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Those who can obtain legal resident status in the United States, then complete a comprehensive cross-border financial planning analysis and execute it with professional help, may have the best of both worlds: access to both the Canadian and US medical systems at a low cost, and income tax assessed in the United States at substantially lower rates. Chapters 7, 8, and 13 should be read closely before one decides to implement this setup, which allows you to "have your cake and eat it too." The plans and procedures needed to make this work are very complex and difficult to maintain, and should not be attempted without professional help from an experienced cross-border financial planning professional.

Many Canadian residents have worked in the US for extended periods and paid into the US Social Security system, and these people (as well as US citizens in Canada) can get full access to US Medicare at age 65, even though they don't live in the US. Having US Medicare not only gives these people full access to the US medical system at low or no cost, but, if they like to winter in the US Sunbelt, US Medicare can also provide very good travel insurance coverage that is not limited to emergency treatment like most other travel policies. As long as these people continue to follow their provincial medicare rules, they will maintain Canadian coverage while being on US Medicare. Therefore, these people will have the best of both worlds. (The exception is that unless they are from Ontario or Newfoundland, as discussed above, they will likely still be paying Canadian taxes on their world income as Canadian residents for tax purposes.)


Contrary to what you might have been led to believe by some Canadian media, you will not be left to die in the streets because you do not have large buckets of cash with you when you arrive in the emergency room of a US hospital. It is the law in every state that you cannot be turned away from an emergency medical facility because of your ability, or lack thereof, to pay for your emergency treatment.

If you are using a travel insurance company with an emergency assistance line, your first call should be to them as soon as possible after entering the hospital.

If you are unable to make the call, instruct someone else to do it for you. Usually the hospital will have trained personnel to deal directly with the insurance company for you, since they have a vested interest in getting paid. The travel insurance company can be invaluable in providing you with reassurance, finding medical specialists, or just getting you home in the shortest possible time.

If you do not have travel insurance, contact your provincial medicare office during business hours at the first possible moment. It won't be quite as easy as contacting a private insurance provider with a 24-hour hotline, but you should receive some valuable assistance nonetheless.

Be careful not to overdo it with medical treatment that can be deferred until you return to Canada, unless you have purchased one of the year-round, full-coverage policies discussed earlier in this chapter. Out-of-province travel medical insurance will not cover elective procedures, so you could be doing it at your own expense. Once again, if you are not sure what is or isn't covered, call the emergency assistance line and confirm the treatments that will be covered.

If your condition has been stabilized and your doctors agree that you are well enough to travel, your insurance company and/or the provincial medicare services will make the necessary arrangements to have you flown back to Canada for follow-up treatment. The insurance company will normally make arrangements for loved ones and your automobile to return to Canada.

Generally, you are exempt from any adverse consequences from the IRS or United States Immigration if your stay in the United States has to be extended beyond normal limits for medical reasons.

Border Guide readers are encouraged to participate in cross-border Q&A through the new The Border Guide Forum, which is a blog where you can easily post questions about the contents of this book, which will be answered by a cross-border financial planning professional in a timely fashion. You can also post comments or create discussions with other Border Guide readers to share experiences and swap cross-border financial planning tips. To post a question or comment, go to www.TheBorderGuide.com and click on the title Border Guide Forum.

Reprinted with the permission of Self-Counsel Press.

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