PFV

On 12/1/2021 at 5:28 PM, Jingthing said:

I think I found the answer about Medigap and other Medicare expat issues.

So there is foreign coverage if you start Medigap BEFORE you expatriate. 

That said its fair to assume that enrolling in Medigap as an expat and faking being a US state resident would be a fraudulent enrollment.

 

Read further in the link for why Medigap is not good coverage for long term expats even if enrolled legitimately.

 

 

https://www.pbs.org/newshour/economy/retiring-abroad-what-medicare-plan-should-i-get

People with Original Medicare (Parts A and B) can get a Medigap policy (also known as a Medicare supplement plan) that provides coverage of emergency medical expenses outside the U.S. Medigap plans are regulated and sold at the state level. According to UnitedHealthcare spokeswoman Sarah Bearce, you need to be a resident of a state when you first buy a Medigap plan. After that, if you moved outside the U.S., your Medigap plan would continue in effect so long as you paid the premiums.

Thank you!

This means that one can acquire US residence for a bit more than 6 months, sign up for Medicare and Medigap, and then move back to Thailand.

16 minutes ago, Jingthing said:

...What are those four states?

Maine, New York, Connecticut, and Massachusetts. I understand that Massachusetts handles Medicare differently from other states.

19 minutes ago, Jingthing said:

I don't follow your logic at all! If you repatriate you will be in a better situation if you're already in B regardless. Are you getting that it can potentially take as long as 15 months to get on B upon repatriation?

I suppose that I could indeed sign up for B. Then, upon repatriating try to sign up for Medigap. If unsuccessful, go live in one of the 4 states that won't block me for pre-existing conditions, or be content with Medicare Advantage's limitations.

15 minutes ago, Sheryl said:

...Or is there a time limit to apply for MediGap after enrolling in Part B?

That is exactly the point. You can enroll in MediGap without going through a medical screening process only during the initial 6 months after signing up for Part B, Folks with pre-existing conditions will either be denied coverage or required to pay a higher premium, depending on the condition.

There are a few exceptions such as having existing qualified insurance, a change in benefits, after a Medicare Advantage Trial period, or if you live in ME, CT, MA, or NY.

I suppose that I could sign up next summer, when I turn 65, and then move to Maine for Medigap. I have always liked Maine, but spending the winter there is not what I had in mind.

Do you really need to be physically present at least 6 months a year, or would it be sufficient to rent a place for 12 months and pay local and state taxes?

3 minutes ago, Sheryl said:

 

I don't follow that.

 

You can enroll in Pasrt B wiht a foreign address, I did it.

 

it is only for MediGap and Medicare Advantage policies that you need a US address. And, for those, you need to be resident in the US at least 6 months of the year.  People have gotten around that by essentially lying, but this is fraudulent and if discovered could invalidate the policy.

For me, getting MediGap is almost more important than Part B. Here in Chiang Mai, my cardiologist told be that I will probably need bypass surgery at some point in the future, given current calcification issues, and without MediGap it would be very expensive. At that point in time I would have no problem in moving back to the US, but would not want to move now just waiting for something bad to happen. So postponing enrollment in part B seems to be the only option for now.

20 minutes ago, flbkk said:

As others have stated, you could enroll in Medicare a and B through the American Embassy in the Philippines, even without a US address. I looked at all this at length, and decided to enroll in Medicare B, pay the premiums, as well as take a high F Medigap policy. It’s expensive, and part B is going up a lot in 2022, ostensibly for some unproven Alzheimer’s drug. If you have the ability to self insure as you say, surely you could pay for a high deductible Medigap, perhaps G, F is no longer available. And I would definitely pay for the part B.

 

You don’t wanna get into a position where you return to United States sick, but have no availability of any insurance at all for a while. I do have a US address, so easily enrolled in a Humana Medigap policy. For other readers going on US Medicare with a US address, you should absolutely get a Medigap policy within the six months to avoid medical underwriting, and avoid Medicare advantage, which are HMOs. They limit your care to the county which US as a US address, except for emergencies, and to certain doctors.

I agree entirely, except that you need a permanent, as in life-long, US address to enroll in Medigap that I am currently lacking. I was specifically looking at a high-deductible G, since F is no longer available, or perhaps a K or N. 

37 minutes ago, Jingthing said:

Again it can take as long as FIFTEEN MONTHS to get enrolled in B upon repatriation.

I realize this, but being able to enroll in Medigap as a diabetic is my primary concern, and therefore cannot enroll in Part B until I decide where to live in the US, since I don't believe that the mile-high city (where I moved from 15 years ago)  is appropriate for aging folks. 

4 hours ago, Jingthing said:

...During the IEP Initial Enrollment Period at your 65th birthday you have about seven months to enroll in B surrounding that date...

 

I believe that the only exceptions are the 4 "Guaranteed Issue" states in the Northeast. Consequently, they have higher premiums. I think I would prefer delaying enrollment than renting a pied-a-terre there due to the weather. Another option could be Medicare Advantage where I don't believe they can deny coverage, but I might be wrong.

10 hours ago, cmarshall said:

How do you figure that?  You pay the 10% premium for each year after 65 that you did not enroll in Part B.  But you pay the 10% penalty not once, but forever.

I am assuming that once you enroll, you stop paying additional penalties. For instance, if you delay enrollment until full reterment age at 67, your new premium will be approximately 21% higher and remain 21% higher going forward. This extra 21% is offset by the 200% you saved while not paying premiums at 65 and 66, until you reach 76, when you will have broken even.

Thank you Jingthing and cmarshall for your replies. Since the only time you are guaranteed enrollment in Medigap is immediately after enrolling in Part B, if you have pre-existing conditions that is, the best course of action for me is probably to delay enrollment in Medicare until I have a place in the US where to spend at least part of the year (if ever) and to rely on travel insurance for short visits. The 10% penalty is roughly equivalent to the monthly premium saved.

Apologies if this is not the proper forum to post this message. I trust a Moderator to change forum if necessary.

With eligibility for Medicare a few months away, I am trying to figure out if it is worth enrolling due to lack of coverage outside the US, or if it is even possible without a US address.

In my situation with pre-existing conditions, buying insurance in Thailand has been impossible, which would suggest the need for Medicare. On the other hand, traveling to the US for anything but a major issue could be uneconomical due to hotel/apartment rental costs, transportation costs, etc. Furthermore, I would also need to sign up for Medigap coverage due to the 80% limit.

I expect to be able to bear the cost of almost any service here in Thailand, including heart bypass surgery, although I am not excited at the idea of spending >1M baht and have doubts about the quality of treatment.

Some options I have considered are delaying enrollment in Part B, despite the penalty, and choosing a high-deductible (plans G-HD or K) to limit costs for services that I would use very rarely (fingers crossed). Then again, if I were forced to return permanently to the US for health reasons, all of it would have been very worthwhile.

I was hoping that a kind reader in a similar situation could share their thoughts and provide some guidance.

Thank you

My experience with Swiss last month was entirely different. 

Originally booked CNX-ZRH-CNX, then domestic flights were cancelled and Swiss emailed a new confirmation without the CNX-BKK segment.

For the return, decided to avoid the Bangkok quarantine and try the Samui sandbox. Swiss cancelled the BKK-CNX segment on WE and booked a BKK-USM on PG, also changing the departure from ZRH to the following day for a shorter connection (was originally booked on LH). Total cost 500 baht. 

I hope I am misinterpreting the new regulations, posted below, but it would seem that anyone entering Thailand, married to a Thai or not, on any type of visa or visa exempt, will need at least 50K Baht of health (not simply covid-19) insurance.

This pretty much means that anyone with a pre-existing chronic condition will not be able to enter Thailand legally (unless willing to lie on the insurance application) or unless they can obtain such insurance abroad

.

A couple of hours ago I received a further update on the vaccination situation from the same school that sent out the original message yesterday.

IMHO, the information on the data collection tool is a bit optimistic, based on the Facebook post that Nancy quoted. The interesting bit is that those of us who registered by sending emails should be contacted in due course and do not need to re-register.

UPDATE COVID-19 VACCINATION FOREIGN NATIONALS CHIANG MAI 14/05/21  PM

Thank you for your patience. Chiang Mai Provincial Health Office has been working today with a professional online application developer. A new efficient, secure app for data collection has been created. Pending approval it should be ready for use tomorrow. 

Those of you who have already sent in information via email or LINE will NOT need to reapply as they have staff working to enter old data into the new platform. You will receive an email acknowledgement in due course. 

1 hour ago, Don Dunkelblum said:

Went today to the Government hospital in Chiang Rai to register for a Covid vaccination.

The Information lady told me:  cannot, only for Thai, comeback in July.

Same info here in Chiang Mai, at McCorormicK, Maharaj, nobody knew about foreigners yet. At Bangkok Hospital, no info yet on vaccines. At our local hospital my wife was told that only Thais can sign up for now. No mention of July.

Keeping fingers crossed.

On 4/21/2021 at 5:33 PM, friendofthai said:

Almost any vaccine have 100% efficacy against severe forms of Covid. So I will buy any of them as soon as possible.

I think Darwin would call it natural selection. When those who cannot throw away all the political <deleted> in the field of vaccines will not survive.

Not entirely true.  None of the current vaccines is 100% effective, and sinovac is only about 50% effective according to a Chilean study. There have been over 5800 "breakthrough" cases in the US, and at least 74 people have died although fully vaccinated, about 1 in a million. This is directly from the CDC.

https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html

PTIS is also starting online on Wednesday

Thank you very much Sheryl, ubonjoe, and Tanoshi.

This was a hypothetical question, in case someone could not apply for a different extension due to lack of funds or some other reason. I think it would be heartless for Thai Immigration to force folks with conditions such as the one I listed above on a risky flight home. But then again, we just need to look at US Immigration to see how callous officials can be (i.e. separating children from families.)

On 7/31/2020 at 7:26 PM, Sheryl said:

You need a letter from a hospital stating you are completely unable to travel, and this would usually also mean you are an inpatrient in the hospital.  In my experience with several different Imm offices, they will also want photos of the patient in the hospital and expect this to show someone obviously very ill/incapacitated.

 

This reason for extension is taken very seriously and not issued lightly or on minor grounds. I haven't  known agents to be able to help with it.

 

The annoubncement is just making clear that this sort of extension is still possible. The normal rules for it have nto been in any way relaxed.

So, although someone could be suffering from diabetes, high blood pressure and obesity, which are common co-morbidities, and being treated in Thailand on an out-patient basis, immigration would not grant an extension unless the patient were also hospitalized, despite the fact that 40% of Covid-19 deaths involve diabetics?

2 hours ago, Tanoshi said:

Did your diabetes condition prevent you from travelling to Thailand.

The answer to that, answers your question.

Traveled well before the COVID pandemic began. Today, I would not travel to Thailand. Insurance agents I contacted for COVID insurance both in my home country and here said I would be crazy to travel right now.

I was wondering if a pre-existing condition, such as diabetes, which makes it very dangerous to be exposed to COVID, would be sufficient to obtain a medical certificate and an extension of stay?

7 hours ago, Peter Denis said:

... your only option left would then be to relocate to a different province with a more accomodating IO that would let you apply for the 1-year extension of stay, even while under the Amnesty.

Relocating would require a rental contract for a place in that other province, and with that rental contract do your TM30 (or TM27) change of address at the local IO of that province.

Physically relocating is not required, if you prefer staying in your present place, but you might need to be there during the 'under consideration' period during which your local IO might visit your place, to check whether you are actually 'living' there.

Not sure this would work. Here in Chiang Mai, although they will extend you on amnesty, they do come visit you at home *AND* require testimony from a neighbor to confirm that you indeed live here. The neighbor needs to go to Immigration and sign an official statement. In other words, the move to a new province needs to look genuine, especially to neighbors. So I would recommend a physical relocation from well before your planned application date until receiving the extension stamp after the under-consideration period. 

I Received both the letter and check, along with other mail from the US, all at the same time.

No postal mark, but the letter was dated May 15. I received them on July 10.