what if scenarios.

I prefer to look at it as being well informed and prepared so we can weight the pro's/con's of all things housing, health care, activities,  before making any decisions.   I have already learned several helpful points from other forum members.   As a medical professional myself I know how quickly a normally healthy person can very quickly succumb to illness and/or  accidental events and the financial implications which can be devastating.  Thanks everyone for your input..

Also sharing some info I have recently found out. For any former federal  US employee's on the forum. I did just find out the Blue Cross now offers more extensive international coverage for it's members.  It may be worth looking at if you are keeping your medical insurance when moving oversea's or even just a frequent oversea's traveler.

Another option for the over 65 group to international insurance is using Travel insurance.  Some companies will cover you for a year or more.  Of course you usually pay up front and get reimbursed but if it is only for occasional use and you go back to Miami for routine medical issues it is a much cheaper alternative. I hope this is helpful.

This is only an opinion but I don't sugar coat things.  Sorry for that.  20 minutes is a death sentence in a real emergency situation.  Having medical professionals in my family (Dominican) and watching them die at a young age because there is inadequate knowledge and care and inadequate facilities to help them and being a Doctor and also having watched friends die here and seeing the lack of proper professional care is simply a red flag for me.  I am not saying that there are not good people or good facilities here, there are, I am simply saying it's not North America by a long shot.  All of the insurance and money will not help you if you suddenly have a heart attack or a stroke.  20 minutes from a good hospital here means nothing.  During rush hour that could easily become 60 minutes and in fact you need 3 minutes or less to be life saving!

Yes I agree. Thank you for your  honest comments.

Yes and that scenario applies almost anywhere. 

Knowing the options is important to your decision making.  So often people make decisions, up and move and then are left sorting though reality.

To the OP, being in the medical field you know the info you are looking for! 

Glad we can be of help!

hey mike I always like your style but lets pause for moment,if a person does medical checkups the results will determine the medical situation of a person so this 20 mins is irrevelant to a responsible individual who knows his or her medical condition.also there are private hospitals with the latest cutting edge technology in the  DR .as for expat durate1 others will advise accordingly,i have medicare a&b with supp,part g total cost of app 270.00 add 45.00 prescription.i am covered for 2 months  worldwide back in the us for 1 day  I can do the same.may this cannot solve the problem but can assist.Tks Pugy  PS  keep a smile u are d best.

Thanks pugypugy.
I have been witness to several young healthy people who died unexpectantly from heart attacks and strokes with no prior history or warning.  I doubt having medical personal close by would have helped in all of these cases but knowing your medical condition is sometimes irrelevant as well.  It can be a false reassurance.  I am simply saying medical assistance is not as readily available in many areas of this country and responses are not the same either as in other countries.  Flashing lights are a normal scene here and for no reason so moving over because  an emergency vehicle is coming means little to nothing to most drivers.  It's not North America and there is no comparison...:)  You just have to be aware.

So true and a good point. I live and work in Santo Domingo and pass the large Trauma Hospital almost daily.

I rarely see vehicles stop, pull over or in any way assist an ambulance in transit.  This makes me NUTS. 

If there  is need to get to the hospital grab a private vehicle or a taxi! It's usually faster.

Hey thanks Mike,I always like your input.and trust me it is to the point.all this information on the forum help us be better prepared interestingly better expats for our journey forward.take care best of luck.Pugy

To retire or find your peace living abroad in the tropics will almost certainly involve compromises on aspects of living.

Access and indeed cost to medical care seems top of many persons list. But the compromise here is that you should be retiring or moving to a less stressed, healthier style of life with an opportunity to be more active too.

DR will probably be as good as most of the tropical retirement destinations for expats when it comes to proximity of best medical care at hand.

Good honest advice is being given here so the OP can evaluate the compromises needed.

That sums it up very well!

Just thought that there is also in country air ambulance insurance you can purchase.  It's done by helicopter and is very inexpensive!  On some medical insurance here, this is included!

Planner, you told me this before but I cannot find my reference. Can I buy insurance now, before I get too old, I am 61, and just pay, or do I have to have some sort of legal residency? My husband plans to get duel citizenship with me as a tag along, but that will be a few years down the road. He is younger than me so I am not concerned about him right now. $55 seems a small price to pay if I can lock myself in.

You can apply with just your passport honey.

If you have a current policy, does it jump in price when you reach a certain age? Or, is it only much higher if you try to purchase initially at a late age?

Mine is a group policy so I am careful about who is in it. My  rates renew every July 1.  We get small increases every year. My rates are better then individual policy rates.

On all group policies and individual policies, once you reach  65 there is an increase like this:  premium plus 50%. At  70 its premium plus 100%   and on and on to I believe age 81 but I need to confirm that.

As a professional Occupational Therapist I understand your basic assumption of humans being functional and at other times dysfunctional when talking about the subject of  Health. That continuum is why we health professionals thrive in the field, as that continuum is a constant. Better to know for sure the immediate areas healthcare assets and its limitations of the provision of services.. (So as not to be caught off guard and ignorant to reality on the ground). Preparation beats ad lib, when minutes count and lives are at stake.
Your US government Medicare part A plan is your entitlement and that option I would not turn away from for any manage care type of substitute in the USA . However if you make the move to Caberete I would get the best full coverage locally that you both can afford while maintaining your Medicare part A. If a critical life experience does occur and a scenario where long term dysfunction and care is necessary make sure where you buy is free of occupational performance inhibitors and or household architectural barriers.Things that will enable a positive recovery or convalescence period need be in place within the structure of the place you will be living. Insurance  for acute and chronic disease is important but thereafter anything acute may have a recovery or maintenance phase. Drug prescriptions are by far less costly in the DR. So that part is a given as long as you find available pharmacy with that medication immediately.
More than most might say I look at this with my OTR background when house searching.  Personally I have seen quite a few homes on the North Coast and did my measurements for w/c accessible Rooms, available spacing for ADL selfcare equipment in bathrooms to enable independence , mobility barriers ie.. potential for ramps, straight walk-in housing as opposed to climbing steps to enter premises. Safe areas with proper ground integrity  for access to vehicles using cane or W/C or Crutches. This is how I would choice a property besides it’s beauty and location. I ask myself is my home assessable to motor vehicles, my ability to ambulate or be transported swiftly and safely, can I transfer myself in and out of a vehicles without having a stair case issued I have gait issues, if phone service is out, what is my next option to communicate distress from the property and what is the distance to ER. And how far will that ambulance be coming from that I am paying insurance for. The option of a medivac airlift is a good option but the other tangible as per immediate acute care on the ground with full coverage is the most important as it will be most likely use the most.

Interesting post! Thank you!

Docsxm,  informative post. Thank you!  Some things to think about.

Hi... I reccomend folks check with Social Security Admin prior to canceling any Medicare Part B, D, etc. We never know when we might have to return permanantly to the USA, and re-establishing said coverage may involve a waiting period, a penalty fee and a much higher monthly payment. When I returned to the USA from 5 years in Argentina, during which time I turned 65, I was told, since I only signed up for Part A, the critical Part B coverage I wanted to sign up for...
o   was not available to me at the time
o   required  for me to wait for the annual signup date. At that time, it was several months away.
o   after awaiting the signup date, when I would start paying the montly premium for Part B, claims
      would not be valid (in my case) for 6 months
o   my monthy premium would be DOUBLE  the normal premium because I failed to enroll for Part B
     before my 65th birthday

What a mess! Fortunately, the Miami VA stepped in and provided unparalelled care and service, and to my great surprised, turned out to be cheaper than my retirement policy plus Parts A and B. Thank you, USAF.

My best to all on the site.

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