Wednesday, February 27, 2013

Retirement Planning: Health Care Update

Last year ago I wrote a short piece comparing the costs of Medicare to those of the Italian health care system. At the time, the Italian system was an incredible bargin compared to ours. That's no longer true in all cases.

This morning Karen at An American in Italy posted information on the current cost of buying into the Italian health care system. In case you're to lazy to click over and read her post it boils down to this:
7.5% of your income up to 20,658 and 4% over that amount up to 51,646
The amounts are euros of course. At the current exchange rate those numbers in dollars are $26995.87 and $67490.99. I expect to have retirement income on the close order of $36,000 per year, including Social Security and income from my 401(k). In euros that comes to about €27,548. That would make my annual cost (in 2013 anyway) about €1825 - $2384.91. Ouch!

Medicare (again, for 2013) works out like this:

Medicare Part A (Hospital Care) - $0.00/ $1184 deductible
Medicare Part B (Medical Insurance) - $104.90/ $147 deductible
Medicare Part C (Medicare Advantage) - optional, may include Part D coverage
Medicare Part D (Prescription Drugs) - $32.50 (Aetna's cheapest plan)

That comes to a total of $137.40 per month or $1648.80 per year. In actual practice it will be a bit different, given regional differences in Part D costs. If you see your doctor a couple times a year and have normal blood work done you'll hit the Part B deductible on the first visit, so that should be added in bring the total to $1795.80- about $600 less than the Italian plan.

What about Part D? I looked at Aetna's plan. It costs $32.50 a month and has a $325 annual deductible amount. So that's another $325 per year (assuming you have pretty minimal drug needs) bringing the total to $2120.80 per year.

Now we're getting closer - only about a $250 difference. The last remaining big difference is potentially huge - in the Italian system prescriptions are "free" (i.e. no co-pay) and many standard disgnostics are completely covered as well. To quote Karen again:
I have seen my regular physician many times for prescription refills related to my Lupus. I have seen an Immunologist related to the Lupus, had lots of blood work, and I have had my regular PAP test and Mammogram, which are free every two years at my age. I saw an orthopedic doctor and had physical therapy when I injured my knees last year. I take medication for thyroidism, lupus, and high blood pressure, and my medical costs outside of the annual fee were less than 500 euro, including the specialist appointments, lots of lab work for the new immunologist, xrays, and month of daily physical therapy...
That's about $653 for a tremendous amount of medical care.

If you fall into the infamous "donut hole" in Medicare drug coverage (it starts at $2,970 worth of drugs for 2013) you start paying a percentage (between 47.5% and 79%) for most prescription drugs up to a total of $3763 when you reach the other side of the "donut".

And there's the big difference - if you're reasonably healthy, Medicare will work for you and it will almost certainly be cheaper than the Italian system. But if you need even a little bit of medical care Medicare can become extremely expensive on a fixed income.

For us the new costs will have to be evaluated as we get closer to retirement. As long as one of us can get insurance through work, it makes sense to stay here. When Beth hits Medicare age (or if one or both of us become disabled) we'll need to carefully evaluate everything. I don't currently need any prescription drugs, but Beth takes medication for hypothyroidism and uses Advair for occasional asthma attacks.

Italy may stll make sense, even as more features of the Affordable Care Act come online. Stay tuned!


Tuesday, February 19, 2013

Termini Part 3 - It's Not What You Think!

View Trophies of Marius in a larger map

West Face of the so called Trophies of Marius
Termini Part 1 - Santa Maria Maggiore
Termini Part 2 - Basilica Santa Prassede

It should come as no surprise that a very large number of places in Rome have names that bear absolutely no relation to what they actually are. The rather imposing ruin above, just a couple blocks south east of the Arch of Gallienus (which is really Porta Esquilina) is almost universally called The Trophies of Marius. It's in Piazza Vittorio Emanuele II, another one of those places one used to avoid.
Yes, I Am the Trophy of Marius
These days it's mostly a big playground where local moms bring their little ones and haven for well fed stray cats. But in fact...

Sunday, February 17, 2013

Termini Part 2 - Basilica Santa Prassede & the Arch of Gallienus

View Basilica Santa Prassede in a larger map

Termini Part 1 - Santa Maria Maggiore

Ok, you've spent some time in Santa Maria Maggiore and maybe even seen the underground parts. You still have hours before they'll let you check in. What next? Follow me to the Basilica of Santa Prassede and the Arch of Gallienus! It's just a couple blocks...

Saturday, February 16, 2013

Termini Part 1 - Santa Maria Maggiore

View Termini in a larger map

Termini Part 2 - Basilica Santa Prassede

The area around Termini station in Rome has a mostly undeserved reputation as a depressing, dangerous haven for bums, drunks, and druggies that's best avoided or, if necessary transited as quickly as possible. In fact, the area around Termini has some really interesting ruins, some of the best kebab joints in town, and what may be the source of the best version of Ma Po Tofu I've had outside San Francisco.

So let's say you've just arrived at Stazione Termini and your hotel room won't be available until 14:00. Leave your bags with the bell desk and head out - there's stuff to see!

Thursday, February 14, 2013

Guardia Sanframondi: Part 4 - Houses!

Ok, Good, So What is Your Budget?

Part 1 - Getting There
Part 2 - Around Town
Part 3 - Good Eats!

During our visit to Guardia Sanframondi we looked at several houses ranging in price from €6,000 to €37,000. Of the group, only the €6,000 house required a full restoration - all the others were livable or nearly so, needing only a thorough cleaning and in a couple cases updated electrical wiring.

Monday, February 11, 2013

Guardia Sanframondi: Part 3 - Good Eats!

Macelleria in Guardia Sanframondi
Part 1 - Getting There
Part 2 - Around Town
Part 4 - Houses

It should come as no surprise to find that Guardia Sanframondi has plenty of good food. It's located in the middle of the area the Romans called campania felix - the fortunate lands. And a couple thousand years later it still is. This is the area that sometimes has as many as four separate sagre in the same week. We didn't have time to visit La Guardiense, the famed wine co-operative but we did drink plenty of the local wine made by the owner of Bar Orso, a short walk from Clare Galloway's ArtHouse Guardia.

Of course the sagre tend to happen in the autumn, so for those of us who visit in the middle of the winter (hey, it's when airfare is cheapest) dining is somewhat less exotic, but just as delicious and quite inexpensive.

La Meridiana

Your hosts at La Meridiana

Sunday, February 10, 2013

Guardia Sanframondi: Part 2 - Around Town

Clare's not the only one with views!

Part 1 - Getting There
Part 3 - Good Eats!
Part 4 - Houses

Clare Galloway's House Hunters International episode introduced thousands of us to Guardia Sanframondi. The view from her ArtHouse balcony is a big part of what seduced us into making the trip. But a 30 minute "reality" show (or a blog post) can hardly begin to show just how wonderful the town and it's inhabitants really are (we'll have more on some of the inhabitants in a later post).

Saturday, February 9, 2013

Guardia Sanframondi: Part 1 - Getting There

A Corner in Guardia Sanframondi
Part 2 - Around Town
Part 3 - Good Eats!
Part 4 - Houses

We did it! Everything went according to plan. We made it to Guardia Sanframondi and Clare Galloway's charming ArtHouse B&B, explored the town, visited a bunch of houses (and found 2 that are almost perfect), enjoyed overwhelming Italian hospitality and lived to tell the tale. So without further ado...


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