Health Insurance Gamble, USA

If you’re moving back to the States following an overseas teaching gig, or just planning a short visit, think health insurance! Without it, a freak accident or sudden illness could leave you burdened with a debt that makes a student loan from Yale University look like a bargain. On the other hand, the sky-high premiums insurance companies charge those of us returning from extended periods overseas could tempt you to risk going uninsured. It’s a gamble.

With no recent State-side medical records to help insurers assess current health status, International Educators are a statistical risk. A teacher who not long ago returned to the States on a permanent basis tells ISR she pays a stiff monthly premium, with all health conditions exempted from coverage for 2 years, except accidental injury which carries a deductible of $4000 along with a 30/70 split until her 30% of any bills reaches 5k out-of-pocket. Do the math…

Exasperating the situation is the practice of charging those individuals seeking coverage a higher premium than someone who is part of a collective of individuals applying as a group. Interestingly, when insurance companies raise your premium each year they base the increase on total claims in your area, not your personal claims. You’re part of a group only when it’s convenient for them.

Consider the following: The CEO of Humana makes $16M a year. Anthem’s CEO takes home a cool $15M. I make $45K. The best policy I could find upon my return to the States was $950 a month (just over 20% of my income) with a $5200 deductible. I’m not willing to go uninsured, putting my house and financial future in jeopardy. This feels like extortion, not a safety net in case of illness or accident.

To cut to the chase: An International Educator returning to the USA pays high health insurance premiums simply due to circumstances and insurance company greed, not health status.

ISR asks: What’s the solution? Forego health insurance, putting your financial future at risk? Head to a country with reasonably priced health care if it’s just for a couple of months while you’re between schools? What about a family of 4 returning home who are living on savings while job hunting? Any advice or experiences to Share?

Comments? Something to Add?
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16 thoughts on “Health Insurance Gamble, USA

  1. Why do people have to be so brutal in their comments and tone? This is a forum to help people find affordable care and to share experiences.


  2. I returned to the US and was able to get a great policy at a very reasonable price through

    Your monthly premiums are based on your income. When you do your taxes for the year you had a policy through, you have to reconcile what you paid with what you earned. If you earned more than you stated on your application, you have to pay the difference in premiums at the time you file your taxes. Investment income counts in the amount that gets figured into your income for the year.

    If you end up making more than 4 times the federal poverty level for your state, you will have to pay back all of the premium support you received from the government. It means you need to be realistic with your budgeting and what you report on your application. If you start earning more money than expected, you can add that information to your account, and your premiums will be adjusted (that is, increased) accordingly, which is better than one large bill at tax time.

    One catch is that if you start the year at low income, and then land a good-paying job with health benefits mid-year. You may earn enough to have pay back all of your premium support for the time before you started your higher-paying job.

    Be aware that policies and premiums vary by state. Some states have better plans than others. You can go to to preview plans and policies for your state before you decide to purchase a plan. (Some states operate outside of, and have their own website and exchange.)

    If for some reason you land a job that pays more than four times the state poverty level and it doesn’t come with any health insurance, which seems unlikely, then you’re on your own.

    Liked by 1 person

    1. What you say is correct. The article/post would have made a lot more sense before Obamacare. Now, insurance coverage isn’t allowed to exempt preexisting conditions, so even if someone pays a lot for their health insurance their situation still wouldn’t be as bad as the article claims.


  3. I returned to the States after 8 years abroad. Not only was health insurance a total rip off, but car insurance as well. As for health insurance, I first attempted to extend my school supplied health insurance under a Cobra plan. The cost was $1,400 a month. They are out of their minds. Next I tried applying for a new policy. The prices were ridiculous and beyond my means.

    Between what doctors and hospitals charge and the insurance companies wedged in between with their hands in your pocket, I agree it’s not much more than extortion. After a few months back in the States I went to see an ENT with a pussy looking bump on one of my tonsils. The guy wanted to operate. “We’ll remove that tonsil.” A month later in Mexico I visited an ENT to get a second opinion. He numbed the tonsil in his office and removed what he called an infection using a scrapple and a suction device. Problem solved for $75 US.

    Since then I have moved to Mexico. America has become a country run and owned by large corporations whose only goal is to extract as much money from it’s citizens as possible, giving back as little as possible. What you get for your money in America isn’t worth it anymore. Unfortunately, so many Americans have allowed themselves to become brain washed into thinking America is the best country in the world. I suppose it is if you’re the CEO of Amazon.


    1. This is frightening. I returned to the US in 2008 after 12 years abroad. I was able to get insurance for me and my child for about $350 a month with a typical co-pay and deductible for then.I thought that was too high. Within a month or two, I was insured by my school in the US. The premiums were a good bit less, but the coverage was almost the same. I’m back abroad now and considering returning after next year. But it sounds like I can’t afford to go home.

      I’m currently not covered in the US, so when I travel home, I usually get temporary insurance designed for expats returning home. I’ve never had to use it, but it is relatively reasonable. It has been a few years since I’ve purchased it because I’ve been trapped abroad due to the pandemic, but if I remember correctly, it was called Patriot. Hopefully, I could use that until I got a job and qualified for insurance with my employer.


  4. If we are making the argument that international educators should qualify for the NHS in the UK or the Canadian system or even a proposed UHC by a prior poster, the only solution is to amend the tax code of every country so that international educators are taxed accordingly. No more tax free income from teaching abroad. Otherwise, you are an entitled free loader who does not pay income taxes to your respective home country but expects to benefit from the “free healthcare” system upon return.

    Sorry, one of the risks you run of teaching abroad and not paying income taxes is being welcomed home with a high premium. If you want to dismiss this issue, get a job at Home Depot or Star Bucks or bag groceries so that you get the group plan as written in the article. All choices have costs and unfortunately, retirement and healthcare burdens are those that international educators face upon returning home.


    1. It would seem that you’ve totally miussed the gist of this article Mr. or Ms.DeCarlo. The US is the only country whose ex-pat teachers have returned to that doesn’t have a Universal Health care program. Also, those who cannot contribute to paying the taxes for universal health care in most other countries are still covered, because it is a collective social propgram paid for by everyone who can. We make a conscious choice to cover everyone, even those who cannot pay. The issue is not that ex-pats come back and expect “free” coverage but rather that they seek an affordable program they can access.
      The only solution is not just amending the tax code of every country but rather to extend the overseas coverage at an affordable rate to ex-pats returning home, until they can find an affordable package there.


    2. Dear Omgarsenal,

      You are kind of a comment troll on this site I’ve noticed. Actually, you are coming from a point of pure economic privilege. You are willing to work abroad and not pay into a system. International teachers CAN pay into the system, I never said that a person living within a country should be denied health coverage. I said that if you are working abroad and are tax exempt, you should not qualify for social benefits that are in place for the most vulnerable. International teacher who were working the outside the country should NOT be entitled to a program they chose to not pay into.
      You my friend, are advocating to market failures leading to the very increasing premiums you hate. These programs need to be available to BIPOC who have never had the opportunity to advance, not affluent individuals who have the means to work abroad for decades, hoard wealth, and then troll comment boards. I saw the abhorrent replies you made on the “Check your Privilege” thread to a black educator. Your kind of hate and intolerance has no place here.


    3. It’s already that way – very few countries (about 19) are tax free for international educators. All European countries tax you not only on what you earn as a teacher there but also on your “worldwide income” which means you’d pay tax in Switzerland on interest you earn in Australia, for example. So yes, you should be able to access NHS. A few countries (like Singapore) do NOT tax you on worldwide income – only on what you earn in Singapore. A source for this is:


    4. Omar, the UK has a system where anyone resident is entitled to treatment. That means people of any colour, religion, creed and ethnicity, despite economic status and despite what they did when not resident. This is a brilliant thing, not least because it doesn’t discriminate between the newly arrived refugee and the millionaire businessman. Everyone is treated equally. Please therefore stop with your divisive and unwelcome language of privilege and your race baiting call to make the NHS available to ‘BIPOC’ (what a silly acronym) rather than the white people to whom you have taken offence. Your kind of hate and intolerance has no place here.


  5. Its long past the time for a national healthcare program like the rest of the world usually enjoys. However the same avaricious, monopoly that controls healthcare in the US is dead set against a universal healthcare solution and have actively promoted and sponsored the meme that its “socialized” medicine. It isn’t but as part of their anti-UHC, they promote every falsehood and fakery they can cling to and manage to convince the poor, gullible Americans that it isn’t “good” for them.


    1. From my understanding we are not exempt from a similar situation. When Canadians live outside of their province for a certain period of time they no longer qualify for their provincial health care plans. There are some unique situations where expats can continue to pay into these provincial plans like British Columbia. However, if you emigrate back to a province like Ontario you will need to find your own private health insurance until you have resided in the province for over 90 days. With covid running rampant in Canada I am sure insurance companies will be raising their rates on returning expats.

      Liked by 1 person

    2. we have been teaching for 14 years abroad and just returned back to the US a little over a year ago.

      It took us a few months but we were able to get a good medical policy from from the state of Mississippi. Our premiums are $290 a month.

      We actually called and talked to them and told them $290 a month was reasonable, $1400 a month was not reasonable and they said OK. Our insurance is through Melina healthcare.

      Liked by 1 person

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