Overseas retirement – what you don’t know

Retirement in a foreign country is the dream of many.

It is expensive to live in Singapore. We have high inflation, high housing cost and high cost of living. In contrast, our nearby countries can offer the same quality or even better retirement life at a fraction of Singapore’s costs.

As more of my friends are approaching the age of retirement, discussions come up on an ideal place for retirement. What about your set of criteria? Affordable with low cost of living? Comfortable living and great food? Nice weather and fresh air? Or professional healthcare and caregiving?

Life after retirement – health span versus lifespan

Although Singapore has one of the world’s highest average lifespan of 84 years, our average health span is only 74 years. This means an average Singaporean lives about ten years in bad health.

In other words, there are two stages of our life after retirement: 1) When we are still healthy and active and 2) when we are sick and require caregiving.

In the first stage, it is up to individuals to choose their lifestyle. And we are free to relocate to any country to enjoy our retirement life. But as we proceed to the last ten years or so, we may have no choice but to seek options for caregiving. The caregiver can be a family member, a domestic helper, or staff in a nursey home.

Obviously, our priorities can be very different in these two stages. When we are planning for our retirement, very often we only focus on health span. Seldom will we think of stage two. It sounds too far away and is unpredictable.

Retirement in a more affordable country

We often heard of Singaporeans or Malaysians working in Singapore talking about retiring in Malaysia, especially Johor Bahru.

Likewise, back in the 1980s and 1990s, it was a popular idea in Hong Kong to spend golden years in more affordable Guangdong. After all, many Hong Kong people came from the province when they were young.

Thirty years ago, a town in Dongguan known as Zhangmutou (樟木头) was advertised by developers as a retirement heaven. At its peak, there were 150,000 Hong Kong people living in an area with a new name called “Little Hong Kong”.

At one time, prices of Zhangmutou condominiums soared to between RMB30,000 and RMB40,000 per sqm. But after the property market collapsed, prices dropped to RMB10,000 to RMB20,000 per sqm. Many shops in the mixed development projects were empty.

Recently, I watched a documentary about Hong Kong elderly in Guangdong. It makes me rethink about overseas retirement.

After his retirement, a man has been living in Zhangmutou for 17 years. When he first came, there were many retirees staying in Zhangmutou. Now many are very old and have returned to Hong Kong.

Some retired couples become widows or widowers. They stay alone after losing their spouse. In his neighborhood, there are already a few cases of elderly dying alone at home. Only when the neighbors smelt something bad did they realize the old person has passed on.

He is 77 years old and can still go for medical appointments by himself. He enjoys staying here. But he doesn’t know when he cannot take care of himself and need to relocate back to Hong Kong.

After he moves back, where is he going to stay? Can he afford the higher housing cost and living expenses?

Viability of nursery homes in a foreign country

Malaysia has retirement villages that cater to the needs of foreigners. From the photos on their website, they look no different from luxury resorts. They provide elderly-friendly facilities, fun activities for the aged and world-class healthcare.

Similarly, China also offers high-end elderly-care options. With an aging population, Hong Kong is running short of places in nursery homes. A decade ago, the government started subsidizing old folks to stay in fifteen nursery homes in ten cities across the Guangdong-Hong Kong-Macau Greater Bay Area (粤港澳大湾区).

Every weekend, the elderly board coaches to travel to the Greater Bay Area, not for quick getaway or property hunting, but for site visits in elderly homes. Besides the usual condominium facilities, these high-end retirement villages provide all sorts of recreation activities and classes, including snooker, mahjong, bakery and calligraphy.

Visitors study the sitemap and floorplans to pick their preferred room type. If they are interested, they can stay behind for a two-day staycation before committing a long stay. If they want to go home, there is also an option to leave the place after six months.

There are subsidies from the government. Nonetheless, after the scheme started ten years ago, only 392 elderly are staying in Greater Bay Area nursery homes.

Healthcare is the major concern. Elderly healthcare may be affordable for the locals, but not for foreigners. In China, healthcare for foreigners is expensive without insurance.

Although the elderly can use Hong Kong healthcare vouchers to pay for outpatient services in six cities, some medical procedures may not be able to use healthcare vouchers. Some complain they cannot open the mobile app to show their medical records in order to buy medicine (China does not have google).

The biggest fear of elderly staying overseas

How can old folks have peace of mind living overseas till end of life?

When we are young, the common illnesses may be flu or infections. Even if we have chronic diseases, we can have them under control with medication. Unfortunately, as we age, the chances of having serious and critical illnesses are higher. The respective costs of medication, treatment and surgery are high, especially in overseas private hospitals.

For elderly living abroad, if they go to hospital emergency or need to stay in the ICU for an unknown number of days, the high accumulated medical bill is a concern. In comparison, if they live in their original country, public healthcare is highly subsidized by the government. The elderly and their families most likely can afford the bill.

Many elderly travels back to Hong Kong from Guangdong province regularly for their medical appointment. But what if it is an emergency?

Hong Kong hospitals do provide cross-border ambulance service. However, very often the condition of the patient is not stable enough to cross the border. Obviously, if the patient is fit enough to cross the border, he or she doesn’t need to call an ambulance in the first place.

As a result, it becomes very inconvenient for the children and friends to visit and take care of the patient in an overseas hospital. It is worse to think of the troubles involved in arranging for any undesirable outcome.

Can we use CPF MediSave overseas?

Since 2012 or 2013, Singaporeans have been talking about buying homes in Johor Bahru for investment and later for their retirement.

What the Hong Kong elderly are now experiencing retiring in China, we can expect similar situations years down the road when Singaporeans retire in Malaysia or other countries.

By the way, if there is heavy traffic jam in, say, Johor Bahru, Kuala Lumpur or Bangkok, can we reach the hospital in time to save our life?

No one can predict when accidents, sickness or death will happen to us. When we are still under employment, our company will make necessary arrangement if anything happens to us during overseas business trips. After retirement, we are on our own once we are outside Singapore. Insurance coverage for elderly foreigners is not cheap.

In Singapore, citizens and PRs can use their own MediSave or MediSave of immediate family members (spouse, children, parents, siblings and grandchildren) to pay for “elective” treatments at overseas hospitals.

However, it is not so straightforward. Patients have to meet many requirements in order to claim MediSave:

1) Patients need the referral from a MediSave-accredited healthcare provider. First of all, they need to contact HMI (Health Management International) to check for affiliated hospitals in the country they wish to receive treatment.

2) MediSave cannot be used for overseas outpatient treatment. Requests to use MediSave for overseas emergency treatment will be considered on a case-by-case basis.

3) Only medically necessary procedures or surgeries with 3 to 8 hours of hospitalization overseas are eligible for MediSave claims. There is also a limit of maximum three surgical procedures (not more than two anatomical systems and not more than two procedures within each system).

Food for thought

My husband is a registered doctor in Singapore. I asked him whether his patients will opt for treatment in nearby countries like Malaysia after their diagnosis.

He said this is rare. Those who do so are usually foreigners with no CPF account. Locals with less means know their medical costs are highly subsidized in Singapore. Most importantly, they can claim MediSave or MediShield for their medical bills. For patients who are well-off, they can afford private healthcare anyway.

When it comes to healthcare matters, most people choose a healthcare system with professionals they trust. They won’t risk their life in another country that might have language or cultural barriers.

Above all, if anything goes wrong, Singaporeans know how to take it to the Ministry of Health. But this is not so simple in other countries, especially when we are foreigners.

“It is sad but true: If you have money, you can go anywhere for your retirement. If you don’t have money, you will be poor wherever you go. To play safe, stay where you are.”

– “So you plan to retire cheap?”, PropertySoul.com

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