Another permutation of medical tourism

In Retiring Abroad May Not Be Paradise the Wall Street Journal explains that moving permanently from the US is not as easy or as inexpensive as it seems. The reasons include difficulties with banking, real estate ownership, and being charged higher prices than locals. Health care is another concern: while Americans abroad are eligible for Social Security benefits, Medicare won't pay for services outside the US. As a result, retirees often hop on a plane to return to the US for medical care or receive care under a local system.US insurers are beginning to catch on. Cigna has a plan that allows US companies to offer insurance to retirees who move abroad. Just 200 people are enrolled up but Cigna expects significant growth.I expect we'll see more seniors leave the US for retirement in lower cost countries with inexpensive labor. If the US continues to toughen restrictions on immigrants it won't be long before shortages of home care workers and nurses begin to bite. If we won't let caregivers come to the US, Americans will need to go where the caregivers are. Some Americans will leave the US once they begin to require nursing care or assisted living services. Other retirees living abroad will age into such situations.Perhaps the trend toward retirement abroad can be used to shore up Medicare's finances. One solution would be to let Medicare pay for care outside the US. That way Americans wouldn't return home for expensive treatments but could stay in-country instead, saving Medicare money. If such a policy also encouraged more people to retire abroad that would be ok with me. A less radical step that would be simpler to administer and could achieve the same effect would be to maintain the prohibition on overseas Medicare coverage but give retirees a stepped up Social Security payment if they forego Medicare.