PART IV Canadian retire in US - Medical Costs - International non-resident cross border expert income tax & immigration help

K wrote
David like most people who have moved from Canada to the US - I find the health care costs amazing. $400 a month for myself and my son. No coverage for the first 6 months of pre-existing (fairly minor) conditions. Copays for EVERYTHING - doctors, prescriptions, lab tests. First $4000 of anything outside of a doctor's office is MY cost per year - so until I've reached 4K I pay for all tests, x-rays etc.

Not to mention that in many places you can't find a specialist as they have quit due to the extensive litigation in the US. For the THIRD time in less than a year I have to find another doctor as each of them have closed their practices.
As to not waiting in the ER come to California. Read about the waits in the ER here. Read about people calling 911 FROM an ER in Los Angeles.
 --------------------------------- AND
F wrote

My dad living in Toronto could not visit me in Wisconsin for the last 5 years of his 90 years of life, OHIP only covered him for something like $50 per day outside Canada, and he could not get private insurance to cover pre-existing conditions which was of course exactly where he was likely to need medical care.
If someone can actually get into the USA as a resident, then the states usually have an assigned coverage requirement where insurance companies are required to cover people who cannot otherwise get private coverage and do not qualify for medicare, on a rotational basis.  Wisconsin does anyway.  It's fairly expensive, but it is somewhat limited.
david ingram replies:

The original question involved taking a Canadian father to the US to live with a green Card holder.  I replied that it was not likely and too expensive, etc.  A client wrote back with his suggestion that it was okay with him and I published his reply out of fairness to my audience.  OOPS!

I have some 125 negative comment replies like the two above and I will bet that only 40% of the 13,000 people that get this will have read it yet.

I promise, this is the last email on this part of the subject but if you have a pro or con comment to make, I would like it for my own research. I just do not intend to publish any more at this time.

I am also sending it to my US list for the first time so that they can see what has happened on the US Canada and Canada lists.

The original sequence (in reverse) follows:

H wrote
The current responder fails to include several caveats: 1. The premium does not cover all costs. There are deductibles and copays that can total up to $2000 per year "out of pocket" expenses. 2. The premium rates could escalate substantially year over year depending on the plan actuarial losses 3. Many individuals may have difficulty obtaining health insurance at all depending on preexisting conditions or they may be subject to substantial surcharges depending on the nature of the condition. In other words it is not as simple as it looks as some people would lead you to believe. However, for those that can afford it, the accessibility to care and technology is probably better down here and when someone needs urgent admission to hospital they don't have to lie around the E.R. for 2 days. ------------------------------------------

david ingram replies:

Thank you for the insite because i know you are "there", living in the US. The writer below was making it look easy but the other letters I have received all seem to agree tih me or at least want to warn the previous writer.

When buying private US medical, pre-existing conditions are usually not covered or are rated so high that the insurance cost IS prohibitive.  Using myself as an example, a previous congestive heart failure diagnosis would likely mean that i would not be accepted for insurance.   

I have just hung up from talking to a medical doctor (from Winnipeg) who moved to Virginia.  Their meidcal insurance for a three person family is $1,800 per month with significant co-pays. and a cap of $1,000,000

Beware if you are going to move an older parent to the US to live with you.


XXX wrote:
David, I don't quite understand why you often say -- as you do below -- that "medical costs [in the U.S.] make it impossible."  We just happen to be considering bringing my 87 year old mother down from Canada to live in an expanded portion of our home in Bellingham.  She would sell her home in B.C. and part of the proceeds would go to covering the cost of the self contained suite we would build on to our house.  Maybe I am missing something in the warning you are giving everyone, but I have to tell you that even the very best medical plan Group Health, for example, offers is far from "impossible" at $564.00 a month for a non-smoker 65 and older, not eligible for Medicare.  Compared to B.C., yes, that's expensive.  But so what if she lives with us and her CPP and OAP go to cover it!

I will be 62 this week and continue to commute each day to my workplace in Surrey, B.C.  I readily admit that if I had to pay such a premium, it would be difficult -- particularly were I younger with many more years to go before I had Medicare at 65.  I currently pay about $100.00 a month for a great medical plan from Group Health.  Of course, it is through my wife on her plan at work.  I also have a dental plan in the same way.  It is just as good as the one I had through a former employer when I lived in B.C.

As someone whose taxes you prepare for me each year, you will recall that I am a Canadian citizen who emigrated here on a fiance[e] visa in 2004 ro marry my American citizen wife.  I am pleased to tell you now that on August 15th of this year I was sworn in as a U.S. citizen!  So now, of course, I am one of those fortunates who have dual citizenship.

On Oct 3, 2007, at 12:08 AM, US / Canada Income Tax Help - CEN-TAPEDE wrote:
david ingram replies:

I have to admit that you make a new point.  Of course, TODAY, at the moment I write this, the Canadian Dollar is actually MORE than the US dollar.  Youir Canadian salary has gone up over 40% in US spending since you moved to the US.  However, if we were talking about taking mom to the US when you moved down in 2003 and the US dollar was 1.401, that $564 would be about $790 Caandian and a year earlier, it would have been $885.00 

We had hundreds of people (remember i am only one person) returning to Canada because they  could not afford it anymore from 98 to 2004.

It has slowed down dramatically and maybe a rethink is in order.

In fact, I have one (only one) daugher looking for a home for her mother in Bellingham because it would be cheaper than what she is paying In Canada.  This is the reverse with a mother who was brought up to live with daughter in Canada when the US dollar was large and Canadian expenses were really cheaper in relation.

Thanks for the insight.



Both My wife and I am green card holder and currently working in US. We would like to ask my Father (Canadian Citizen) to come to live with us. He is above 65, would he be able to qualify for any Medicare plan? would private Health care be an option?

david ingram replies:

Since I am now 65, that does not seem that old any more but I have to tell you that you are asking for the impossible.  The medical costs will make it impossible even if you could do it.  You can take out US citizenship and sponsor your father but I doubt if it would work out for you financially.

If you have a real problem, get your US citizenship so that you can come and go for long periods (if necesasary) from Canada without any problems. (i.e. if necessary, you opr your wife can come to Canda for a year or two without a problemm if a US/Canada dual citizen).

Another partial solution is to move to some place like Bellingham (means changing jobs) and have dad live in White Rock officially and visit you a lot in the US.  Even then, over 80, even medical trip insurance will become prohibitive.

Niagara Falls New York and Niagara Falls Canada work as well but the winters are less friendly.

Sorry I do not have a better answer.  Every week, I have someone moving back to Caanda because of the US medical system which is just not as good for the average person as the Canadian system.


It is very unlikely that blind or unexpected email to me will be answered.  I receive anywhere from 100 to 700  unsolicited emails a day and usually answer anywhere from 2 to 20 if they are not from existing clients.  Existing clients are advised to put their 'name and PAYING CUSTOMER' in the subject and get answered first.  I also refuse to be a slave to email and do not look at it every day and have never ever looked at it when i am out of town.  expert  US Canada Canadian American  Mexican Income Tax help
However, I regularly search for the words"PAYING CUSTOMER" and always answer them first if they did not get spammed out. As an example, as I write this on Sept 2, 2007 (the day before I turn 65), since June 16th (78 days), my 'spammed out' box has 24,417 unread messages, my deleted box has 8063 I have actually looked at and deleted and I answerd 576 email questions for clients and strangers.  I have also put aside 472 messages that I am maybe going to try and answer because they look interesting. - expert  US Canada Canadian American  Mexican Income Tax help
Therefore, if an email is not answered in 24 to 36 hours, it is lost in space.  You can try and resend it but if important, you will have to phone to make an appointment.  Gillian Bryan generally accepts appointment requests for me between 10:30 AM and 4:00 PM Monday to Friday VANCOUVER (Seattle, Portland, Los Angeles) time at (604) 980-0321. expert  US Canada Canadian American  Mexican Income Tax help.
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Disclaimer:  This question has been answered without detailed information or consultation and is to be regarded only as general comment.   Nothing in this message is or should be construed as advice in any particular circumstances. No contract exists between the reader and the author and any and all non-contractual duties are expressly denied. All readers should obtain formal advice from a competent and appropriately qualified legal practitioner or tax specialist for expert help, assistance, preparation, or consultation  in connection with personal or business affairs such as at . If you forward this message, this disclaimer must be included." expert  US Canada Canadian American  Mexican Income Tax help.
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This is not intended to be definitive but in general I am quoting $800 to $2,800 for a dual country tax return.
$800 would be one T4 slip one W2 slip one or two interest slips and you lived in one country only - no self employment or rentals or capital gains - you did not move into or out of the country in this year.
$1,000 would be the same with one rental
$1,200 would be the same with one business no rental
$1,200 would be the minimum with a move in or out of the country. These are complicated because of the back and forth foreign tax credits. - The IRS says a foreign tax credit takes 1 hour and 53 minutes.
$1,500 would be the minimum with a rental or two in the country you do not live in or a rental and a business and foreign tax credits  no move in or out

$1,600 would be for two people with income from two countries

$2,800 would be all of the above and you moved in and out of the country.
This is just a guideline for US / Canadian returns
We will still prepare Canadian only (lives in Canada, no US connection period) with two or three slips and no capital gains, etc. for $150.00 up.
With a Rental for $350
A Business for $350 - Rental and business likely $450
And an American only (lives in the US with no Canadian income or filing period) with about the same things in the same range with a little bit more if there is a state return.
Moving in or out of the country or part year earnings in the US will ALWAYS be $800 and up.
TDF 90-22.1 forms are $50 for the first and $25.00 each after that when part of a tax return.
8891 forms are generally $50.00 to $100.00 each.
18 RRSPs would be $900.00 - (maybe amalgamate a couple)
Capital gains *sales)  are likely $50.00 for the first and $20.00 each after that.
Just a guideline not etched in stone.  
This from "ask an income trusts tax and immigration expert" from or or . David Ingram deals on a daily basis with expatriate tax returns with multi jurisdictional cross and trans border expatriate problems  for the United States, Canada, Mexico, Great Britain, United Kingdom, Kuwait, Dubai, Saudi Arabia, Thailand, Indonesia, Japan, China, New Zealand, France, Germany, Spain, Italy, Russia, Georgia, Brazil, Peru, Ecuador, Bolivia, Scotland, Ireland, Hawaii, Florida, Montana, Morocco, Israel, Iraq, Iran, India, Pakistan, Afghanistan, Mali, Bangkok, Greenland, Iceland, Cuba, Bahamas, Bermuda, Barbados, St Vincent, Grenada,, Virgin Islands, US, UK, GB, and any of the 43 states with state tax returns, etc. Rockwall, Dallas, San Antonio Houston, Denmark, Finland, Sweden Norway Bulgaria Croatia Income Tax and Immigration Tips, Income Tax  Immigration Wizard Antarctica Rwanda Guru  Consultant Specialist Section 216(4) 216(1) NR6 NR-6 NR 6 Non-Resident Real Estate tax specialist expert preparer expatriate anti money laundering money seasoning FINTRAC E677 E667 105 106 TDF-90 Reporting $10,000 cross border transactions Grand Cayman Aruba Zimbabwe South Africa Namibia help USA US Income Tax Convention. expert  US Canada Canadian American  Mexican Income Tax help.
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