Moving to USA and applying for Medicare Supplement and RX Plans

[BobTH]

For your information. I moved back to the USA after living 8 years in Thailand. Having applied for Medicare when I became eligible while living in Thailand. As you know you can't sign up for the Medicare supplemental and RX until you return to the USA. I assumed that it would be no problem and when I went to apply I found that they wanted me to prove I was insured while living in Thailand from the time I became eligible for medicare or be penalized for ever and pay a higher monthly premium. This was for both the supplemental and RX plans. I did have insurance while living in Thailand so I was able to show it after a few phone calls I was not penalized. Anyway I have been a member of this forum for  the entire time I lived in Thailand and never saw this mentioned. So I thought I would give a heads up for those that might return back to the USA and needing the supplemental and RX plans back here. I hope this is the correct forum for this thread, thanks.    

[PatchinExPat]

I have Medicare and Medicare part B. When you say supplemental, are you talking about part B

or something through a company like Blue Cross.

I am thinking I too will return some time in the next 12 months.

 

[Langsuan Man]

It has always been that way, OP did not sign up for Medicare Part A, it was given to him automatically when he turned 65 and does not effect his monthly Social Security payment

 

Part B is the coverage that you must apply for and is designed: 

Quote

Medicare Part B covers medical services, including doctor visits, preventive screenings, certain vaccinations, lab tests, and durable medical equipment.

You also pay for Part B via a deduction from your Social Security payment. You can also purchase a separate policy from most private insurers that will pay anything over the part B allowance

 

But this is where the OP's problem is since if he didn't apply for part B:

Quote

if you don't sign up for Medicare Part B when you're first eligible, you'll have to pay a late enrollment penalty.

And the rate goes up 10% per year if you don't apply when eligible

 

And  for the OP's information , if your income goes over a certain threshold you will pay an additional fee call a Medicaid Surcharge for your part B coverage

 

source:https://www.medicare.gov/what-medicare-covers/what-part-b-covers

[BobTH]

The Medicare Supplement plan I was referring to is called AARP United Healthcare Insurance Supplement Plan G. The RX is a Humana Medicare RX Prescription Drug Coverage. These two companies required me to prove I had insurance in Thailand. And yes I did apply for part B when I still lived in Thailand and enrolled in the allotted time frame without penalty.  

 

Edited May 15, 2020 by BobTH

[cmarshall]

2 hours ago, BobTH said:

The Medicare Supplement plan I was referring to is called AARP United Healthcare Insurance Supplement Plan G. The RX is a Humana Medicare RX Prescription Drug Coverage. These two companies required me to prove I had insurance in Thailand. And yes I did apply for part B when I still lived in Thailand and enrolled in the allotted time frame without penalty.  

 

That's disturbing news.  Instead of the private supplemental insurance you list, have you considered applying for Medicare Part D for drugs?  My understanding that on returning to the US you can apply for Part D without any penalty and without exclusion of any existing conditions.  I don't know if there is a Medicare Part that would replace the AARP supplement.

[Dwig]

Have you been using any part of your Medicare A or B?  When I return for a visit I always go in for a wellness checkup under Humana.  Never had a problem.  They deduct part A B from SS check each month.  I even get a 3 months supply of drugs while there.    I am not sure why they would insist on me being covered while out of county.  

[thailand49]

One can miss it the reason I never tell anyone especially government what I'm doing and going! Talk is really cheap they use words like global economy but have no idea what it really means. So when I signed up while living in Thailand I went with the zero monthly package offer in certain zip code so I don't run into such a problem.  You should have just told them you took a chance because you travel a lot. The more the government knows the more problems???? it is true they can't run <deleted>!

[Pib]

 

Quote

 I did have insurance while living in Thailand so I was able to show it after a few phone calls I was not penalized.

OP,

   Do you mean you showed your had "Medicare Part A & B coverage" or are you talking about showing some other kind of coverage?  I assume you mean Part A & B, but want to be sure. 

 

   Since the plans you applied for are also commonly referred to as  MediGap plans and benefits are standardized by the federal govt regardless of the company selling such plans, sounds like AARP and Humana just don't have the capability to confirm you had coverage so they could comply with federal law...requires the individual to provide that proof.  Sounds like standard operating procedure.

 

   

[wpcoe]

I turned 65 this month.  I verified via the ssa.gov web site that I was enrolled automatically in Part A on 01-May-2020.  I had called Medicare in the USA to enroll in Parts B & D and they advised that they could only assist residents living in the USA to enroll in the supplemental parts, so I managed to get the embassy to submit my enrollment for Part B, but they said Part D must be enrolled via the USA office.  I was going to give the embassy a week to get the paperwork filed and then call the USA Medicare office again next week to see about enrolling in Part D.

 

I pay for an Aetna (BUPA) full-coverage health insurance policy in Thailand.  Could I have waited to enroll in Part B -- without penalty -- until such time as I moved back to the USA, providing I kept the Aetna policy?  (Asking for friends who will soon be reaching my age.)

 

Also, is it possible to enroll in Part D with the USA Medicare office?  And, as with Part B, the same question:  can I delay enrollment -- without penalty -- in Part D as long as I maintain the Aetna policy?

Edited May 15, 2020 by wpcoe

[CMBob]

38 minutes ago, wpcoe said:

....Could I have waited to enroll in Part B -- without penalty -- until such time as I moved back to the USA, providing I kept the Aetna policy?  (Asking for friends who will soon be reaching my age.)

Can't answer your Part D question....but, with respect to Part B, there's a 10% premium penalty (which you pay forever) for each 12-month time period you don't sign up past age 65.  You can go to the Medicare website and it's fairly plainly spelled out there about the penalty (and few exceptions).

 

 

[bkk6060]

56 minutes ago, wpcoe said:

I managed to get the embassy to submit my enrollment for Part B

What embassy was that?

[AAArdvark]

Were you paying the Medicare monthly payments which are usually done by deduction from your social security payments?

They want you to prove that you either had been paying for social security or had a qualified insurance plan which would have exempted you.  If your insurance was with a non-US company, I doubt they would accept that.

 

Otherwise, millions of people start off with plain Medicare and then switch to either an Advantage plan or a Supplemental plan.  You should be able to access either Medicare or Social Security to verify that you were paying for Medicare.

[Sheryl]

9 hours ago, BobTH said:

The Medicare Supplement plan I was referring to is called AARP United Healthcare Insurance Supplement Plan G. The RX is a Humana Medicare RX Prescription Drug Coverage. These two companies required me to prove I had insurance in Thailand. And yes I did apply for part B when I still lived in Thailand and enrolled in the allotted time frame without penalty.  

 

Then something was wrong, as there is no penalty for not having a Medicate Supplemental Plan, only for late enrollment into Part B.

 

Unless this is some rule of the private insurer. Not a Medicare rule. But I doubt it. Sounds like they were confused and thought you had not had Part B. For that, there is a lifelong penalty unless you were abroad and can prove your were insured there.

[AAArdvark]

One other thing is that you have to show that you had a life change.  Meaning, that normally you can only enroll in an Advantage plan during the normal enrollment period (December).  

[Pib]

31 minutes ago, Sheryl said:

Then something was wrong, as there is no penalty for not having a Medicate Supplemental Plan, only for late enrollment into Part B.

 

Unless this is some rule of the private insurer. Not a Medicare rule. But I doubt it. Sounds like they were confused and thought you had not had Part B. For that, there is a lifelong penalty unless you were abroad and can prove your were insured there.

There can be penalty for late Medigap policy enrollment....with late enrollment being outside the 6 month period of turning 65...the time when become eligible for Part A/B.   After that window Medigap policy providers can charge your higher rates, refuse to sell you a policy, etc.   Take a look at below article and partial quote from it.

 

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/supplemental-insurance-for-original-medicare-medigaps/medigap-purchasing-details-enrollment-periods-guaranteed-issue-and-more

 

Quote

 

Buying a Medigap outside protected enrollment periods

You may run into problems if you try to buy a Medigap policy outside a protected enrollment period. For instance, companies can refuse to sell you one or impose certain medical requirements. If a company does agree to sell you a policy, you may need to pay a higher monthly premium and be subject to a six-month waiting period before the Medigap will cover pre-existing conditions. Be sure to contact Medigap insurers in your state to learn if they will sell you a Medigap policy outside protected enrollment periods.

 

 

[taxout]

The typical returning expat has no guaranteed right to a Medigap policy.

 

However, there IS a guaranteed right to Part D prescription drug coverage without penalty, so long as you enroll within two months of your return to the U.S.

 

And there IS a guaranteed right to enroll in a Medicare Advantage plan (the HMO-like option) without penalty, again, so long as you enroll within two months of returning to the U.S.

 

As I understand the rules, if you enroll in a Medicare Advantage plan and later move outside the plan area, you have the right in your new area of residence to enroll in a Medicare Advantage OR a Medigap policy. It would be interesting to know whether anyone has used this approach to obtain Medigap coverage when returning to the U.S.

 

Because the two-month rule is quite short, if you're planning to use it you have to be very careful about delineating your period of foreign and U.S. residence.

[Pib]

 

https://www.cnbc.com/2019/08/08/retiring-overseas-how-medicare-may-or-may-not-fit-into-your-plans.html

Quote

 

For people living abroad who sign up for Part D upon returning to the U.S., there is no late-enrollment penalty as long as you get coverage within a certain time frame of relocating (either two or three months, depending on the specifics of your situation).

If you miss your window, you’ll face a life-lasting penalty of 1% for each month that you didn’t have coverage but should have, along with a possible delay in when coverage is effective. That penalty amount is based on the “national base premium,” which in 2019 is about $33.

 

 

[flbkk]

You have 6 months after you turn 65 to enroll in any Medicare Advantage (HMO, good only on your county with their doctors/hospitals, except for USA emergencies) or Medigap (pays for most deductible and copay to any Medicare doctor/hospital in USA). After the 6 months, unless possibly if you had other coverage or certain life changing events) Advantage and Medigap plans may require medical underwriting–they may not take you unless you are sick. Some of these planes provide a 60 day travel coverage, $250 deductible and $50,000 lifetime maximum. You cannot say you live overseas to sign up for any of these. I keep Plan Hi F Medigap (covers everything after $2000 deductible) in USA + Part D (bought from insurance company, not directly from government like Part A And B) dental and vision on USA.  Won’t help me in Thailand but if I return to USA I don’t want to face waiting periods, open enrollment period, lack of coverage choice. 

[BobTH]

1 hour ago, Sheryl said:

Then something was wrong, as there is no penalty for not having a Medicate Supplemental Plan, only for late enrollment into Part B.

 

Unless this is some rule of the private insurer. Not a Medicare rule. But I doubt it. Sounds like they were confused and thought you had not had Part B. For that, there is a lifelong penalty unless you were abroad and can prove your were insured there.

When still in Thailand I enrolled in Part B through the US Embassy in the Philippines. So I was paying for it knowing I could not use it overseas thinking I might move home and not wanting the lifetime penalty. I made it perfectly clear to them when I moved back and although you are correct, the situation was something they were not used to dealing with. Both policies (AARP United Healthcare Insurance Supplement Plan G. The RX is a Humana Medicare RX Prescription Drug Coverage) wanted proof of coverage in Thailand. I had to explain on a recorded deposition, explaining I was covered under the Thai Health Insurance company LTD. I was not expecting this questioning either, and perhaps it was the private companies policy rules but it happened. I only wanted to share my experience so other forum members could prepare for this questioning. I was not penalized on either policy but they were suggesting lifelong penalties.

[Thomas J]

13 hours ago, BobTH said:

For your information. I moved back to the USA after living 8 years in Thailand

BobTH 

 

There are three sections to Medicare A, B, and D.  A you automatically and it covers hospitalization.  B you have to sign up for and it covers Doctors expenses.  If you don't sign up for it when you are first eligible the cost does increase.  D covers prescription drugs.  There are Medicap supplemental plans offered by private insurance carriers to covers some or all of the expense that Medicare might not cover.  Personally if I were you, I would look for a Medicare Advantage Program.  This is a HMO that covers A, B, and D.  In many metro areas you have a huge choice of doctors and hospitals and they offer varying coverages within the HMO plans.  I found they are markedly cheaper at least in my area of West Michigan offering the most doctors and often even supplemental benefits like a free health club membership.  

[ThailandRyan]

4 hours ago, Dwig said:

Have you been using any part of your Medicare A or B?  When I return for a visit I always go in for a wellness checkup under Humana.  Never had a problem.  They deduct part A B from SS check each month.  I even get a 3 months supply of drugs while there.    I am not sure why they would insist on me being covered while out of county.  

This is exactly why its important to make a trip yearly back to the US to keep the benefits active if you have them..

[wwest5829]

4 hours ago, CMBob said:

Can't answer your Part D question....but, with respect to Part B, there's a 10% premium penalty (which you pay forever) for each 12-month time period you don't sign up past age 65.  You can go to the Medicare website and it's fairly plainly spelled out there about the penalty (and few exceptions).

 

 

My understanding is that all citizens eligible for retirement benefits are automatically enrolled in Medicare, Part A at age 65. I also signed up for Part B, for which I pay a monthly premium. As I reside outside US territory, I am not eligible to recieve the benefits. A bit of an issue as I note military retirees are accorded global medical coverage. Both are earned benefits.

[ericthai]

14 hours ago, Langsuan Man said:

It has always been that way, OP did not sign up for Medicare Part A, it was given to him automatically when he turned 65 and does not effect his monthly Social Security payment

 

Part B is the coverage that you must apply for and is designed: 

You also pay for Part B via a deduction from your Social Security payment. You can also purchase a separate policy from most private insurers that will pay anything over the part B allowance

 

But this is where the OP's problem is since if he didn't apply for part B:

And the rate goes up 10% per year if you don't apply when eligible

 

And  for the OP's information , if your income goes over a certain threshold you will pay an additional fee call a Medicaid Surcharge for your part B coverage

 

source:https://www.medicare.gov/what-medicare-covers/what-part-b-covers

Also part D if you dont sign up when eligible or have creditable coverage you will pay a penelty which is 1% per for every month you did not sign up.  Any questions you can PM me I worked in the medicare insurance market for several years. 

[ericthai]

13 hours ago, BobTH said:

The Medicare Supplement plan I was referring to is called AARP United Healthcare Insurance Supplement Plan G. The RX is a Humana Medicare RX Prescription Drug Coverage. These two companies required me to prove I had insurance in Thailand. And yes I did apply for part B when I still lived in Thailand and enrolled in the allotted time frame without penalty.  

 

Have you checked into Medicare advantage plans?  Typically an advantage plan will include RX coverage.  Premiums are anywhere from $0 per month upto $110, the cost of the plans are dependent on location. There are limitations, you have to stay in network in most cases, but the costs are typically much lower over a 12 month period. A visit to your primary is anywhere from $0 - $25, plans usually include dental, vision, hearing and transportation.  Best is they have a Max out of Pocket, so once you hit the max out of pocket you stop paying the plan pays 100%. Max out of pocket ranges anywhere from $1500-$10,000  the $1500 would be an HMO ( need to stay in network) the $10,000 would be a PPO (allows you to go out of network). 

 

If you have any health issues i.e. Diabetes, Hypertension, etc typically there are special Medicare Advantage plans that provide more benefits and in some places lower your Medicare part B payment ($144.60). 

 

The supplement plans are good, they allow freedom that you can go to any doctor that accepts Medicare. However you have the monthly premium which will depend on age and location, Ive seen as low as $125 a month and has high as $550 a month, then you still need your part D coverage this ranges from $15-65 per month.  There are allot of options and it can get complicated. If you have any questions you can PM me. 

 

 

[ericthai]

5 hours ago, Pib said:

 

OP,

   Do you mean you showed your had "Medicare Part A & B coverage" or are you talking about showing some other kind of coverage?  I assume you mean Part A & B, but want to be sure. 

 

   Since the plans you applied for are also commonly referred to as  MediGap plans and benefits are standardized by the federal govt regardless of the company selling such plans, sounds like AARP and Humana just don't have the capability to confirm you had coverage so they could comply with federal law...requires the individual to provide that proof.  Sounds like standard operating procedure.

 

   

correct, if you have what is considered creditable coverage (has to cover the same Medicare) then you will not have any penalties for not enrolling when eligible. The responsibility to prove this is always with the beneficiary.  

 

I've seen issues where people turned 65 stay on their spouses medical coverage which was not creditable and had to pay a penalty.  It's terrible because people dont know and then get hit with a $200-300 a month penitently for life!.

[ericthai]

5 hours ago, wpcoe said:

I turned 65 this month.  I verified via the ssa.gov web site that I was enrolled automatically in Part A on 01-May-2020.  I had called Medicare in the USA to enroll in Parts B & D and they advised that they could only assist residents living in the USA to enroll in the supplemental parts, so I managed to get the embassy to submit my enrollment for Part B, but they said Part D must be enrolled via the USA office.  I was going to give the embassy a week to get the paperwork filed and then call the USA Medicare office again next week to see about enrolling in Part D.

 

I pay for an Aetna (BUPA) full-coverage health insurance policy in Thailand.  Could I have waited to enroll in Part B -- without penalty -- until such time as I moved back to the USA, providing I kept the Aetna policy?  (Asking for friends who will soon be reaching my age.)

 

Also, is it possible to enroll in Part D with the USA Medicare office?  And, as with Part B, the same question:  can I delay enrollment -- without penalty -- in Part D as long as I maintain the Aetna policy?

depends on your Aetna policy, it needs to be considered credible coverage by medicare.  For part D, I would not contact medicare. Do a web search for part D providers, Do you have a US address? 

[ericthai]

3 hours ago, flbkk said:

You have 6 months after you turn 65 to enroll in any Medicare Advantage (HMO, good only on your county with their doctors/hospitals, except for USA emergencies) or Medigap (pays for most deductible and copay to any Medicare doctor/hospital in USA). After the 6 months, unless possibly if you had other coverage or certain life changing events) Advantage and Medigap plans may require medical underwriting–they may not take you unless you are sick. Some of these planes provide a 60 day travel coverage, $250 deductible and $50,000 lifetime maximum. You cannot say you live overseas to sign up for any of these. I keep Plan Hi F Medigap (covers everything after $2000 deductible) in USA + Part D (bought from insurance company, not directly from government like Part A And B) dental and vision on USA.  Won’t help me in Thailand but if I return to USA I don’t want to face waiting periods, open enrollment period, lack of coverage choice. 

The 6 months is incorrect. You have a 7 month window to enroll into medicare (3 month prior, the month you turn 65, and 3 months after the month you turn 65). Once enrolled in Medicare you can enroll in a medicare advantage or supplement (medigap) during the same window. Life change events (marriage, childs birth, etc)  dont effect enrollment windows.  To be able to enroll outside AEP (annual enrollment period Sept 15th- Dec 7th) you would either need to have moved from one service area to another service area or have qualified for medicaid or qualified for a Special Needs plan due to health conditions.  Medicare advantage plans can not refuse your enrollment no matter your health conditions. Only exceptions is if you have renal disease (end stage Kidney failure) other than that a Medicare Advantage plan can not refuse you due to health conditions.  Medicare supplement (medigap) plans can refuse enrollment, and or increase rates. Advantage plans the rates are same for everyone.

[ericthai]

1 hour ago, wwest5829 said:

My understanding is that all citizens eligible for retirement benefits are automatically enrolled in Medicare, Part A at age 65. I also signed up for Part B, for which I pay a monthly premium. As I reside outside US territory, I am not eligible to recieve the benefits. A bit of an issue as I note military retirees are accorded global medical coverage. Both are earned benefits.

Correct if eligible for free part A (need to work about 10 years) you are auto enrolled. Part B is optional, good you signed up to avoid the penalty. The issue was people would not enroll in part B when turning 65 so not pay the part B premium and then they get sick and run out sign up for part B and this was becoming a big issue so they instituted the penalty.

 

It would be nice if Medicare could pay something for citizens enrolled and living outside the USA.

 

The military have their own coverage for retired service families called Tricare. This is the best coverage and covers worldwide, which our men and women deserve it!!

[BobTH]

53 minutes ago, ericthai said:

Have you checked into Medicare advantage plans?  Typically an advantage plan will include RX coverage.  Premiums are anywhere from $0 per month upto $110, the cost of the plans are dependent on location. There are limitations, you have to stay in network in most cases, but the costs are typically much lower over a 12 month period. A visit to your primary is anywhere from $0 - $25, plans usually include dental, vision, hearing and transportation.  Best is they have a Max out of Pocket, so once you hit the max out of pocket you stop paying the plan pays 100%. Max out of pocket ranges anywhere from $1500-$10,000  the $1500 would be an HMO ( need to stay in network) the $10,000 would be a PPO (allows you to go out of network). 

 

If you have any health issues i.e. Diabetes, Hypertension, etc typically there are special Medicare Advantage plans that provide more benefits and in some places lower your Medicare part B payment ($144.60). 

 

The supplement plans are good, they allow freedom that you can go to any doctor that accepts Medicare. However you have the monthly premium which will depend on age and location, Ive seen as low as $125 a month and has high as $550 a month, then you still need your part D coverage this ranges from $15-65 per month.  There are allot of options and it can get complicated. If you have any questions you can PM me. 

 

 

I looked at all the plans and met with someone who was independent to explain all the different plans and companies. I knew what I wanted and it was covered by the plan G that I opted for. Yes I pay a monthly premium but I can go to any doctor anywhere in the country that takes Medicare. And the coverage if you become seriously ill long-term is much better. I recently had surgery that was billed at $86,000 US, I paid $179 out of pocket. The plans can get confusing, but I did my homework and got the plan that fit me.

[wpcoe]

I'm getting a clearer picture of the situation now.  Thanks to all who have posted.

 

Do you have to have Medicare Parts B & D to subscribe to a Medicare Advantage plan?  When I've looked at (admittedly, summaries of) Medicare Advantage plans on the internet, I didn't see any reference to Parts B & D, particularly not a different (higher) premium if you didn't pay for Parts B & D.