Tag: Cost of health care in Italy

Ankle Broken in Alghero

by midgeguerrera, posted in Practical Matters - Living Abroad

An amusing tale of pain, angst, laughter and the emergency medical system in a tourist town –

Love the school. Could I win the lottery and stay here?

Pintadera is the fabulous Italian Language school in Alghero, Sardegna. Pintadera and I have a love-hate relationship. I love Alghero. I love Nicola – my first Italian friend and the ace administrator. I love the teachers.  I love organizing groups of American students for the school.  I hate studying. Maybe that is why after studying Italian for a pazillion years, I still sound – well – not very Italian.

Sometimes our subconscious gives us what we want – just not the way we would want it. Just as I was thinking, do I have to go back to class, pop went my ankle and I fell on my ass. Actually, I was dashing around the historic center of Alghero solving some of my groups housing issues when I fell off of a step. DUUCK! I screamed! A waiter came running. A darling gas delivery man came running. Nicola came running. I looked at all of them and simply said, my ankle is broken. One, two three – heft – the beached whale was now balancing on one fin.

Everyone sprang into action. Cars are’t allowed into Alghero’s old town.  Nicola raced to bring hers a bit closer. The darling delivery man tossed me like a canister of gas into his L’api three wheeled mini delivery truck and whisked me along with the other canisters to where Nicola was parked. With lots of help, I hopped into the car and off we went to an orthopedic emergency room.  I had never heard of an emergency room just for broken body parts – though Jack who skied said there were lots of those near the mountains.

Nicola procured a wheel chair, I crawled into it and she wheeled me into the waiting room.  There was a sign on the door to the medical team that said “ring when you arrive.”  Nicola pressed the buzzer.  A nurse came out and Nicola pointed to me, told her I was part of the Italian Healthcare System and that I had probably broken an ankle.  The nurse nodded and closed the door.  Nicola went back to work.  I plopped the wheelchair near the door and turned to the people waiting.   Like I would in the doctor’s waiting room in Pontelandolfo, I asked Chi è l’ultimo?  The person who came in before me raised a broken arm.  I settled in the wheelchair and waited.  And waited.  And waited.  The nurse would come out and yell a name.  That person would drag a broken body part to the door.  Ambulances with tourists speaking a variety of languages and writhing on stretchers went straight into magic door.  After two hours of folks seeming to get called randomly, I asked the nurse if there was a list.  She said, si. Anybody guess where this story is going?  What did I not ask the nurse?

Three plus hours later Nicola comes back with my husband, Jack.  You haven’t been seen yet!  She rang the bell and berated the nurse who then asked for my tessera sanitaria – health insurance card and went back in.  OK – I should know better.  What did I not ask the nurse an hour or so earlier?  Am I on the list?????  Duh!

They whisked me in to see a doctor who looked at my ankle and ordered an X-Ray.  Jack wheeled me to X-Ray.  There was a paper over on the pillow but not the whole table and as I climbed up to be scanned I wondered how many pairs of dirty shoes had preceded me.  Next stop a second doctor and a nurse.  They looked at the scan and said the ankle was broken.  Did I want a plaster cast or a boot?  The boot of course.  They explained that the system paid for plaster but not a boot.  I said I’d pay for it and could they put it on.  Nope they couldn’t put it on because they only do plaster casts.  I asked if I could get copy of the X-Ray.  Jack whisked me back to X-Ray and I was told I had to pay €7 for a CD.  Not a problem.  Off we went to the counter to pay – which was closed until the following morning.  Again, I didn’t ask the right questions.

God Bless Nicola who was my Florence Nightingale and drove us to a medical supply house.  The owner was putting up an “out for coffee” sign when she saw Nicola and asked if she wanted to join her.  Nicola pointed at me and explained we needed a boot.  The store was up a giant curb and then 5 steps.  Italy isn’t the most handicap accessible place to visit.  The owner brought out a wheelchair.  I squeezed into it and Jack pushed me around the block to a second door that was quasi ramped.  Boot on and bought.  Now I needed a wheelchair.  There was no way in hell that I could manage crutches on uneven cobblestoned streets.  The store would take a week to get one in, but the Sisters of Misericordia loaned hospital equipment to people.  Next stop Misericordia!  Problem – American sized butt and Italian sized wheel chairs.  Again, I squeezed into one and Jack and Nicola were able to wheel me back to our rented house in the historic part of town.  The cobble stones are rocks of a variety of shapes – not smooth pavers.  That meant Jack was probably herniating himself pushing me up to our house.  DUUUCK – the very step I fell off of guarded the entrance to the house’s courtyard.  Somehow without me tipping over onto my head they managed to hoist me and the chair up to the terrace.

I now became a prisoner in the house.  Not able to get out of the place without lots of help and certainly not able to wheel myself on the streets.

Guess I won’t  be dashing over to Central Mediterraneo Pintadera for those  Italian Language classes.  Be careful what you wish for or even think!

Ci vediamo!

Retire to Pontelandolfo!

by midgeguerrera, posted in Practical Matters - Living Abroad

Join the likes of George Clooney, Jonny Depp, Madonna, Sting, and Francis Ford Coppola.  Live the Italian life you’ve thought was impossible. Wait!  Is it possible?  Seriously, can a normal person afford to retire or own a home in Italy?

MIdge Jack Ponte

Jack and I are always being asked How did you do it? How can you afford to live in Italy?  My first response is to remind folks that we do not live in a tourist packed, guidebook referenced city.  We live in a village in the Sannio mountains.  There are lots of small villages like ours, throughout Southern Italy.  Village populations have plummeted.  The lack of jobs has sent the young folks north or to other European cities.  Earlier emigration, during the 20thcentury to the United States, South America and Australia has resulted in lots of empty housing stock.

There are relatively large apartments here that are listed at €40,000.  By large I mean two or three bedrooms, living room, dining room and kitchen.  Yes, of course there are bathrooms too with bidets even. Today, the exchange rate would put that home at $44,458.  Average rents range from €250 to €300.  We pay more than that but not a hell of a lot more for a three-bedroom, three-bathroom, two-kitchen house on a working farm.  We were lucky, when we first rented, it was fully furnished.  Over the years we have personalized our home with our own furniture and art.

Buying a house or renting here in Italy normally means you are getting an empty house, unless someone died and the heirs are selling with all the stuff.   That means no kitchen cabinets, no appliances, bubkas, niente, nothing.  That said, the folks who are leaving a rental unit have paid for a kitchen that probably won’t fit in their new place and might be willing to sell it to the new tenants.  I have seen homes for sale that are being sold full.  Jack cried when I said NO to a house in CentroStoricothat was for sale for a song, had great views and was full of antiques – including art. I love where we live and at this point in my life didn’t want to pack up and move.

Our furniture comes from the ever-popular IKEA!  The price point is almost equal to the USA prices.  More important – they deliver!  Of course, I am delighted that Jack so throughly enjoys putting it all together.  I also found two amazing resale shops in Benevento.  For my Seven Events for Seven Decades festa in May I needed lots of tea pots, teacups and serving pieces.  That is when I discovered the resale shops. Great stuff – housewares, furniture, clothes etc. at Salvation Army store prices.

When we decided to look outside of the United States for quasi retirement options, we sold our house, our cars, our clothes, our housewares, just about everything.  The art I didn’t sell and my favorite kitchen toys have been coming here in our checked luggage.  Jack and I still go back to New Jersey annually for 5 or six months.

According to a February 21, 2019 article in the money section of USNews:

The average Social Security benefit was $1,461 per month in January 2019. The maximum possible Social Security benefit for someone who retires at full retirement age is $2,861 in 2019. However, a worker would need to earn the maximum taxable amount, currently $132,900 for 2019, over a 35-year career to get this Social Security payment.

https://money.usnews.com/money/retirement/social-security/articles/2018-08-20/how-much-you-will-get-from-social-security

Let us arbitrarily and capriciously use $1600 per month as our starting number. Today, that would be worth €1439.55. I am math deficient but will give a monthly budget based on what we pay a whirl. Let’s pretend you bought a €40,000 home.  REMEMBER ALL OF THESE NUMBERS ARE GUESTIMATES AND NOT TO BE TAKEN AS HARD COLD FACTS! Also remember that I am math challenged.

Monthly Fixed Costs

Taxes  €280 a year for our place but I couldn’t get the tax formula.  Some people pay as much as €800 €23.23
Electric This is what we pay for a super huge house.  Bills are for 2 months. We average €63. €31.50
Cell Phone Vodofone cell service – unlimited everything.  I use the data for a hot spot everywhere. €20.00
WiFi   €20.00
Garbage €93 all year €7.75
Car Insurance We have the large Fiat 500 XL and pay €1000 a year. €83.33
Gas –  propane or natural In the winter we heat with propane.  We also use it for hot water. I’m not sure how to figure this out.  Last December we spent €1,000. This summer for most of the summer €400.  Many people heat with pellet or wood-based systems. €400.00
Car Gas Cars are well designed and can be bought that run on gas, metano (natural gas), gpl (propane) and electricity.  We have diesel and fill up once every few weeks unless we are taking road trip.  You buy it by the liter. 65.00
Water 24 Every two months 12.00
Sewer We have septic. 0
MONTHLY FIXED COSTS 662.81

I have never done this before!  Thanks for the budget Midge!  Did I just thank myself?? We average €662 a month for fixed costs.  Actually €10 more – I forgot Jack’s cheap cell phone plan.

Medical care for folks in their second act is really important.  Jack and I are super lucky that I was able to become an Italian citizen and he, as my husband, was too.  That means we have access to the incredible socialized healthcare system here.  I am going to base my thoughts now on your not being of Italian heritage and able to live here and access the system.

Before Jack became a citizen, he was able to purchase in our local Farmaciaall of the medications prescribed in the United States.  That includes meds for diabetes, cholesterol, blood pressure and heart issues.  Every month we saved a bundle.  His purchase price RETAIL was less than or equal to his Medicare part D copay.

We both use a great dental team here – private and not in the system.  Because of dead root issues with the anchor stubs, Jack just replaced a bridge here.  The old bridge with preparation of the anchors cost approximately $8,000.   With two root canals the new bridge cost €1900.

We had an interesting dental experience the first year we were here and subsequently learned from it.  I made an appointment for us to have our teeth cleaned.  The dentist looked in our mouths and said why are you here? You have no plaque or other gross stuff. Your gums look great.  Well, we replied our NJ dental office says you should go every six months and the dental hygienist calls to remind us.    I now go once a year for a check up and a cleaning.  The dentist – not a dental hygienist- does the cleaning and takes what ever time it needs.  I just had it done for €85.  The full panoramic X-ray cost €30.  The dentist doesn’t have the machine. We go down the street to a Diagnostic center.  I am guessing that keeps costs down.

Private doctor visits range from €50 to €150 depending on who you see and for what. Last year I paid a cardiologist €150 for an exam.  He, himself, did an echocardiogram and Doppler for carotid artery stuff.  He also gave me script for blood work.  I returned with the blood results and there was no fee for the second visit.  Since I liked the idea of knowing a cardiologist here, I made an appointment for Jack.  The doctor didn’t charge us for that either.

The town arranges for the Croce Rossaand doctors to bring medi-vans to town for things like free sonograms of your thyroid.  I mention this one because I availed myself of the service and they discovered a few nodes on my thyroid.  I went to my PCP here and got script for a full blood work up that included thyroid tests.  The blood test at a private lab cost €60. (Have you looked at what LabCorp charges medicare?). Then I went to see a fancy endocrinologist who not only looked at the blood work but gave me the same kind of exam an internist would do.  Cost €100.

If you had to go the hospital, I have no idea what they would charge. This is a country with socialized medicine and there isn’t any mechanism for collecting.  This May a friend of mine was visiting from the USA and thought he was having a heart attack.  The rescue squad came – complete with a medical doctor and nurse on board – examined him, gave him an elettro-cardiogram and then took him to the hospital.  The ambulance cost nothing and the hospital didn’t charge. That said, we asked and discovered that if you are from the United States, which does not have health care reciprocity with Italy, you are supposed to buy private insurance. Jack bought it the first year we were here and it cost us about $1000 for a year.  He never used it.

Let’s Eat Out! Why should I cook when we can go to a fabulous restaurant and have great food with good wine and leave with a bill for often less than €40?  At a local tavola caldawe can get lunch for about €10 each.  Why make a cappuccino at home when you can sit in a bar, stare at the piazza, chat with pals and pay barely anything.  Here are some local bar prices.

Croissant          €1

Cappuccino       €.90

Caffè                €.80

Aperal Spritz     €2.50

Tap Beer           €1.20

Tap Wine          €1.50

Cocktails           €3.oo to €5.00

Amaro              1.50

Fast Food – usually only available at night or during one of the many festas

Pork or beef grilled on a hard roll           €3.00

Porcheta on a hard roll                          €3.50

Sausage on a hard roll                           €2.50

I can’t remember the prices of everything – I need to eat out even more. The local bars have specials often.  For example, €5 dinner included a glass of wine, steamed mussels, bruschetta and a fried fish. Every weekend you can get a gyro for €3.50.  The take-away pizza place has whole pizza from €3 to €6.

Our favorite and really exceptional seafood restaurant has fish entrees that range from €8 to €12 -of course  –  fresh not frozen.

Buying Clothes for us is hard here.  We are both too big!  Jack wears a USA men’s XL and I wear a size 18.  I get my dresses made by the seamstress.  The cost of labor is so low that I am embarrassed to tell you what I spend. Jack orders clothes from Lands End UK. If you are thin, you can buy clothes at the market and spend peanuts.

Pets are a dog or three running loose outside or cats.  Most domestic animals are outside, fending for themselves and get fed what the family eats.  I don’t know what pet food costs.  The local shop for farms has all kinds of stuff for cows, pigs, sheep and maybe dogs. It is loose and you buy it by the kilo. Recently we noticed a few families with a dog on a leash.

Yikes, information overload!

Have I convinced you to come?  Let me know what else you would need to know. 

Ci vediamo!