General Discussion
In reply to the discussion: I reach "retirement age" soon. Like in fifteen minutes. So, now what? [View all]BlueMTexpat
(15,385 posts)mentioned that because I was about to bring it up too. But if you are covered by other health insurance and can prove that, you should be OK, if for any reason you return to the US full-time and want to participate in Medicare. Still, do check it out because things change - and God knows what Trump and his cohorts will do.
My husband and I are among the weirder expat cases. We are both US citizens - no dual nationality issues - although I am eligible for Swiss citizenship. I retired from working in an international organization located in Switzerland, which entitled me to retire here as a permanent resident. I also had worked in the US for long enough to more than qualify for SS and Medicare. Working with an IO outside the US doesn't require putting money into US SS, nor did it require putting $$ into the Swiss version of SS ("AVS" . So while I qualify for US SS, I don't qualify for Swiss AVS. I have a pension from one IO and a "Provident Fund" from the other. The PF is similar to a 401K, but it didn't qualify for a rollover into my US IRA plan so I took the lump-sum distribution that I was entitled to and invested it. Fortunately, we had been paying US tax on PF amounts all along, so I didn't have a tax hit on the lump sum.
As for health care, unfortunately, I worked for two different IOs - with slightly different health care programs - for a total of 13 years, but with neither for the requisite 10 years to be vested in one of those programs. Switzerland does not have universal health care; it's basically an employer-mandated benefit. Otherwise, it works a lot like Obamacare in the US. The terms of my residence permit require that I show proof of insurance coverage. As you correctly note, Medicare coverage does not apply here in Europe. So I have to purchase private insurance. The Swiss plan I chose has a deductible of CHF 1000 and the premiums run about CHF 450/mo - for GLOBAL coverage, although the presumption is that the global coverage applies primarily to accidents, force majeure, etc., rather than to routine prevention, etc.
My husband retired after several years at a US company and it was after his retirement that I followed my dreams to Geneva and he was my "support spouse." But he is decidedly anglophone and feels more comfortable generally in the US (MD), while I REALLY love Europe. So since my retirement, we have compromised with a "commuter" lifestyle. I am a "permanent resident" of Switzerland; he is not. So, just to hedge my "healthcare" bets in case circumstances ever require that I return to the US full-time, I have the Medicare A premiums deducted from my SS and we pay a modest additional premium for the additional Medicare coverage through the program established by my husband's former employer. I began seeing a GP in the US even before Medicare coverage. This is because we had been warned that some physicians will not take Medicare patients if they haven't had a relationship before then. This strategy paid off when a routine mammogram in Switzerland showed early stage breast cancer. As I was due to "commute" to the US at the time, having maintained Medicare allowed me to receive full coverage in the US for a confirmatory mammogram (that was easier and less costly than having to have an official translation of the Swiss results), easy and immediate access to specialists, and all resulting tests, surgeries and follow-up. I can't say enough good about the experience and only wish that all could have the same! Being located within the Johns Hopkins system in MD REALLY helped.
The "fun" thing about this particular lifestyle is taxes. As a US citizen, I am required to pay federal income taxes. Because my husband is a resident of Maryland and we file jointly (it works out better financially), I also pay MD state & local taxes. While working for an IO, I was NOT subject to Swiss taxes. But now, as a permanent resident of Switzerland, I am also required to pay Swiss federal, cantonal and communal taxes. The Swiss system does not allow a married person to file a separate tax return. However, they have allowed me a Swiss-like compromise. Because my husband is not a permanent Swiss resident and we make sure that he is never here for six months and a day during any tax year, they tax me only on my income (and "wealth" - something that the US tax system really needs to think about along with "transaction taxes," IMO, so that the One Percent can begin paying their fair share) and not his. I just have to file some previously agreed-to explanatory documents every year. Together with the foreign income exclusion, etc., the combined tax hit works out to about the same as we would pay if I only lived in the US. It's just that we have to jump through a lot more hoops to stay legal.
But please do be sure to inform yourself as much about Medicare as you can - as early as you can. But you really have to register for both SS and Medicare through the regional consular office you are assigned to. As an expat, you should be able to get some info about this from the Department of State - at least until Trump's draconian budget takes effect. You may already have done that. Your regional consular office is probably in Germany; Germany currently is also responsible for US expats in Switzerland who receive SS, etc. So we may be talking to some of the same people.