Comparing Cost of Living in USA and Nicaragua: It will surprise you!


“Everything costs something.”
Zara Hairston

When we lived in Nicaragua, we occasionally referred to ourselves as economic refugees. We took early retirement and lived off our small teaching pensions. We did everything financial experts advised to prepare for living abroad such as, becoming debt free, having an emergency medical fund, purchasing international health insurance plans, saving money for unexpected emergencies like trips back to the states to help our families, and living within our budget.

Thank goodness we didn’t burn any bridges. We rented our house in the states and kept our stateside bank account and address, which was important in keeping our U.S. credit card.  We were legal residents of Nicaragua and Tennessee and had the best of both worlds.

When the Nicaraguan crisis and Ron’s lumps in his neck made us reconsider moving back to the states, we were concerned about the cost of living after spending more than 10 years abroad with cheap, cheap living and all the comforts of home.

What we learned surprised us!

Most retired expats in Nicaragua will tell you that their main reason for moving abroad was affordability. They said they had a hard time living on a fixed income in their home countries.

But, what they don’t tell you is that everything costs something! It is cheap because there is no quality control, the education system does not prepare employees to be productive and skilled laborers, the infrastructure such as roads, utilities, and internet are pitifully unreliable (and many times unsafe), and most materials and foods imported come with a hefty price tag. In other words, you get what you pay for…and it isn’t much!

So, I made a comparison of the cost of living in Nicaragua and the USA for the month of February. I used eight general categories and color coded them the same in each pie graph.

The monthly cost of living in our home in TN is $1,626.20. The largest slice was miscellaneous, which included paying off our credit card in full each month. We rarely use cash here and pay for almost everything with our credit card. I missed that so much in Nicaragua, because I can always accumulate enough reward points to pay for several airline tickets.

Surprisingly, several items are cheaper in the states, like gasoline for transportation. It is $1.80 per gallon with my grocery store discount card. The package deal for fast internet ( I mean really, really fast…100 mbps) and cable TV is $101.24 a month. I paid much more in Nicaragua for the internet, not including the maintenance of a very tall microwave tower that was always breaking. And…AND…the speed, if we were lucky, was 8 mbps, when the system was working. The internet blinked on and off daily many, many times.

We have a heat pump and several small portable electric room heaters for the winter months. February is usually the most expensive electric bill according to our past usage. In the summer, we have whole house air conditioning and our electricity averages $75. Most of the time we don’t use the air conditioning. We prefer opening the windows and every room has ceiling fans and window fans.

We own our house in TN and are mortgage free. Rents are reasonable in our small town, averaging $871 per month for a 1 bedroom house or apartment. For a single person a monthly cost of living on average is $1,600.

 

In Nicaragua, our monthly expenditures were  $1,341.00 Our cell phones were cheaper… we had two cell phones and only one with unlimited data from  Claro. The data transmitted was only 3g and service was spotty depending on where we were in Nicaragua. In the states, I have 4g and unlimited data with free calls and text in the U.S., Canada, and Mexico with AT&T prepay.

Transportation was more expensive in Nicaragua for two reasons. Gasoline is very expensive and taxis are expensive. Usually, we took a monthly trip to Managua with our taxi driver, Francisco. The cost round trip was $60 and we tipped him $10 and bought him lunch.

Although we had an abundance of fruits on our property, we enjoyed some imported foods like peanut butter, dill pickles, chocolate, and wine, which increased our monthly food expenditures.

Nicaragua is a cash society. We seldom used a credit card. Our miscellaneous fees included propane for cooking, house repairs, and workers.

We still support our goddaughter and my children’s library and librarian, so that has not changed.

 

Overall, the difference in monthly costs is about $300. When the weather warms, our electric will go way down and make up much of the difference. We can reduce our monthly internet/cable TV service by cutting the cable cord. The only reason we have cable TV is so Ron could watch his sports throughout the long winter cancer treatments. We can stream everything we want to watch, so the cable will be cut soon.

Our annual expenses are comparable in some areas, and more expensive in others.

Comparable:

1. International health insurance in Nicaragua and Medicare with Medicare supplemental insurance in the U.S.

2. VPN service for our internet remains the same.

3. Amazon Prime yearly bill is the same, but living in the states we have used it so much more for free shipping and streaming movies.

More expensive:

1. Property taxes $650 yearly in the states vs $60 in Nicaragua.

2. Car insurance is much more in the states. We bought and paid cash for a car when we returned…and we have to have car insurance. In Nicaragua, we had our dune buggy and our motorcycle insured for $75 a year. However, there is no telling what the insurance would have covered if we had an accident in Nicaragua.

In making comparisons, the best decisions we made were to pay off our mortgage in the states and buy our house in Nicaragua. Our house is rented in Nicaragua now. The worst case scenario would be that our house in Nicaragua would be confiscated by the government. If that would happen, because of our wise financial decisions, we would not suffer, nor would our retirement  funds be affected. We are not in any hurry to sell our place, nor do we feel pressure to sell. Although we will probably not return to live in Nicaragua, we have no regrets about financial decisions we have made throughout our lives.

It feels kind of weird to say we aren’t expats any longer. But, we are redefining the term expat. Possibly global citizens would be a better term. I’m in the process of writing a post about that. Stay tuned while we rewire.

 

 

 

Rewiring and Reclaiming


One man’s distraction is another man’s refuge. ~Khang Kijarro Nguyen

    

Oh Ometepe! Do I miss you? Not really. I have always said I have a love/hate relationship with Nicaragua. I am in the hate phase…not because of the people, instead because of the Ortega regime. I abhor what they have done to the people. But, this post isn’t about Nicaragua. It is about how distractions and a crisis in Nicaragua helped to save our lives.

Ron felt a lump in his neck last February. Friends and professionals said it was nothing to worry about. It was palpable and soft. But, they cautioned us to get it checked anyway. We waited under a mango tree on Ometepe Island, avoiding the hot sun, to see the technician who had an ultrasound machine. He discovered two lumps, one the size of a grape, and the other the size of a pea which was deeper in the tissue of his neck.

Again, he said it was nothing to worry about, but recommended a biopsy. So, we ferried to the mainland the next day for a fine needle aspiration of the largest lump in his neck.

When the results were ready, we were unable to go to Rivas because the paramilitary had blocked the roads and they were shooting up the town. So, we asked Robinson to call the doctor and if it was cancer, just don’t call us back.

Minutes later Robinson called us and said Ron was good to go. The results were benign, however the doctor recommended surgery to remove the lump because it could turn into cancer in 10 years or less. It was diagnosed as a pleomorphic adenoma of the salivary gland.

Relieved that Ron’s tumor was benign, yet still stressed from the gunfire we heard late at night on the street behind our house, we debated on whether to stay or leave Nicaragua. If we left, we could go to the states and have the tumors removed. It was impossible to travel to Managua because the paramilitaries were shooting, kidnapping, imprisoning, and killing protesters. It took two more months to pack, give away our belongings, and find trustworthy renters who would adopt our pets and love our home. On July 19th, we left Nicaragua on one-way tickets and returned to our home in the states.

We forgot how beautiful our area was. The Nolichucky River beckoned Ron for a few abundant fishing days, and because our home in Tennessee was rented to our friends, we decided to make an appointment with the Ear, Nose, and Throat doctor to have his tumors removed, buy a car, drive to Canada for a couple of months, return to TN and have the tumors removed, and plan a six month trip to warm places for the winter. 

Little did we realize that “Winter was Coming” in more ways than one…and beyond our control.

Again, Ron’s tumors were biopsied and the results were both benign. The ENT surgeon removed the tumors and sent them to pathology. Meanwhile, we were staying in a small bedroom in our house while Ron recovered from his surgery and I planned our six month trip to warm places in tropical zones.

The week before we were to leave, the doctor called. “You need to have a PET scan as soon as possible.” OMG! Frantic with worry, we knew the news could not be good. The pathology report returned with a diagnosis of HPV+ squamish cell carcinoma. The glands that were removed were the secondary source of the cancer. The PET scan would determine if the cancer had spread to other parts of his body, locate the primary source, and tell the doctors the next course of action.

We entered Cancerlandia…. it was a mystifying, stressful, anxious, and fearful world. We would rather be whale watching in the Dominican Republic.

 We were living in crisis mode. The stress was overwhelming with the anguish of 3 more surgeries, radiation, and chemotherapy which was the recommended standard treatment for HPV positive throat cancer according to the American health-care system. The turmoil of the many choices we had to make, and the false hopes such as three benign biopsy results, were almost too much to bear. We fluctuated between periods of happiness and despair, gratefulness and the curse of hope, spiritualism and faithlessness in a religious world, and anger accompanied by bouts of grief. We had to rewire to survive. Yet, how? 

The radiation oncologist wouldn’t start radiation until Ron had all of his teeth pulled. The chemotherapy oncologist would’t start chemo until Ron had a port and a stomach tube embedded into his body. The ENT surgeon had to find the primary source of cancer at the base of his tongue before treatment could start. Everyone wanted a piece of him and we were led like zombies from one office to the next, wondering how much this would cost.

Our salvation actually came in a gallon of Tropical Nut paint. Since we were going to be spending the winter in our house, it disheartened us to see the paint chipped off the walls and ceilings and blankets covering the skylights and doorways to save heating costs. It resembled a dark, cold cave. I couldn’t imagine Ron trying to recuperate in such a depressing environment.

The day after he had all of his teeth pulled, we started scraping the walls of the hallway closest to our little bedroom and repainting. Little by little we were reclaiming our house and our space….and it felt so good!

Our friends moved into his mother’s basement until home sales increased, which would probably be spring. Throughout the daily radiation treatments and three chemo treatments scheduled two weeks apart, we dreamed of complimentary paint colors, watched YouTube videos on how to repair peeling ceilings, and woke up excited to take our daily walks in Lowes and buy more painting supplies.

The snow fell and we were blissfully unaware of the cold. Ron started toasty fires in the wood stove in the basement. Our distractions of painting, remodeling, decorating, and unpacking our belongings that we stored in our house for eight years were life-saving. Our lives didn’t revolve around cancer.

We tore down the blankets covering the sky lights and heavy dark curtains on the windows. Let there be light… symbolic of the tunnel we were traveling through…we could see light pouring in at the end of the treatments.

Cory took family leave from Yosemite National Park. He brought another fantastic distraction, a sour dough starter from 1890. He taught me how to make a delicious sour dough bread that we could share with the nurses and doctors who tended to Ron’s every cancer need.

By mid February, Ron’s treatments were over. The doctors and nurses declared him their star patient. He was in a clinical trial to reduce the painful side effects of the radiation. He received weekly infusions to prevent the throat sores and mucus build-up from the radiation. It was a roaring success. He was the only person in the trial in our area who had no side effects from the radiation…no mouth sores…no trouble swallowing…no throat pain!

Our remodeling was almost done, too! The downstairs was painted and redecorated. the boxes were lovingly unpacked and our treasures were placed around our home. Transformed from a house to our home, we were both proud of how well we handled the stress and demands of the cancer treatments. As the doctors have repeatedly stated, “This is not only the standard treatment for your cancer, but it is the cure.”


What is next? We are not sure where our paths will lead us. Ron has several months of recovery. Meanwhile, we have many miles to go before we rest. We would both like to explore Croatia, Slovenia, Slovakia, Greece, Prague, Montevideo, and Albania this fall.

However, I learned to buy travel insurance for those unexpected emergencies, like Ron’s cancer. Travelex was better than my expectations. I spent two months planning our winter trip, and a month canceling our reservations and verifying our refunds, but we received all of our money back down to the penny.

I want to thank everyone for your concern and comments since I have not been posting. Please know that I appreciate you! My focus has been on helping Ron through the maze in Cancerlandia.

Our lives have changed drastically since last April. But, throughout all the stress and changes, we have both remained optimistic and are looking forward to new paths in our rewired lives…with a little help from our distractions, passions, and friends. 🙂

Next up:

Comparing cost of living in Nicaragua and USA
Will we return to Nicaragua?
The cost of Cancer in the USA

 

 

Review of WEA International Health Insurance


I want to give you a quick update on our WEA International Health Insurance. In 2015, we explored options for Health Insurance coverage in Nicaragua. See my post below:

Part One: Let’s Get Real about Health Insurance in Nicaragua

After much research, we opted for WEA Signature Plan excluding coverage in the United States. See my post below:

Part Two: Let’s Get Real About Expat Health Insurance

We have now completed two years with WEA Signature Plan and are currently renewing for our third year and this is what I have learned.

1. Deductibles
Each year, as we move into a different age bracket, the cost rises, like all health insurance. We counteract the rising cost by increasing our deductible. Our first year, our deductible was $250. Our second year, our deductible was $1,000. This renewal year since we both have moved into a different age bracket, our deductible is $2,500.

Living in Nicaragua, the cost of procedures and hospital care is much less, thus we pay out of pocket for small procedures and apply them to our deductible.

2. Claims
Our second year with WEA ( Nov. 2016-Nov. 2017) was the first time I had to file claims. I had two eye operations at Vivian Pellas Hospital in Managua with a wonderfully competent retina specialist, Dr. Juan Rivers.

After each operation I filed the necessary documents they requested. My first surgery was considered an emergency, so I did not have to be pre-approved. My second surgery, I requested approval and received it before the operation.

Filing the documents was very simple. I took pictures of all the documents provided by Dr. Rivers, including receipts of the costs of the operations. Then, I attached them to an email to the claims department.

I received instant notification that they received my documents and was assured that they would contact me if they needed additional information. So far, so good.

Then, I waited and waited. They say that all claims will be processed within 22 days of receipt. However, that was not the case. I began to worry when we got closer to our renewal date of Nov. 7th because how could we renew and why would we renew if my claims were not approved.

The closer we got to the renewal date, the more I panicked. I sent emails every day to the claims department. Finally, with the help of Robert Tillotson, the Offshore Health Benefits, LTD and my awesome agent, my claims were processed a day before our renewal.

3. Reimbursement

All of my claims were approved and I received almost total reimbursement for everything, except for my initial exam. My exam cost $220, and I was reimbursed for $70 because I had exceeded the maximum benefit for my policy.

My first reimbursement check was sent to my house in the states. All other reimbursement checks are deposited into my bank account.

4. Customer Service

Except for the lateness of my claims, they were efficient, polite, and responsive to my inquiries. If they were not in the office, they responded with an auto message email that said they had received my email. I think the claims department needs  some encouragement to respond to their customer’s requests, but then I had Robert that pushed them into action. Thank you so much Robert!

I know many people interested in getting WEA Signature International Health Insurance asked me about the claims process. Now, I can respond with my assurances that viable and documented claims will be reimbursed, but not with speed! You must keep on top of them.

Overall, I am pleased with their service and grateful to have insurance that can be used in 182 countries, excluding the U.S.

 

Tale of Two Surgeries


“If I save my insight, I don’t attend to the weakness of my eyesight.” ~Socrates

 

For six months, I lived in a blurry world. Although it was difficult to attend to the visual world due to weakness of eyesight, I gained an accurate and deeper intuitive understanding of people, places, and things. Instead of relying on outsight, I gained a better appreciation of my world through insight. 

Since I had my first eye operation in the United States and my second eye operation in Nicaragua, I thought it would be interesting to compare the surgeries in two vastly different countries. Both surgeries were similar. I will try to withhold judgment, but I can guarantee that if you are concerned about having a delicate or major surgery in a developing country, I will put your worries at ease.

A Tale of Two Surgeries Through The insightful Observations of an Expat 

A look at my island from the taxi window as I was on my way to the hospital in Managua.

Surgery in the United States

1. Facility

The facility where I received my vitrectomy in the U.S. was modern with all of the latest equipment. Johnson City Eye Clinic Website

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Random Rants about My Country of Birth


Random ranting is always good for the soul. It is like a pressure cooker value releasing steam. A good rant is cathartic. Sometimes ranting keeps me sane. And living in Nicaragua as an expat, I have some frustrations about my country of birth. It has been a while since I’ve ranted, and Anita of the blog No Particular Place to Go inspired me with her rant-a thon, so here are a few of my random rants.

U.S. Health Care Rant

Don’t get me wrong. I appreciate having Medicare, but we can’t use it abroad! With my first eye surgery in the states, single payer was quick and easy. I paid 20% of the total cost of the doctor, facility, and anesthesiology. When I told my doctor that I needed to fly back to Nicaragua, he said he would have to replace the vitreous in my eye with silicon oil, which necessitates a second eye surgery to remove the oil.

“I am going to see if a doctor in Nicaragua can remove the oil in my eye,” I said to my surgeon. “Good luck with that,” he responded. “I doubt that you will find anyone as competent in Nicaragua as eye surgeons in the states.”

What is it with doctors’ arrogance? Waiting for surgery in the gurney, I watched as a train of gurneys were moved in and out of the operating room. “How many retina surgeries do you do here in a day?” I asked the attending nurse. “Usually 15 per doctor per day,” she said. I quickly calculated that the doctors each made $1750 per surgery X 15 surgeries a day = $26,250 a day!!! That is just the doctor! It doesn’t include the facility or anesthesiology fees.

I made an appointment in Managua at Vivian Pellas Hospital to see a retina specialist. Dr. Juan Rivers gave me a through exam and patiently answered all of my questions. When he said my eye was still extremely swollen, he asked, “Why didn’t the surgeon give you steroid shots to reduce the inflammation before injecting the oil?” I said that the doctor told me oil and water don’t mix, so he couldn’t put steroid shots in my eye. “Well, that is what we do before we inject the oil or gas,” he said kind of irritated. He shook his head and said that I would have to keep the oil in my eye for three months, which could have been avoided if they reduced the swelling first.

Through my tears… in only one eye… I thanked him for his patience and his TLC and scheduled another eye appointment for the end of August. His initial consultation cost $160.89. The surgery to remove the oil and replace my corroded lens will cost $3,000 for everything. Since we have international health insurance, we weighed the cost of airline tickets, a rental car, and at least two weeks of expenses to repair my eye in the states in a train of gurneys vs the cost of surgery with Dr. Juan Carlos Rivers at Vivian Pellas. I opted for a competent, caring doctor in Nicaragua. I can file claims with my international insurance and get some of my money back.

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My First Experience with Medicare


“One quarter of Medicare beneficiaries have five or more chronic conditions, sees an average of 13 physicians each year, and fills 50 prescriptions per year.”
― Clayton M. Christensen, The Innovator’s Prescription: A Disruptive Solution for Health Care

I went to see my eye doctor in Tennessee the other day. When the nurse entered my information into the electronic files, she asked me, “Are you sure you don’t take any medications?” I replied, “Yes. Nothing.”

She couldn’t get over the fact that I had no pre-existing conditions, took no prescription medications, and had no medical history other than my appendectomy and tonsillectomy, which were removed when I was a teenager.

“I have to put something in the spaces,” she commented. “Do you take any vitamins?”
“Once in a while I take glucosamine,” I replied. With almost a sigh of relief, she asked me how many milligrams and how often I took glucosamine. “You are the best and easiest patient I have ever had,” she said. “But, you aren’t normal.”

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First Aid on Ometepe Island


Safety is as simple as ABC – Always Be Careful.

Several years ago, there was a horrible accident on Ometepe Island. A drunk driver on a motorcycle crashed into another motorcycle head-on. Then, two more motorcycles tried to swerve to miss the accident and they both laid their bikes down.

One motorcyclist died on the panga that transported the injured to the mainland. Two suffered traumatic head injuries. The scene was horrific. The first-responders were ill-equipped police. They had no equipment, no understanding of assessing the injured before moving them, no latex gloves, no ambulance, and no training in first aid or CPR.

Nicaragua has come a long way since then, but there is still a long way to go in training first-responders at the scene of an accident. This past December, every community in Nicaragua held an emergency simulation.

Since Ron is a CPR and first aid trainer, he volunteered to head the simulation.
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The Best Water Therapy Resort on Ometepe Island


“The water doesn’t know how old you are.” ― Dara Torres

I’ve started water therapy exercises for my knee. I love the feeling of freedom walking in the water. Although we live on the beach and have a plunge pool, neither are suitable for water therapy exercises. We’ve been going to Moyogalpa to swim and exercise in the Hotel Nicaraus pool. Yesterday, they told us that they were going to drain the pool and repair it. Time to look for another pool close to our house.

Hotel La Punta is our new hot spot located a short five-minute drive from our house at Punta Jesus Maria.

img_1570The hotel recently opened, but it is the slow season. Today we had our own private resort.

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The Power of Focus


Stay alert and aware. The signs you are seeking are very clear at this moment. ~Hawk

IMG_1817

The month of August has been extremely challenging for me. Two weeks ago, I partially dislocated my kneecap chasing my dog in flip-flops. Then, our new internet tower was possibly struck by lightning. I say possibly because every technician who has been to our house has a different troubleshooting approach for our internet loss.

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Humans of Nicaragua: Don Ebierto the Sobador


“Injuries obviously change the way you approach the game.” ~Brett Favre

I’ve watched the Olympics everyday, all day, with my leg raised and my knee iced and compressed. You see, I have my first sport related injury. That is, if you can call chasing my dog in flip-flops a sport.

I hyperextended my knee as I twisted my leg with my foot implanted in the sand. POP! And I fell to the ground in agony. Ron and Jose carried me back to the house and Lourdes ran to find Capitan (Cappy) who likes to run through the holes in the fence and visit the neighbor’s cows and dogs.

Meanwhile, I howled in pain when they plopped me on my couch and I couldn’t move my leg. Ron wrapped my knee, elevated it, and iced it immediately. But, what was the problem and how do I get to the mainland to get a MRI?

My first mistake was using Dr. Google to diagnose the knee problem. It could be a meniscus tear, or an ACL tear, or a sprained knee. The more I read, the more anxious I became. I couldn’t walk and the pain was excruciating.

“Ron, I have to go to the bathroom,” I shouted. He tried to support me and I attempted to hop, but every hop jarred my bad knee. Then it dawned on me! My wheelie office chair. Perfect!

The day after my knee injury, I called a sobador to come to my house to look at my knee. A Nicaraguan sobador is a healer who works on the material level and specializes in the treatment of sore muscles and sprains, and deep muscle massage. Sobadores are traditionally used by many Nicaraguans as a form of alternative medicine. They are a mix of traditional healers and chiropractors who blend their self-taught knowledge of the human body with faith and traditional herbal remedies.

Don Ebierto is a well-known sobador on Ometepe Island. He is respected for his knowledge of the human body and his ability to reset broken bones, massage sore muscles, and set dislocated joints. He doesn’t live very far away, so I called him and he came immediately.

I was apprehensive about calling a sobador mainly because I have little experience with natural healers. Most of my life I have relied on medical doctors, although fortunately the only medical emergency I ever had was an emergency appendectomy. I’ve never broken a bone or sprained or strained a joint. Amazing, right?

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