I'm sure this thought has crossed all of our minds at some point or the other -- how do we take care of our aging parents while staying in the US (or any other country but I'll focus on US since that's where I live).
Specifically, there are issues related to immigration and insurance. Most folks on visa or GC and can only bring parents on a visa restricting them to 6 months at a time. How do you bring them here for a longer period of time especially when your parents are getting to a stage where they can't travel that often.
The second, and perhaps more important issue, is how do you take care of their health w/o medicare and health insurance. We all know the pitfalls and shortcomings of visitor insurance. In any case, it is called visitor insurance for a reason. What about more permanent solutions even if we put aside cost issues for a moment?
I'm posting this question here because taking care of parents seems to rank pretty high among the reasons for R2Iing.
Taking care of aging parents in US
Taking care of aging parents in US
The prognosis appears to be grim on this subject but I would like those with actual experience having parents living in US to comment. Even if one has the option to sponsor aged parents on GC (i.e. he/she is a naturalized USC), there are other important issues to consider:
1. Cost of Insurance. A reasonable medical insurance plan (with even high deductibles) can cost $1000-1500 per month per elderly person (65+) Even "catastrophy" insurance has premiums of say, $500/month or so for elderly folks and these have very high out-of-pocket costs ($5K per year if not more). I would argue that this is not enough for elderly people who may need frequent medical attention. Generally, catastrophy insurance is a cost-saver only for young people in the prime of their health.
2. SS/Medicare/Medicaid ineligible. I believe family-sponsored GCs are ineligible for Medicare/medicaid for a period of 5 years from the date of GC. Considering the time to get GC (say, 1-2 years), this means for a period of 6-7 years, elderly parents have to be supported on private insurance. Even after medicare kicks in, the costs are still sizeable (although less expensive than private). With no SS payments coming in (unlike those who worked in U.S. for at least 10 years to get SS vesting), the premium costs for an elderly couple will be very high (say $1500-2000/mo. for two).
3. Long term insurance. Having not signed up for it when young (as many US citizens are urged to do), cost of long term insurance is too high. The premiums can run $10-30K/year someone told me once. Nursing home costs start at $70,000/year per person for basic assisted living support. Even if the elderly are supported at home, the ongoing stress it puts on a family even with in-home nursing care ($30K/year for a part-time nurse to visit every day) is too high. Since US homes have multi-income couples, the idea of a stay-at-home spouse to take care of the elderly person full time is also fraught with difficulties - many will refuse to do it.
4. Lifestyle adjustment. Even if we ignore all the costs, this is another big issue. Consider that in our 30s and 40s, if many of us are contemplating R2I to avoid being an "alien" in U.S., one can only imagine what an immigrating 65+ year old person will feel about leaving his/her entire life and memories behind in India. Despite all the temple visits and senior networks you can plug an elderly person into, the fact remains that the differences between U.S. and India are simply too many and it is difficult to adapt at that age group. Also, many elderly folks feel they are a "burden" to their sons/daugthers in U.S. more so than in India as their mobility is better in India. Heck, if an active professional with a young family can feel lonely at times in U.S., what will a retired 65+ year old person with nothing in common with U.S. feel like? Familiarity and cultural context contributes much to their self-confidence in India. By taking them away from their "home" at this age, the odds of them developing health problems (i.e. issues raised in points 1-3) are much higher. Cold weather is another factor to consider if you live in the Northeast U.S. Elderly people are less tolerant of cold.
This is why, among several reasons for R2I (see another thread where this is polled), R2Iing for family reasons (such as taking care of parents) ranks #1.
1. Cost of Insurance. A reasonable medical insurance plan (with even high deductibles) can cost $1000-1500 per month per elderly person (65+) Even "catastrophy" insurance has premiums of say, $500/month or so for elderly folks and these have very high out-of-pocket costs ($5K per year if not more). I would argue that this is not enough for elderly people who may need frequent medical attention. Generally, catastrophy insurance is a cost-saver only for young people in the prime of their health.
2. SS/Medicare/Medicaid ineligible. I believe family-sponsored GCs are ineligible for Medicare/medicaid for a period of 5 years from the date of GC. Considering the time to get GC (say, 1-2 years), this means for a period of 6-7 years, elderly parents have to be supported on private insurance. Even after medicare kicks in, the costs are still sizeable (although less expensive than private). With no SS payments coming in (unlike those who worked in U.S. for at least 10 years to get SS vesting), the premium costs for an elderly couple will be very high (say $1500-2000/mo. for two).
3. Long term insurance. Having not signed up for it when young (as many US citizens are urged to do), cost of long term insurance is too high. The premiums can run $10-30K/year someone told me once. Nursing home costs start at $70,000/year per person for basic assisted living support. Even if the elderly are supported at home, the ongoing stress it puts on a family even with in-home nursing care ($30K/year for a part-time nurse to visit every day) is too high. Since US homes have multi-income couples, the idea of a stay-at-home spouse to take care of the elderly person full time is also fraught with difficulties - many will refuse to do it.
4. Lifestyle adjustment. Even if we ignore all the costs, this is another big issue. Consider that in our 30s and 40s, if many of us are contemplating R2I to avoid being an "alien" in U.S., one can only imagine what an immigrating 65+ year old person will feel about leaving his/her entire life and memories behind in India. Despite all the temple visits and senior networks you can plug an elderly person into, the fact remains that the differences between U.S. and India are simply too many and it is difficult to adapt at that age group. Also, many elderly folks feel they are a "burden" to their sons/daugthers in U.S. more so than in India as their mobility is better in India. Heck, if an active professional with a young family can feel lonely at times in U.S., what will a retired 65+ year old person with nothing in common with U.S. feel like? Familiarity and cultural context contributes much to their self-confidence in India. By taking them away from their "home" at this age, the odds of them developing health problems (i.e. issues raised in points 1-3) are much higher. Cold weather is another factor to consider if you live in the Northeast U.S. Elderly people are less tolerant of cold.
This is why, among several reasons for R2I (see another thread where this is polled), R2Iing for family reasons (such as taking care of parents) ranks #1.
Taking care of aging parents in US
I would look at first applying for USC for them, if you can do that then they would be eligible for Medicare (assuming they are 65+), IF you run the options in the following website, you can check for eligibilty, but it require you have lived continuously in the US for 5 years, befiore eligibilty
http://www.medicare.gov/MedicareEligibility/home.asp?version=default&browser=Firefox%7C2%7CWinXP&language=English
http://www.medicare.gov/MedicareEligibility/home.asp?version=default&browser=Firefox%7C2%7CWinXP&language=English
Taking care of aging parents in US
vijay;69326I would look at first applying for USC for them, if you can do that then they would be eligible for Medicare (assuming they are 65+),[/quote]
Just because they are eligible for Medicare does not mean their health costs will be zero or next to zero. I did some reading up about Medicare and what I found is even if you are a USC or GC holder with 5 years stay in the US, there is a cost of about $400+ per month if you don't have 30 quarters of contribution to medicare part A. I think the cost of Part D is around $90 a month.
http://en.wikipedia.org/wiki/Medicare_(United_States)
Also "After a beneficiary meets the yearly deductible of $131.00 (in 2007), they will be required to pay a co-insurance of 20% of the Medicare-approved amount for all services covered by Part B."
Roughly I'd estimate a cost of $1000 per month for each parent to take care of medical expenses assuming they have not worked in the US to earn the required credits. If they do earn the required credits (I did this to estimate how much I would need to retire in the US), it would cost roughly $600 per month. With health costs far outweighing inflation, may be even $1-2K by the time we are ready to retire. :emsad: :emdgust:
I have seen some parents work at Walmart and such part time to pay for health insurance benefits. If parents are willing and able, that is cool, if not it is pretty expensive.
Taking care of aging parents in US
Thanks everyone for the great information!
For parents who have never worked (and are not likely to work) in US, Medicare is automatically out regardless of the immigration status because of the following requirement (taken from http://en.wikipedia.org/wiki/Medicare_%28United_States%29 Thanks Mel for the link):
In general, individuals are eligible for Medicare if they (or their spouse) worked for at least 10 years in Medicare-covered employment and are at least 65 years old and are a citizen or permanent resident of the United States of America.
I also did some digging on what it would cost for private insurance. I researched Kaiser and Blue Shields. Blue Shields even refused to give me a quote as soon as I entered that the individual is 65+. They wanted to redirect me to a "medicare supplemental program" which is obviously non-applicable in my case.
Kaiser's website was a little more kind and actually gave me a few choces even for a 65+ individual. The monthly premium ranged from ~$900 - ~$1000. But they had several other conditions, such as copays ranging from $25-$50, copays for hospital stay ranging from $100-$500 per day. Yes that was per day. So, KRV was right on.
What still confuses me somewhat is how these copays relate to annual out of pocket maximums. E.g. here's the link to the $50 copay plan which costs $871 pm in premium (I hope the link still works): http://ckp.kp.org/locations/california/individuals/personaladv/plan_50copay.html
This link shows copays for hospital stay as $500 pd and an annual out of pocket max of $3500. Does this mean that hospital stays beyond the 8th day are at no cost?
Does anyone know if the premiums paid for (dependent) parents' health insurance are tax deductible.
BTW, I completely agree with the last point made by KRV -- whether parents would be able to adjust in a foreign land to which they have so little connection for an extended period of time. In general people like to go back to the land they grew up in to spend their last years, not oceans away from it.
So, all of this may turn out to be just an academic exercise after all.
For parents who have never worked (and are not likely to work) in US, Medicare is automatically out regardless of the immigration status because of the following requirement (taken from http://en.wikipedia.org/wiki/Medicare_%28United_States%29 Thanks Mel for the link):
In general, individuals are eligible for Medicare if they (or their spouse) worked for at least 10 years in Medicare-covered employment and are at least 65 years old and are a citizen or permanent resident of the United States of America.
I also did some digging on what it would cost for private insurance. I researched Kaiser and Blue Shields. Blue Shields even refused to give me a quote as soon as I entered that the individual is 65+. They wanted to redirect me to a "medicare supplemental program" which is obviously non-applicable in my case.
Kaiser's website was a little more kind and actually gave me a few choces even for a 65+ individual. The monthly premium ranged from ~$900 - ~$1000. But they had several other conditions, such as copays ranging from $25-$50, copays for hospital stay ranging from $100-$500 per day. Yes that was per day. So, KRV was right on.
What still confuses me somewhat is how these copays relate to annual out of pocket maximums. E.g. here's the link to the $50 copay plan which costs $871 pm in premium (I hope the link still works): http://ckp.kp.org/locations/california/individuals/personaladv/plan_50copay.html
This link shows copays for hospital stay as $500 pd and an annual out of pocket max of $3500. Does this mean that hospital stays beyond the 8th day are at no cost?
Does anyone know if the premiums paid for (dependent) parents' health insurance are tax deductible.
BTW, I completely agree with the last point made by KRV -- whether parents would be able to adjust in a foreign land to which they have so little connection for an extended period of time. In general people like to go back to the land they grew up in to spend their last years, not oceans away from it.
So, all of this may turn out to be just an academic exercise after all.
Taking care of aging parents in US
neon_lite;69271I'm sure this thought has crossed all of our minds at some point or the other -- how do we take care of our aging parents while staying in the US (or any other country but I'll focus on US since that's where I live).
Specifically, there are issues related to immigration and insurance. Most folks on visa or GC and can only bring parents on a visa restricting them to 6 months at a time. How do you bring them here for a longer period of time especially when your parents are getting to a stage where they can't travel that often.
The second, and perhaps more important issue, is how do you take care of their health w/o medicare and health insurance. We all know the pitfalls and shortcomings of visitor insurance. In any case, it is called visitor insurance for a reason. What about more permanent solutions even if we put aside cost issues for a moment?
I'm posting this question here because taking care of parents seems to rank pretty high among the reasons for R2Iing.[/quote]
My parents are in the same boat. Getting harder to travel, getting older.
I got my parents health insurance in India, in the process learnt that i waited too long to get the insurance for my dad - there is an age limit ( i think its' 65) after which getting any kind of health insurance is a night mare. Most parents like mine would push back saying why pay so much premium when u get nothing out of it -- but really this is a practical thing to do (you have to love insurance for that - NOT )
Just like spouses have issues with R2I plans (there was a pretty active thread on this) with my parents one of them wanted to get green card the other wanted to stay in india. So neither of them is getting it now :(
For now, my short term solution is to R2I for a few years. Some of my friends who had R2I'ed for their parents ended up deciding to move back to the US -- this is even harder according to them. Your parents only get older after a few years and it's much harder decision to come back.
IMO, we should think not only from our POV, but more importantly theirs and what would make them happy -- not just what would appease our emotional need of the hour.
It's said that people are more happy a little distance away than very close. Imagine a life where the daily struggles with the whole extended family is far worse for the parents than just living in peace and solitude in India. What would one do then?
Taking care of aging parents in US
MeraNaseebR2I;69514Put yourself in a 65+ or a 70+ person's shoes and imagine life after 50 years!!
Would you want to die in a remote place or be close to your family ...i.e., your kids. Because that is what you will be left with.
Either your kids move to be with you or close to you OR you move closer to your kids.
Same equation works now as well as 50 years from today.
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In several cases in this forum, your parents might have been working in a city far away from where your grand parents lived. In how many cases, did your parents have the facility and time to be close to their parents when death came knocking?
I know someone whose grand parents died in India when their parents were visiting US. Well they lived all their life in India and could not see their parents or be near their parents during death.
It's harsh reality of life. Can't be answered with a simple answer like R2I or R2A.
I understand your point but I have to disagree. Having lived thus far in India without their grown children being there, the parents already have a decent support system they could count on. Sure, it is not the same as their own son/daughter being there but at least it gives parents a sense of independence (till they physically become incapacitated).
Sure, nobody can prevent death. But what R2I does is help in the case of prolonged illness preceding death where it DOES make a difference to the parents (and to the son/daughter as well) to be with each other. From this perspective, compared to leaving one's parents alone in India, bringing them over to U.S. is a more responsible choice. However, the main point here is that the child R2Iing (instead of parents immigrating) is an even better choice as far as parents are concerned as they not only get to be near or with them but they also spend their last days in an environment they are most comfortable with.
Taking care of aging parents in US
MNR2I,
There is an eligibility criteria for California Medicare as well. If not you will see a ton of Desis (of course not you since you love the NE, just pulling your legs) move there for free medical coverage for their parents.
The eligibility requirements are similar to Medicare's.
http://www.calmedicare.org/eligibility/eligibility.html
"People age 65 and older who are citizens or legal residents of the United States and who have worked (or their spouse has worked) for at least 10 years (or 40 quarters) in Medicare-covered employment."
"If you are 65 or older and you do not qualify for Medicare under the categories above, you may still be able to enroll. If you are a U.S. citizen or a legal resident who has been in the United States for five years, you may enroll in Medicare as a "voluntary enrollee." You will have to pay monthly premiums that do not apply to people who qualify under the categories listed above."
If you are talking about Medicaid (medical coverage for the poor), first of all the coverage with Medicaid is pathetic. Secondly you still have to live in the US for 5 years after getting your GC .
http://www.cms.hhs.gov/MedicaidGenInfo/
If I am wrong please let me know.
There is an eligibility criteria for California Medicare as well. If not you will see a ton of Desis (of course not you since you love the NE, just pulling your legs) move there for free medical coverage for their parents.
The eligibility requirements are similar to Medicare's.
http://www.calmedicare.org/eligibility/eligibility.html
"People age 65 and older who are citizens or legal residents of the United States and who have worked (or their spouse has worked) for at least 10 years (or 40 quarters) in Medicare-covered employment."
"If you are 65 or older and you do not qualify for Medicare under the categories above, you may still be able to enroll. If you are a U.S. citizen or a legal resident who has been in the United States for five years, you may enroll in Medicare as a "voluntary enrollee." You will have to pay monthly premiums that do not apply to people who qualify under the categories listed above."
If you are talking about Medicaid (medical coverage for the poor), first of all the coverage with Medicaid is pathetic. Secondly you still have to live in the US for 5 years after getting your GC .
http://www.cms.hhs.gov/MedicaidGenInfo/
If I am wrong please let me know.
Taking care of aging parents in US
MeraNaseebR2I;69561Check here
http://www.dhcs.ca.gov/services/medi-cal/Pages/MediCalBenFAQs.aspx
Mass. has a similar program.
Some of you will have problems and issues with this as well. Oh Well ! can't keep everyone happy I guess.
--
And yes - several desis use this. There are Desi doctors who recommend using this program.
And yes - there is a reason why I live in Mass. as opposed to a country called Ohio.[/quote]
I have gone through the application in the link you sent, there are eligibility requirements like I mentioned earlier - "you have to live in the US for 5 years with a GC to be eligible OR be a USC". If you can satisfy that, then good by all means take advantage of whatever system you want. But first you pay approx 5 years of health costs till you get your USC (or choose GC + 5 years stay) in order to be eligible for Medicare or Medicaid (btw all states have some form of Medicaid not just CA and MA).
Very touch about living in Mass. :emteeth: .. take it easy dude. I didn't mean to ruffle any feathers.
Taking care of aging parents in US
If what MNR2I says in Post #13 is true, then most of the aspiring elderly GC applicants would want to live in CA. Federal Medicare plugged the FOB-elderly loophole in the 90s by requiring a 5-year stay post GC issuance to qualify. If post #13 is true, CA has not done so. This is surprising and a part of me feels there must be some catch here. It should be easy to check by calling any of CA's county health offices (some have a dedicated Medi-cal helpline). Not living in CA, I am disinclined to put the effort.