Medicare deductions from US SS

[Pib]

 

If hit with the surcharge your 2019 premium would be based on your 2017 income....basically two years back.  Below Medicare Center link will also show the most current costs which include the 2019 inflation adjustments.

https://www.medicare.gov/your-medicare-costs/part-b-costs

[dddave]

I opted out of "Part B" five years ago when I was enrolled in the Veterans health care system.  The plan seemed redundant as my VA status covered medication and out-patient care.

I now regret making that decision. 

At some point, I will need double knee replacement surgery.  The VA will cover it but with something as serious as this surgery, especially considering my age (75) it would be nice to have the option of selecting a surgeon and the venue of the surgery. 

On paper, Medicare will cover it but when I was in the US last year exploring the issue, I found that no orthopedic surgical group would talk to me without my having "Part B".  It was explained to me that not having Part B makes it much more difficult for them to get paid for all aspects of the surgery and recovery. It's not worth it for them to do it.

I'm fortunate that the VA Hospital in my area is one of the top rated in the system but veterans in other areas are often not so fortunate.  Many news stories over the last several years have shown just how bad some of them are.  This makes it very important for vets in those areas that are ill served to have the option of using Medicare rather than the VA.  If you keep "Plan B", your chances of getting better treatment elsewhere are greatly enhanced.

[keemapoot]

23 minutes ago, Langsuan Man said:

The MAGI is only for determining Medicare Premiums penalty and your adding "surcharge"  into the mix would cause confusion. 

 

What I think you are getting at is if your MAGI goes down then your penalty goes down.  Which is how it works, since Medicare will send you a letter every year telling you what your penalty will or will not be that year.  For two reasons, the penalty amounts change yearly and your income changes yearly

 

Remember that IRS has to report your MAGI to Social Security / Medicare based upon your previous years tax filing so the MAGI will always be a year or more late

 

Looking at the above chart it appears to me that most married couples would not have a problem, but not so for single filers 

 

No you don't Pib , I snore   

Yup, and it appears just doing some quick back of the envelope rough calculations, if the penalty for late enrollment is 10% each year you are late, if you waited to enroll at say age 69, you would have a 40% increase in the part b premium vs. if you were say, in tier 2 and still working until age 69, you would pay a 50% premium surcharge from age 65 to 69 for 4 years, but if you retire at age 69, in that case, your premium would roll back to normal depending on your retirement income yearly.

 

So, it appears one is better off going ahead and enrolling on time at age 65, and take the hit and pay the 50% premium surcharge until retirement because when you retire and income goes down, you are better off until end of life. If waiting to enroll, you would pay the higher late enrollment penalty every year until death, correct?

[gamb00ler]

On 4/5/2019 at 12:16 AM, Sheryl said:

Actually I got in under a Special Enrollment provision (not open period) and avoided late penalty on grounds of having had insurance through employment while outside the US. People in that group are exempt from requirement to opt into Part B by age 65 provided they are insured throughout the interim.

Turned out that purchasing your own insurance if you were self employed qualified as insured through work. Luckily for me.

I just finished a call to CMS about this exact issue.

 

I started my Medicare in my 65th birthday month.  I won't be receiving SS until I'm 70.

I am planning on moving to Thailand in a few months and also plan on being a digital nomad in that I will be self employed in Thailand with overseas clients.  I will be covered by health insurance I purchase.  I asked CMS if I would qualify for a Special Enrollment Period (SEP) and avoid the penalty as Sheryl has done.

 

The representative said I would not qualify for an SEP.  They require that I have Group insurance coverage from an employer with 100+ employees.  I will call them back and explain in detail the process that Sheryl (without mentioning any names) outlined plus refer them to a non-official page that implies that what I seek is possible.

 

As a gambler I give my chances very low probability, but at least the loss upon failure is only a few minutes of my time.  I think Sheryl somehow hit the jackpot.  If I ever do repatriate, I will try the "Sheryl" strategy.

Edited April 16, 2019 by gamb00ler

[keemapoot]

12 minutes ago, gamb00ler said:

The representative said I would not qualify for an SEP.  They require that I have Group insurance coverage from an employer with 100+ employees.  I will call them back and explain in detail the process that Sheryl (without mentioning any names) outlined plus refer them to a non-official page that implies that what I seek is possible.

Please let us know what you find out. My situation is similar to yours in that I will have coverage until I quit working so would like to find out for sure if I qualify for SEP too. I am a bit younger but planning for next year. I also like Sheryl's overall strategy and I plan to follow that too.

[dave s]

I am 69 this month. I retired last September, and started social security pension and Medicare A. Since I had the medical benefits of the Thai social security program while I worked here 15 years, I asked my former employer to fill out the USA form for a special enrollment period, and SSA started deducting Medicare B from my monthly check right away at the ordinary price, no problem or question whatsoever. I plan to stay in Thailand for a while and see how it goes, but if I got really sick I would go home to a USA hospital. The regular Medicare B payment seems worth it to me as a backup.

 

I had thought I could continue with the Thai social security medical benefit by paying the premium myself (I cannot find the Thaivisa discussion that talked about this ????), but the Thai office in this province says no and has told me (or a Thai coworker accompanying me

) a different story every time I have gone there.

[gk10002000]

On ‎4‎/‎6‎/‎2019 at 8:01 PM, Pib said:

 

If hit with the surcharge your 2019 premium would be based on your 2017 income....basically two years back.  Below Medicare Center link will also show the most current costs which include the 2019 inflation adjustments.

https://www.medicare.gov/your-medicare-costs/part-b-costs

This is why people really need to understand AGI and MAGI.  Some of you may have tax free investments.  I certainly do in Muni bonds and funds.  While those are NOT taxable by the IRS, their income is included in your MAGI.  MAGI is used to determine many benefits out there such as how much of your social security benefit is taxed, the price of your Medicare Premiums, and some other things.  Distributions from your ROTH IRA are NOT counted in the MAGI.  So I highly recommend you take a look at your 401ks or traditional IRAs and consider when to convert some of those monies over to your ROTH IRA when it is best for your situation like a lower tax bracket year, etc.  I also point out that ROTH IRAs do NOT have any required minimum age distribution when you hit that 70 year age mark.  So that may be another factor on which IRAs you start taking money from, how much and when.

[Sheryl]

I am 69 this month. I retired last September, and started social security pension and Medicare A. Since I had the medical benefits of the Thai social security program while I worked here 15 years, I asked my former employer to fill out the USA form for a special enrollment period, and SSA started deducting Medicare B from my monthly check right away at the ordinary price, no problem or question whatsoever. I plan to stay in Thailand for a while and see how it goes, but if I got really sick I would go home to a USA hospital. The regular Medicare B payment seems worth it to me as a backup.  

I had thought I could continue with the Thai social security medical benefit by paying the premium myself (I cannot find the Thaivisa discussion that talked about this [emoji20]), but the Thai office in this province says no and has told me (or a Thai coworker accompanying me

) a different story every time I have gone there.

 

You absolutely CAN continue the SS medical cover by paying on your own and your local SS office is absolutely wrong. The only circumstance in which you would not be able to do this is if you were employed less than a year. 

You must however set this up within 6 months of the end of your employment. Do not fail to do this, it is by far the best insurance deal possible and you cannot count on always being stable enough to fly back to the US for medical care.

 

A number of people have had this problem with branch SS offices. A call or email to the head office in Nonthaburi will clear it up. Start by emailing them and show the reply to your branch office. If that fails either

 

1) call the head office while you are in the branch office, explain the problem and have them talk to the ataff. Problem with this approach is it can take a long tine to get through on the phone. Don't use the call center number, use the iffice number. (See SS website).

 

2) just go to the head office in person and complete the forms there.

 

One of the problems (other than sheer laziness) is that the forms have a mandatory field for a Thai ID card number. There is a way to work around this and enter passport number instead but seems many branch staff do not know how. So they just tell foreigners "cannot".

 

SS is now a cardless/paperless system and it links people by ID number. If you can get a pink Thai ID card that will solve a lot of problems (and it is a useful thing to have, easier to carry than a passport and accepted for identification most places). Getting the pink card is easy once you have a yellow tabian ban -- done in a few minutes, free, at ampur office needing only your tabian ban and passport.

 

When I am back at my computer I will post reply from SS head office given to another TV member with the same problem and also the SS law wherein you will this described.

 

 

Aside from being able to continue your medical cover for life you also have entitlement to either a lump sum cash payment or a small monthly pension.

 

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

 

[Sheryl]

@dave sOK back at my computer.

 

Here is verbatim email from SSO min office who was getting the same run around from his branch office:

 

For English language version of the SS Act see

http://www.thailawforum.com/database1/social-security-act.html

 

Note especially section 39

 

Armed with all this you could try going back and insisting on your rights,  asking soecifically for the relevant form by number.  It will go better if you can show a pink Thai ID card, Without one you my have to call the main office and have them explain to the branch office what to do. It is essential you know what number gets entered into the ID field as this is how it will appear in the hospital computer. Without it they may not be able to locate your record tio confirm you are enrolled.

 

 

[claynlr]

So seems to be quite the Catch-22. I turn 64 in July and will retire to Thailand a month or so after then. Will have an International inpatient health policy at that time. At 65 get medicare A and B that is possible I will never use. But if ever have to repatriate a big penalty on the B if you don't sign up at 65. So an extra $135 a month to the budget for something not using.

 

All the chat about Immigration not wanting us here but our home country has ignorant rules also. Sux.....

[Langsuan Man]

18 hours ago, claynlr said:

All the chat about Immigration not wanting us here but our home country has ignorant rules also.

Do you think your home country should have rules that favor "ex pats" instead of rules for those who remain home to avail themselves of those services ? 

[claynlr]

Rules for both would be good, as in if you repatriate you can begin paying for services you will use. If you never repatriate you don't pay for insurance you never need.

[Pib]

42 minutes ago, claynlr said:

Rules for both would be good, as in if you repatriate you can begin paying for services you will use. If you never repatriate you don't pay for insurance you never need.

You can do that right now with Medicare.   

 

If you don't enroll when first eligible but say go repatriate to the US 1, 5, 10, etc., years later you can still enroll in Medicare but must pay the late enrollment penalty.   

 

If you never repatriate simply do not enroll....no premiums...no coverage.

 

Now where you say "....begin paying for services you will use..." as in cherry picking your coverage....like coverage only for cancer, for a heart attack, etc.,....or jump in and out of full coverage whenever desired with no penalty..... well, that ain't never going to happen.

Edited April 24, 2019 by Pib

[keemapoot]

14 minutes ago, Pib said:

You can do that right now with Medicare.   

 

If you don't enroll when first eligible but say go repatriate to the US 1, 5, 10, etc., years later you can still enroll in Medicare but must pay the late enrollment penalty.   

 

If you never repatriate simply do not enroll....no premiums...no coverage.

 

Now where you say "....begin paying for services you will use..." as in cherry picking your coverage....like coverage only for cancer, for a heart attack, etc.,....or jump in and out of full coverage whenever desired with no penalty..... well, that ain't never going to happen.

I think for Americans that enrolling and keeping both A & B are good decisions if your budget can handle the additional monthly cost. It would be worth it as a backup for something serious that you would rather have done in the states.

[mtls2005]

If one chooses to opt out of Part B am I correct in assuming that residing full-time in Thailand is a satisfactory reason to use on the CMS 1763 form? (Assuming one has a Thai address with SSA.)

 

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1763.pdf

 

 

[claynlr]

38 minutes ago, Pib said:

You can do that right now with Medicare.   

 

If you don't enroll when first eligible but say go repatriate to the US 1, 5, 10, etc., years later you can still enroll in Medicare but must pay the late enrollment penalty.   

 

If you never repatriate simply do not enroll....no premiums...no coverage.

 

Now where you say "....begin paying for services you will use..." as in cherry picking your coverage....like coverage only for cancer, for a heart attack, etc.,....or jump in and out of full coverage whenever desired with no penalty..... well, that ain't never going to happen.

Not talking about cherry picking coverage. I understand the rules. If one wants to be safe without paying the huge late enrollment penalty for the rest of your repatriated life, you need to sign up for B at 65. Just saying no one knows what will happen in the future...maybe you live until you die in Thailand and never need the B. Or, in 10 years you need to move back to US and if didn't have the B you would pay a 10% penalty for each of those 10 years. Just commented that it sucked! LOL

[Pib]

Yea....it can be a very tough decision whether to enroll in Part B when living outside the U.S.  No one wants to pay for something they can't easily use.   And no one can really say with absolute certainty that they will never move back to the US to live.....or always get their medical care in Thailand even for the most serious condition.

 

Now as a military retiree I had medical coverage under the Tricare (i.e., medical coverage for active duty and retiree) up until turning 65 when that coverage terminates for a retiree "unless" you enroll in Medicare Part B which allows the Tricare coverage to continue.  Medicare still does not provide you any coverage outside the US but since I'm paying the Part B premium that allows my Tricare to continue as before age 65...and whenever I set foot in the US for one millisecond to permanently I'm also covered under Medicare.  Basically have coverage under both Tricare and Medicare when in the U.S.  Hop on the plane and leave the US then it's back to Tricare coverage only.   This pretty much makes being enrolled in Part B a no-brainer for a military retiree outside the US.

 

But if I wasn't a military retiree with Tricare coverage I know I would struggle with deciding whether to enroll in Part B while living outside the US.  A lot depends on the individual as to their financial position (the old self-insure idea), their medical condition, whether their mindset "I will never go back to the US to live or just go for medical care"---that is, their medical care will be obtained where ever they happen to live and based on whatever financial means they have.   It's all a personal decision. 

 

But one thing for sure, when ever a person needs medical treatment for a serious and/or chronic disease (or an major accident) the ensuring medical bills can be HUGE and long term--even in Thailand.   Such an event can easily make a person change their mindset about enrolling in Part B when it first become available to them.   One could also take the mindset of Part B being a safety net.

 

[JimmyJ]

When dropping Medicare and then wanting to re-enroll - It's not only the extra expense for each year one was not enrolled - it's also that there's only a brief period each year of about 2 months during which one can re-enroll.

 

So if planning to drop out of Medicare and then re-enroll if a serious illness - one may have to wait up to 10 months before being allowed to re-enroll.

 

For me, an easy choice to stay enrolled even if planning to stay out of the US.

As Sheryl mentioned, if I ever do visit the US I would get checkups at each of my regular doctors.

(And I'll probably be returning eventually to get cataract surgery/new lenses).

Edited April 24, 2019 by JimmyJ

[KhunFred]

On 4/4/2019 at 9:02 PM, rodknock said:

if you are living outside of the U.S. the part "B" is a waste of money, as you can only use it with in the states.

I always thought NO part of Medicare could be used outside the USA. I pay for it in case I need to go back to the USA for a  health care emergency.

[claynlr]

Yep Pib, I am going to sign up for part B at 65 and will have an International Health plan while in Thailand. Just whining!

 

I was on American Citizens Abroad web site and read that they have been unsuccessfully advocating to the government about this issue:

 

TheTriCare program available to military personnel overseas has shown the feasibility of extending Medicare coverage abroad. TriCare is available to retired U.S. military personnel and their dependents. Eligible recipients submit forms to overseas processing centers and have most of their medical bills reimbursed by the U.S. Government. The problems of establishing rules and control procedures have already been addressed and resolved. It would, therefore, be possible to integrate a Medicare component into the existing overseas health care benefit system, if the government so desired. See ACA’s position here

 

https://www.americansabroad.org/medicare-healthcare/

 

 

 

 

 

 

 

Edited April 24, 2019 by claynlr