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I have considered this option myself. One way to deal with the cultural differences lies in the fact that there are some fairly large American retirement communities in Mexico. Probably more expensive than Central America, but cheaper than the US, and a safer bet.

For me the crux of the issue comes down to medical care, especially emergency medical care. Somehow in my heart of hearts I believe that it is entirely possible to have a medical emergency that would be a routine, almost trivial thing in any US hospital, with excellent prospects for a complete recovery, but that could lead to death or even worse, permant disablement, in any third world nation. This is not the way I want my retirement to end.

There are also a few ammenities, like fast internet access, that would have to be thoroughly researched.

Have you thought about lower cost areas of the US?

I live in CA where we have both state income tax and sales tax. I think there are still a few states where there is neither, plus housing is much less.

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