Still Keeping Me Rudely Awake 2018

Still Keeping Me Rudely Awake.

(Last Updated 02 November 2018)

Three years ago I wrote about some current costs in Colorado and why the Cost of living Philippines is often 1/12 the cost of the USA.  It’s summarized below.

Why bring up something three years old today?



Still Keeping Me Rudely Awake.Well, my wife and I are currently in Florida, getting ready to return to our home in the Philippines in just a few days.

Many of our experiences on this trip are about the same as our trip three years ago.

To Stay Or Move

A  primary purpose of this trip (October 2018) was to “sniff the air” if you well, to see if we both might decide it was time to move back to the USA.

I was recently diagnosed with chronic obstructive pulmonary disease (COPD).  Not very happy news.  But I’m taking steps to minimize the issues (like getting off those damn cigarettes (yet again)), losing weight and other health-promoting things.

One of the reasons I started thinking strongly about going back to the USA is …

There’s No US Medicare in the Philippines

Many of my readers, of course, know this, but every month I get contacted by people who want to know the answer to things like “What hospitals in the Philippines “accept” Medicare”? and similar queries.

The answer is short and simple (although harsh to some).  None.

US Medicare does not pay at all for any procedures or care received outside the USA.

The only exception (and is a very narrow and limited one) is that Medicare will pay minimal amounts if you are stricken on a short, tourist-type trip outside the USA for minimal care needed to get you back to the USA.

Senseless In Some Ways, But The Law Is The Law

Now in many ways, this policy of US Medicare makes little sense.  Medical care in virtually any country aside from the USA costs less than US costs.  In the Philippines, for example, a LOT less.

Thus, if Medicare paid for care in the Philippines, the costs to all US taxpayers would be a LOT less than costs for the same procedures in the USA.  Makes sense to me, but not to the US Congress.

But our lawmakers have decided and if you don’t like the situation the only recourse is to start campaigning for Medicare benefits overseas with your elected representatives.  Best of luck with that.

So If I Moved Back To the USA, I’d Be Covered By Medicare

Part A (the program everyone gets when they turn 65) and Part B, an optional program which I pay for, currently about $108.00 a month.

If Medicare doesn’t ever pay anything for me while I am overseas, why am I spending the money for Part B?

Good question indeed.  One of the reasons I have been toying with (and frankly am still toying with) the idea of moving back to the USA.  After all, I’m paying for the care already, correct?  Makes no sense to live where I can’t get any benefits.

Except I do get one benefit, an important benefit which makes paying the Part B premium worth it to me.

Enter TRICARE

TRICARE (yes, that’s the proper way to write it out, I know, looks silly to me, too.) is a program managed and paid for by the Department of Defense that provides medical coverage for active duty and retired military members and their dependents.  I’m a USAF retiree and TRICARE coverage is a free benefit extended to me because I put in the time serving my country.

But, as with most “good things”, there’s a catch.

Once I turned 65, my TRICARE plan became the TRICARE For Life plan (TRICARE-TFL)  In order to keep my TRICARE-TFL coverage I must also opt into and pay for Medicare Part B.  So much for the “free medical coverage” that many people think retired military enjoy.  It’s “free” if you pay, only.

Since Medicare doesn’t pay overseas, TRICARE does not require me to make useless claims to Medicare for treatment I receive, they pay their share of my medical costs directly after I submit claims for coverage.

If I get medical treatment in the USA, I go directly to a hospital or doctor who accepts Medicare payments, and any costs which Medicare does not pay I can then submit to TRICARE for possible cost-sharing.

My choices and the real conundrum I’m struggling with is this:

  1.  Move to the USA and accept the outrageous bills that hospitals submit to Medicare, collect my “share of the spoils”( What do I care how much the hospital charges, the insurance pays, right?) and then try to milk the rest out of TRICARE, or ….
  2. Stay in the Philippines, use TRICARE approved hospitals (which I can easily do in the place in the Philippines where I live) and ay upfront for medical care and then accept the 75% which TRICARE reimburses.

It Might Sound Simple, But It Ain’t

First of all, I hate the whole Medicare system.

As far as I am concerned the crappy care both my parents received in their old age was directly responsible for their earlier than necessary death.

Especially in the case of my dad, I felt we had an excellent medical malpractice case against his surgeon, but my brother and sister didn’t want to join with me and were very uncomfortable with the idea of getting tied up in the US court system, so I gave up on the idea.

I am still very, very bitter, though.

Secondly, I feel That I’ll Be Joining The Whole Crooked System That Passes For US Medical Care.

We Americans have the highest cost of health care in the world, bar none.  Do we get the best?  Personally, I don’t think so.

On this trip, I was happy to meet up with my daughter, whom I hadn’t seen in some years.  She had a very serious stomach problem a few years back, and during her hospital stay, she kept track of the doctors who visited her who had nothing to actually do with her upcoming operations.

22 of them!  Yep, 22 doctors who ALL BILLED HER INSURANCE for “consultations”.  Just like a farmer being let loose in a herd of milk cows with a bucket, milking and all “cows” he could catch up with.

When she complained to the hospital administration she was told basically to “shut up and color”.

After all, she finally did get the operation she needed and recovered nicely, so why should she care … “insurance paid”.

Well, She Did Care, Bless Her, And So Do I!

I wasn’t raised and I didn’t raise her to participate in fraud, even if someone else is the one paying (and doing the stealing).

Some of you may think I am too straight-laced on this, and see nothing wrong with massive overcharging, as long as “Medicare” or the insurance companies are paying.

Fine with me, I will not judge you, what’s right for you is right for you, but I know what’s right for me.

So At Least For Now, Medical Care In The Philippines Seems The Best Choice For Me

Now I want to point out that I don’t believe cost is everything in life, and that one shouldn’t decide on a place to live based only on costs,

BUT we have to accept the fact that costs do matter … a lot in some cases.   So let’s look at a few more current, 2015 (still very current today) examples.

We Decided to Fly To Florida

Kind of spur of the moment my wife and I decided that since we were already in the USA we ought to hop down to Orlando and see one of our favorite sisters/sisters-in-law.

Not having the opportunity to book weeks or month in advance, I just went and looked and decided to just go for a two-person, round trip deal on US Air/American for about $670USD.

Not too bad, I suppose for flying 2/3 of the way across the country and back.

But for comparison purposes, I priced a similar “length of the country” round trip for two in the Philippines.

About $178 all-in for the same sort of distance.

US domestic air travel?  3.76 times more expensive than Philippine domestic air.

Getting to the Airport  I Found a Nice Deal (or so I thought)

Our flight left Denver a bit early in the morning and my son was working that day, so I decided to rent a car the evening before the trip and turn it in at the airport to catch our flight.

No extra charge for airport drop off.

Estimated cost, with some discounts and promos, $44 USD.

Couldn’t beat that so I got a lift to the Budget rental office at the local Sears store.  Nice car.

Got up at 4 am, got us to the airport in time and after turning it in, noticed that my $44 USD fee had only escalated to $165 USD.

Huh?  How did a $44 charge turn into $165?  3.75 times as much as the estimate?

Oh well, 20 minutes ‘til the flight boards, no time to argue.

Mainly, airport fees and special taxes on rental cars coming or going from the airport.  Wow.

Sure sounds like robbing the tourist to me, the same complaint I often hear from foreigners visiting the Philippines.

(Oh, and just to add insult to injury, 2 weeks later my credit card was charged $22 in tolls.  For about 10 miles of expressway leading to the airport.)

If we had been in the Philippines I would have hired a local car service guy to take us for, at most P2500 (or about $47 USD).

US price to get us to the airport on time?  About 3 times more expensive than the Philippines (plus I had to do the driving at 0400 … yawn instead of snoozing in the back seat).

Having a Nice Time At the Sister’s

That is I was having a good time until I discovered I had stupidly forgotten to pack part of the stock of my blood pressure pills I had purchased back in the Philippines.  Duh.

I had a prescription but it was from my Philippine cardiologist (about $10.00 USD full price for an office visit).

I went to Walgreens.  Nothing doing, no foreign issued prescriptions.  BUT … service with a smile.

“No problem sir, we have a health clinic right here in the store.  Just see our smiling Nurse Practitioner and I am sure she can help you.”

So after a short wait and not too many forms to fill up (fill out in the USA), I did see the nurse.

She asked me a few questions (mainly about what living in the Philippines was all about), she diligently copied my Philippine doctor’s prescription onto a US form, signed it (electronically) and presented me my bill.  $89 USD.

Hmm, don’t even know if this is a fair comparison, seeing a board certified cardiologists office visit in the Philippines versus a Nurse Practitioner in Florida?

You be the judge, the US cost was 6.8 times the Philippine cost.  Talk about picking the pocket of a visitor.  Wow!

Cost of Living PhilippinesSo How Much Did the Medicine Cost?

Well, unfortunately, I can’t yet tell you.  You see after I took my “slightly” overpriced  American copy of my Philippine prescription over to the prescription drop off window I received the answer we foreigners so often complain about in the Philippines … “Sorry sir, out of stock”.

Yep at a name brand drug store in a major US city metro area, for a very common maintenance drug which hundreds of thousands of people take regularly … out of stock.

The pharmacist’s solution was, come back tomorrow after two pm, I’ve located some I’ll have it here then.  Hard to believe.  But again, I’m a stranger in a strange land here.  I want to be back in the Philippines sooo bad right about now.

The drug store was miles from where I was staying, so that meant I had to borrow a car or smooze a ride from someone else yet again for a totally unnecessary second trip to the drug store if the huge name-brand drug store had bothered to keep common medications in stock

Or, I could have called a cab and paid $40 or$50, counting with time while I got my ‘srcip’ filled.

Update

OK, an update. I went back to the store the next day a bit after 1430 (2:30 pm for you non-military types).

After a significant search amongst literally thousands of prescription envelopes, (everyone in the USA seems to pop soo many pills) (there are more ads for medications for everything from heart disease to hangnails on the TV in Florida) the pharmacist serving me (not the same one as the guy the day before), finally found my prescription.  Phew.  Sigh of relief.

Then came the cash price… $112.70.  Roughly FIVE TIMES the exact same product costs me in the Philippines.  exact same drug … made by the same large German drug company (There are very few drugs made in the USA these days).  Exact same strength, trade name, etc. … but five times the price I pay in the Philippines.

As I said to my patient and long-suffering wife, “I sure paid a “dumb-ass” tax on this deal … forgetting to pack my meds.

Are “They’ Out To Get You In The Philippines?  Well “They” Are In The USA As Well

So many people operating on scuttlebutt and barroom rumors will tell you there is always someone out to get you in the Philippines.  Well from what have seen there’s at least as many “out to get you” in the good old USA.  Thanks for lightening my wallet so helpfully, Walgreens.

And I guess you could also say, based on what I paid in the USA in September 2015,  is it cheaper to live in the Philippines?  Yes by a very wide margin.

Another very interesting comparison I came across the other day at Wal*Mart, the place for bargains in the USA (I miss having Wall*Marts in the Philippines).

My Wife and I had been discussing visiting my eye doctor in the Philippines as soon as we get back home.  My doctor is a board-certified ophthalmologist and a practicing eye surgeon (he did my cataract lens replacement a few years back, for about 1/5th the price US doctors wanted), and the results have been great.

The doctor charges P550 for an eye exam or P600 if he needs to dilate the eyes during the examination.  That’s about $10.30 or $11.30 USD).  Now, remember, I’m talking about the full price for these exams, not a co-pay with the insurance company kicking in many more dollars.

Well, back to Wal*Mart.  There was a huge display poster in the entryway about some specials being offered by Wal*Mart’s “captive” eye doctor.  “Get your eye exam right now for only $65.00 or for contact lens exams, only $105.00.  YGBSM (Google it if you don’t know what it means).  $65 bucks just for an exam?  It was hard for me to believe, seriously.

More Comparisons

Some more interesting figures here, Expatistan, cost of living  and here Numbeo: Cost of Living

If you think you’re “paying through your (long) nose” in the Philippines, just wait until they get your hands on you in the USA.  (and I kind of hesitate to throw this in, since none of us should be smoking, but at my corner store in Marilao, Bulacan, a “ream” (carton)(200 ciggies or sticks) of Winston costs $8.91 USD

It’s at LEAST 5 or 6 times that price in the USA, isn’t it?

One Last Comparison That Interested Me.

Philippine Cost Of LivingIn the Philippines, the majority of people I know or have visited use Propane for cooking.  It’s a pretty universal fuel, and it is normally a part of almost every person’s budget from the ultra-rich to the very poor.

Right outside the drug store was a propane exchange stand.  A couple of cabinets, one for empties and one for full “20 pounder” propane tanks, exactly the same tanks as we use in the Philippines.

Of course here in American by far the largest number of customers come in to exchange an empty BBQ tank for a full one, especially if they are heading for a football game and planning to tailgate.

Taking a close look at the prices kind of made me catch my breath.

To get started with a full tank, if you don’t I already have one to exchange, you pay $55 USD.  Wow.  Then every time you need a refill you have to haul yourself and your tank to the store, fork over just under $20 USD and then haul you and your (now heavy) tank home.

In the Philippines no one I know of except a gas dealer owns a propane tank.  Why on earth would I want to own a propane tank?

To get started with gas service when you first move in, you call or text a local dealer and perhaps you pay a refundable deposit of perhaps $6 or $8 USD … although I never have.

The dealer brings a full tank with him, typically on the back of his motorcycle, hooks it up to the stove, makes sure it lights and that your flame is burning properly, charges you about P460 (about $9.60 USD), straps the empty on the back of his bike and heads off to the next customer.

Forgetting the idea of buying a tank (which I don’t know how to compare, really, what would I want to own a propane tank for, anyway)?

It looks like the cost for the most common cooking fuel is about 40% cheaper in the Philippines.  Or one could say the US price is about 1.66 times the Philippine price … for one of the more basic commodities of life.

Any more questions about the Cost Of Living Philippines?

Now here’s sort of a summation of why I am making the decision (at least for now) NOT to move back to the USA.

  1.  My wife and I already own our home, free and clear in the Philippines.  We built it, essentially from scratch and paid for everything over five years of “living cheap”.  If I moved back to the USA I would just be another “whale” to be gutted bt the hordes of high-pressure real estate salesmen, mortgage brokers, insurance salesmen, and on and on.  Starting from scratch would be hard.
  2. I’d have to buy a car (enter again all the high-pressure hordes).  You can’t live in most places in the USA without a car.  In the Philippines, we do own a car, bought and paid for long ago, but we could easily do without a car at any time.  It’s a luxury, not a near-necessity.
  3. I’m old (and getting older, I hope).  You know you’ve made jokes about senior drivers (I sure have).  Although I am still enjoying driving and I don’t think I piss off too many younger drivers, the day will come when I can’t drive safely anymore, and how on earth can I get by then.  I don’t want to end my life as a joke.
  4. In the Philippines, I don’t need a car.  I also have people available with merely a text to do carpenter work, fix a leaky pipe, replace tile, install a ceiling fan, all the things you have to pay huge charges for in the USA.  A few dollars a day is more than enough for a tradesman in the Philippines.
  5. I think that even with paying as I go for medical care and accepting the not always certain reimbursements from my TRICARE insurance, I’m money ahead by staying in the Philippines.  One thing for sure, I won’t be just another Medicare cash cow or big insurance, who is actually running the USA these days.

Those are my thoughts.  Let’s hear yours on the relative cost of living between the USA and the Philippines.

Still Keeping Me Rudely Awake 2018.