Medicare Advantage Plans

[Sheryl]

I've just started utilizing Medicare in the US, mainly for preventive services but also for cover during my annual visits back to USA.

 

I currently have conventional Medicare (Parts A and B) and am weighing the pros and cons of switching to Medicare Advantage so would like to hear the experiences of those who habe it.

 

So far the main "pro" I see is having a limit on maximum out of pocket expense per year...though these limits are pretty high (usually $6,700) it is better than no limit at all which is what one has with regular Medicare. Lso a little easier to anticipate copays as they ate glat amounts rather than percentage of amount billed.

 

However a major "con" is that the plans I have looked at limit non-emergency cover to the state you enroll in. When visiting the US I travel around a lot.

 

Also, I have no sense at all for how easy or hard it may be to get statements and appeal decisions. With Medicare I get online statements pretty quickly. I am about to initiate an appeal for a coverage denial for the first time and knock on wood, that process so far seems straight foward and it was easy to find out how to do it, as well as the basis for the denial and relevant rules.

 

I also can't readily figure out if like Medicare the Advantage program restricts coverage for certain tests, procedures and other services. I suspect that they do and that the restrictions are the same as in original Medicare, i.e. the only thing that really changes is the structure of copays and the OOP limit.

 

Any and all first hand experiences will be appreciated.

 

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[taxout]

First, you cannot enroll in a Medicare Advantage plan unless you are actually honest-to-God resident in the US. This is a rule without exceptions.

 

Second, unless you enroll in a Medicare Advantage plan when you are first eligible for Medicare, you normally have no guaranteed right to enroll in Medicare Advantage later: your late enrollment will be subject to an underwriting test in which you can be denied because of pre-existing conditions. There are some exceptions to this, and under one exception if you have been living overseas and move back to the US, you have a guaranteed right to enroll in Medicare Advantage (but not Medigap) within the first two full months after you return, regardless of pre-existing conditions. Obviously if you go this route you need to take great care in establishing the date of your return to the US.

 

In practice, Medicare Advantage is managed care, with all the advantages and disadvantages that brings. It certainly does not work well for someone who travels quite a bit in the US, since emergencies apart you're limited to a local network of providers, as in any managed care plan. Nor does it work well for someone not accustomed to American managed cared, where tests and surgeries and such must be pre-approved and you have a gate-keeper physician who controls your care.

 

In short, traditional Medicare, not Medicare Advantage, provides the flexibility and freedom you want.

[jjczap]

if you have legal US address you can get a Medicare advantage plan the main benefit is that it covers emergency treatment outside the US  heart attack  stroke broken arm/leg  anything that requires emergency treatment   Medicare does not cover outside of US 

[jjczap]

I forgot to mention that you have to have part A and B  some elect wave part B to avoid the monthly payment   look carefully  there are different types  the main ones are POP  and HMO  some allow you to use out of network providers for a higher co pay United Health Care HMO you have to use in state network but out of state you can use Urgent Care centers for a copay of I think 25$   AARP  has a POP plan that looks pretty good 

[taxout]

"If you have legal US address you can get a Medicare advantage plan."

 

NO! You must be resident at that address. See Chapter 2, Sec. 20.3 of the Medicare Managed Care Manual:

 

https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY-2014-MA-Enrollment-and-Disenrollment-Guidance-r.pdf

 

(I'd copy the relevant section here, but it's long and the PDF is set to prohibit copying.)

 

Medicare Advantage plans and premiums vary widely, sometimes just across county lines, so Medicare is alert to fraudulent residence claims. (Under Medicare Advantage, the insuror receives a fixed sum each month from Medicare for assuming responsibility for your care, in addition to whatever premium you might pay. So Medicare has a strong incentive to make sure an insuror only enrolls eligible individuals in its Medicare Advantage plans.)

 

I believe some Medicare Advantage plans do provide limited coverage outside the US. However, I suspect the terms are the same as some Medigap policies that provide limited coverage outside the US: no coverage overseas after you've been outside the US for more than 60 consecutive days, But since Medicare Advantage plans, unlike Medigap plans, aren't standardized I can't confirm the terms of overseas coverage, if any.

 

Bottom line, your horse is going to lose if you enter it into a race against Medicare and the insurors. Don't waste your time.

[Sheryl]

if you have legal US address you can get a Medicare advantage plan the main benefit is that it covers emergency treatment outside the US  heart attack  stroke broken arm/leg  anything that requires emergency treatment   Medicare does not cover outside of US 

I would not count on that emergency overseas cover when they find out -- as they will -- that you have been living in the foreign country most of the time.

Provisions for emergency cover while abroad usually have a time limit attached. You are not covered for an indefinite period.

Anyhow cover in Thailand is irrelevant fir me, I am already well insured here.

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[Blue bruce]

Hi Sheryl, I have had Blue Cross Blue Shield since i enlisted for medicare. The plan I have is supplemental plan F. It covers everything with no deductibles, no co -pay for office visits or any other co -pay. You are also entitled to go to any doctor or specialist in the U.S. With this plan you do not have to be approved by your GP health care provider. As far as traveling is concerned it is limited to 60 days outside the country at one time. 

I am very happy with this plan as I never have to worry about a deductable or co-pay and am free to see any specialist I choose. Hope this helps with your decision.

[jjczap]

I think I used the wrong statement instead of legal address I should have said permanent resident  as defined in the in the Medicare info you pointed out

 

" A permanent residence is normally the primary residence of an individual. Proof of permanent residence is normally established by the address of an individual’s residence, but an MA organization may request additional information such as voter’s registration records, driver’s license records (where such records accurately establish current residence), tax records, and utility bills. Such records must establish the permanent residence address, and not the mailing address, of the individual. "

 

with such documentation permanent residence address is established  and as such you can travel anywhere you want stay as long as you want as long as you maintain your status 

 

As of Oct 1 2020 in the US you will not be able to get on a plane or enter a Gov facility without either a passport or a validated Gov id card  drivers license or ID  a non verified drivers license ok to drive but will not be excepted as ID.  To update your license or id you must go thru the Verify program. To get verified you must be present for photo and provide 4 pieces of evidence as to your address.  For  example SS statement with SS# and address voter registration card property tax statement vehicle registration on and on      once excepted you will be given a new drivers license or id with with a symble that you have been Gov verified as to your legal address or  residence   you will now be in possession of an id that show your permanent residence address   

 

[taxout]

Good luck with that if you're living in Thailand.

 

Anyway, no doubt you'll be paying state income tax, if any, when you "reside" at that US address.

 

We're all adults here and we can all make our own choices. Myself, I strongly suggest others here don't play games with the Feds and don't apply for Medicare Advantage unless they actually reside in the US.

[Sheryl]

13 hours ago, Blue bruce said:

Hi Sheryl, I have had Blue Cross Blue Shield since i enlisted for medicare. The plan I have is supplemental plan F. It covers everything with no deductibles, no co -pay for office visits or any other co -pay. You are also entitled to go to any doctor or specialist in the U.S. With this plan you do not have to be approved by your GP health care provider. As far as traveling is concerned it is limited to 60 days outside the country at one time. 

I am very happy with this plan as I never have to worry about a deductable or co-pay and am free to see any specialist I choose. Hope this helps with your decision.

 

Thanks, but I'm in the US just 1 - 1 1/2  month a year so not really suitable to my circumstances and certainly not worth the cost.

[Sheryl]

12 hours ago, jjczap said:

I think I used the wrong statement instead of legal address I should have said permanent resident  as defined in the in the Medicare info you pointed out

 

" A permanent residence is normally the primary residence of an individual. Proof of permanent residence is normally established by the address of an individual’s residence, but an MA organization may request additional information such as voter’s registration records, driver’s license records (where such records accurately establish current residence), tax records, and utility bills. Such records must establish the permanent residence address, and not the mailing address, of the individual. "

 

with such documentation permanent residence address is established  ....

 

 

no, it is not. Those are just examples of the sort of proof often used and the provider (and Medicare auditors) can ask for as many different proofs as they like. You may have a driver's license but do you have utility bills? Tax rerturns showing you live at that US address?

 

"Primary residence" by any definition means the place a person usually lives. No way can someone living  in Thailand and just making occasional short visits to the US be considered to have primary residence in the US.

[jjczap]

with a smile I think we are dealing with semantics here .  Legal residence  living  staying. I along with many many expats all over the world I know maintain a legal residence in the US. Some own condo some houses   I own a house in my name where the property bill is sent to me at that address  I am a registered voter in the town at that addr the utility bills are in my name at that addr my tax fillings both state and fed at that addr  my SS is in my name at that addr deposited in an US financial company in my name at that addr I just renewed my DR license thru the verify program with the symbol that the state has verified that I am a resident at that addr  my medicare advantage is in my name at that addr I could go on        as a US citizen I can travel to where I want stay where I want for as long as I want and it does not effect my residence status as long as I maintain it

for example for the past 1 1/2 years I have stayed in Euro for 3 months  stayed in  thai for 10 months and now 3 months at my residence and will be going to stay in thai soon for maybe 5 months  before I come back to my residence

This is the  reason I brought up the benefit of  med advantage  in overseas emergencies

Medicare Advantage is not Medicare and if you have plan a and b you can get it thru a private ins company   and when you sign up you are under the rules and policies of that company not Medicare   I have a plan that I pay 0 $ a month and the max out of pocket is 6700   but guess what under law  the ins co offering medi adv is required to provide emergency medical overseas.   So as I tried to tell you guys if you are already have plan b and paying for it for 0$ and can prove residence you get emergency coverage all over the world    

 

 

  

 

 

[Sheryl]

I think the "prove you have residence" part would be a barrier for many of us who have completely settled down here. The only home I own is my Thai home; my tax returns have my Thai address and I take the living abroad tax exemption and have done for the past 20 years or more. I do have a US drivers license but spend maybe a week a year actually at that address and only a month a year in the US. I have voter registration but in a different state than my drivers livense. It wouldn't take much digging to establish that Thailand is my actual primary residence. I certify that fact to the IRS annually.

 

You sound far more established in the US than most of us...still maintaining a personal residence, traveling to different locations with the US as your home base. I agree the pattern you describe does sound like a US resident who just travels a lot.

 

I was responding to the idea that a US drivers license or the like would be enough for someone like me who lives in Thailand to qualify as a permanent resident for MA purposes.

 

As for the emergency coverage, it will not work for someone whose "trip" abroad has lasted many months or even years. There are time limits and they will check your passpirt for entry date.

 

There ate people on this board who have been in Thailand for years yet think Medicare will cover them in a pinch. It won't unless they are well enough to fly back to the US. Obviously someone just visiting short term us another matter

 

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[jjczap]

Sheryl I think we are now in synch   I wish you good luck on your journey  I have read some of your posts  I think you are fair and a a good one enjoy the ride