The Grown-Up's Guide to Running Away from Home, Second Edition: Making a New Life Abroad (29 page)

Some health insurance companies have set up reciprocal agreements, enabling you to transfer coverage from a company in the States to another company overseas. The benefit is that you can maintain your policy and avoid preexisting condition exclusions. Ask your current insurer if the company has any such reciprocal agreements.

Some people who can’t get affordable health coverage in the States self-insure by setting aside money to cover medical expenses in a less-expensive country. Many choose to pay most medical bills but have insurance with a high deductible. Their savings wouldn’t pay for open-heart surgery but do cover basic care and enable them to purchase insurance with a higher deductible and therefore lower monthly payments.

In many countries overseas, medical care is much less expensive than in the States, so some expats take a calculated risk. They “self-insure” by paying their own health expenses overseas and assume they will return to the States in case of a serious medical need to use Medicare or private insurance they have there. I don’t recommend this route, since I want the peace of mind gained by knowing that emergencies and major medical costs would be covered.

That said, our health insurance had a high deductible, so we paid for most doctor and dentist visits ourselves. The consolation was that health services were excellent but less costly than we were accustomed to in the United States. We were happily shocked to discover that the recommended French physician who spent nearly an hour with my husband charged him $20.

If you reside in another country, even as a U.S. citizen, you can sometimes participate in that country’s health-care system. Residents of Ireland, whether or not they’re Irish citizens, get free outpatient services, free care in public hospitals, and refunds on prescriptions over a certain price. People retiring as residents of Mexico can participate in the Mexican National Health Insurance Plan (
Instituto Mexicano del Seguro Social
, IMSS), which costs about
$240 per year (depending on exchange rates)—including dental and eye care. In many countries, if you work within the borders, you will pay into that country’s social security system and therefore be covered for health care.

Start your adventure by planning for health care and you’ll be prepared when you first arrive overseas or suddenly need care.

What if you become ill overseas? Don’t panic over the mere thought. Many doctors and hospitals overseas are not only available but offer excellent care. Go prepared to find the best medical services you can.

Take a list of medical doctors who speak English. Sometimes you can accomplish this by simple word of mouth. It turned out that my dentist in Atlanta, a true Francophile, had a French dentist friend. Though that dentist was in Paris, two hours away, having a name before I arrived was at least comforting. As it turned out, I found two excellent French dentists just a few kilometers away through expats we met in town.

Medical specialists can refer you to other specialists throughout the world. My husband’s cardiologist provided names of three cardiac specialists, one of whom spoke some English, within thirty minutes of our location in the French countryside. He didn’t know them personally, but used an authoritative reference: the
Directory of Medical Specialists
. Your physician should have it. If not, check the library.

You can also write the Office of Overseas Citizens Services, Room 4811, 2201 C Street NW, Washington, DC 20520. Specify which country you’re going to and they will provide names of medical providers in that area.

Once you’ve actually settled into life overseas, find good doctors, dentists, and hospitals by asking the nearest U.S. embassy or consulate, other expats, your neighbors, or a pharmacist. Look for a university-affiliated teaching hospital in a major city.

Let’s say you just arrived. What do you do if you break a leg as you trip over the baggage cart in the airport? Here are a few forms of emergency assistance to remember:

The U.S. Embassy or consulate will help you find medical assistance and, at your request, inform family and friends.

International Association for Medical Assistance has names of English-speaking doctors and hospitals. Call (716) 754-4883.

Global Assist Hotline (only for American Express cardholders) provides emergency medical, legal, and financial assistance. Call (800) 333-2639 or, from abroad, call collect (715) 343-7977 to reach multilingual operators twenty-four hours a day. Have your AMX card number ready.

If one of a couple is sick, the other should be able to pay the bills, so if you rely on traveler’s checks, be sure either person can cash them. These are called “two-signer” checks. Or have enough checks in individual names to cover emergency situations.

If you’re traveling to a first-world country, you won’t need to worry about cholera outbreaks. However, if you intend to travel widely or visit a third-world country, prepare yourself more carefully to avoid health problems. Do basic research about your destination to see if you need special vaccinations or if any health or safety warnings have been issued. Since conditions change, get up-to-date information. Here are a few ways to get it.

The CDC in Atlanta, Georgia, provides the latest information for travelers on disease prevention for areas throughout the world. Information ranges from vaccine recommendations to safe food and water ratings to disease outbreak bulletins. See their website at
www.cdc.gov
.

The State Department provides Consular Information Sheets on areas around the world and any special warnings that may have been issued about possible trouble spots for your health and safety. See
www.travel.state.gov
.

No one wants to consider death, but it happens to us all once, whether in the United States or overseas. You won’t want to lose sleep over the possibility in Portugal or England any more than you would in the States; however, if you become a resident of a foreign country, investigate any special requirements for wills or inheritance taxes should you die outside the United States. Ensure that your family and your own final wishes will be taken care of properly.

The U.S. Department of State estimates that about six thousand Americans—either expats or visitors—die abroad each year. The consulate office contacts the next of kin and can help make arrangements for the body to be either buried overseas or returned to the States. If you want to be buried in the family plot in Cincinnati, your body will have to travel back. Some insurance policies cover this, but if not, it will be paid from the remaining estate. The U.S. government will not pay for this service.

Inheritance laws in other countries may surprise you. In some, if you’re considered to be domiciled in another country, you will pay their taxes, and your will may be overridden based on the country’s requirements. France, for example, has a system whereby children inherit over the surviving spouse. Right. You could find the money you and your spouse saved over the years going to the kid’s new Mercedes. Even if they give you a ride with the top down, that’s not a surprise you’ll want to discover at the last minute.

Don’t assume that common sense or your U.S. will takes precedence. It may not in a foreign country, but you can take steps to avoid potential problems and enjoy your adventure with an easy mind.

First of all, if you’re merely traveling through a country, staying for just a few weeks or sometimes months, and retaining obvious ties to the States, you’re a tourist, not a resident. In this case, don’t worry. If, however, you decide to live overseas for an extended period of time, contact an attorney who specializes in international law to ensure that your final wishes will be followed.