Health Insurance Under the Affordable Care Act

In the post, the user outlines the three-tier approach they use for healthcare while living overseas. The three tiers are:

1. Using local healthcare for out-of-pocket costs
2. Travel insurance as a transition safety net
3. US insurance for anything catastrophic

The user also mentions that they pay for subsidized US insurance under the Affordable Care Act (ACA). This raises an important question: how does the ACA impact Americans living overseas?

ACA Coverage for Expatriates

The ACA generally requires most Americans to have health insurance, but there are exceptions for those living overseas. According to the Centers for Medicare & Medicaid Services (CMS), you may qualify for an exemption from the ACA coverage requirement if you:

Are living outside the United States for more than 330 full days in a row.
Are a citizen of another country and are not a U.S. resident.
Are not eligible for Medicare.
Are not receiving any health insurance coverage from an employer or government program.

If you meet these criteria, you may be able to avoid paying the penalty for not having health insurance. However, it’s important to note that you will not be eligible for any subsidies or cost-sharing reductions if you do not have ACA coverage.

ACA Coverage While Traveling

If you are living overseas but plan to return to the United States for a temporary period, you may be able to maintain your ACA coverage. However, you will need to pay the full premium amount, as subsidies are not available for those living outside the country.

It’s important to note that the rules and regulations surrounding ACA coverage for expatriates can be complex. If you are an American living overseas and have questions about your health insurance options, it’s recommended that you consult with an experienced insurance professional or contact the CMS directly.

Additional Resources

[CMS: Health Insurance for Americans Living Outside the United States](https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Health-Insurance-for-Americans-Living-Outside-the-United-States.pdf)
[Healthcare.gov: Health Coverage for People Living Abroad](https://www.healthcare.gov/coverage-outside-us/)