The following is an article written by Helen Hootsmans, a FAWCO member who has returned to the US and is currently a FAUSA member, as well. With Helen's permission, it is being posted on the Transitions: Growing Older Committee webpage in an effort to inform other FAWCO members who have returned, or are planning to return, to the US and will be dealing with Social Security and Medicare issues. If you have encountered any of the problems outlined below, or others, please contact the committee chair so that others may benefit from your experience. Questions may be addressed to Helen through the Transitions: Growing Older Committee at .
Reflections on the FAUSA Social Security and Medicare Questionnaire
During the period February-June 2007, some 32 FAUSA members responded to a pilot questionnaire regarding their experiences with Social Security and healthcare coverage regulations in the U.S. Their responses, while statistically insignificant considering our current membership and the total number of expats who may have returned to the States in the last few years, can be seen as indicative of a number of issues specific to three groups of American women resident abroad for different periods of time. Their experiences add new dimensions to the discussion within FAWCO regarding the non-accessibility of Medicare overseas. Awareness of these issues can also benefit FAWCO members planning for repatriation in the future.
RESPONDENTS
Of the respondents, 3 were 71 years or older, 7 were between 66-70 years, 13 between 56-65 years, and 6 were aged 46-55. The largest group responding were expats married to Americans. The length of time spent abroad varied from 2 to 45 years. (The response of one member who was only abroad for a summer are not included in the results.) Many were employed overseas but taxed in the country of residence via bilateral tax treaties.
Most of the respondents had been members of FAWCO clubs in Europe. The newer clubs in Asian and former Eastern bloc countries were under-represented, possibly because of their short-term expat membership. Countries of resident included: Australia, Austria, Belgium, Denmark, England, Germany, Hong Kong, Ireland, Israel, Italy, Japan, Korea, Malaysia, The Netherlands, Norway, the Philippines, Sweden and Yugoslavia.
The main groups:
•1. have a partner employed by an American company abroad;
•2. are, or were, married to a foreign national;
•3. are single (never married), or divorced.
Women in group 1, company-sponsored, have the fewest problems with health insurance now. The future of company-sponsored health insurance is in flux at the moment, but the group is not presently affected. Most are now especially knowledgeable about Medicare, as it is not considered relevant for them. Their health plans also allow them to ignore the government drug prescription plan.
Groups 2 and 3 share a number of problems. The first of these is the possibility that they may not have sufficient Social Security quarters to be eligible for Medicare coverage at age 75, but need to sign in at that point. Their insurance, as well as their old age pensions, may be linked to foreign country programs.
Secondly, they will be faced with the requirements of the government's drug prescription plan if they do not locate insurance comparable to that plan's coverage. Third, a problem specific to group 2 is coverage for their partner if they return to the States while he is still alive.
A subgroup of those married to a foreign national is the "mixed marriage" group currently living here and there. I suspect that FAWCO could provide better numbers on those women as most are not yet FAUSA "international members." They are in the unenviable position of having to carry two sets of insurance in preparation for an eventual return.
Healthcare, specifically Medicare accessibility, has long been an issue for Americans abroad. In relation to gender, Phyllis Michaux (AAWE) signaled the issue of elderly American women in France who were not able to return to the States for lack of insurance. Repeated efforts on the part of FAWCO, AARO and Democrats Abroad have been unable to convince the Government to open TRI CARE (military insurance) to American civilians abroad. The addition of a so-called National Drug Prescription Plan adds to the complications.
In regard to the latter, there is a requirement that all Americans prescribe to a plan under the Drug Prescription Law, or have equivalent coverage in the U.S. The plans are state controlled and differ from state to state, as well as from plan to plan in regard to which drugs are covered. In addition, Americans resident abroad cannot join a state program. The US Embassy in Dublin looked into this matter for us and got a written statement permitting a time allowance after repatriation before penalties would start accruing (1% per month.)
Responses to the question about the quality of healthcare abroad, considering the countries noted, were mainly either "the same," or "higher." US accessibility was ranked "quicker" and "easier." There was general agreement that US costs were "higher." No one noted that medical costs would bankrupt a patient in their former country of residence. (Since the time period when the pilot was completed, the dollar has devalued considerably, affecting some members in groups 2 and 3 positively, and others negatively.)
Coping strategies for these members range from "I try not to get sick," to paying directly into Medicare, a prerequisite for certain types of supplemental insurance elsewhere. A better solution would be to press for legislation that equates the monthly payments made to Medicare for health care coverage as Social Security quarters. This would assist those were short (e.g., up to 15 quarters or less) to accrue sufficient quarters to eventually qualify for the usual coverage granted to other Americans who were able to meet the requirement by age 65.
UNIVERSAL HEALTHCARE
Healthcare is a crucial topic in this year's election discussions. The term "universal" is, nevertheless, a misnomer. The real issue today is the creation of a national healthcare system, a full step behind a truly universal system which the 21st century global community needs. Unfortunately, neither US nor EU insurance companies offer such borderless coverage. FAUSA members, as well as FAWCO members, need portable healthcare insurance for themselves, their partners and their families. Perhaps this vision of universal healthcare could be included in a FAUSA presentation in Lithuania.