U.S.A. Topic: Approaching age 65 so therefore it's Medicare time

[Jingthing]

Hi there,

 

I hope I can get some help with this.

 

I have a specific situation that I'm sure isn't uncommon though, but people with other situations most likely wouldn't be able to advise. 

 

My situation:

 

Already have an existing Social Security claim

They know I'm living abroad

(Do have a myssa.com account if that's relevant)

Of course I want to sign up for regular Medicare

I've decided that I also want to sign up for Part B

I understand (ouch) that the fee for Part B is deducted from the social security check

 

My understanding (which may be wrong) is that because I have an existing social security claim (obviously "early) that I will be signed up AUTOMATICALLY for both Medicare and Part B.

 

Is that correct?

If not, what should I do?

Should I expect something in the mail, like a Medicare card, etc.?

 

My understanding also is that people living abroad can't sign up for Medicare Advantage or Part D, etc. True?

 

[olfu]

65 is not full retirement age--its 66 or 67--check with official ssa site.

Part B is not granted--you have to apply in January and it will start from July.

Part B is only for use in US unless you are ex-military.

In short do your home work.

[Jingthing]

10 minutes ago, olfu said:

65 is not full retirement age--its 66 or 67--check with official ssa site.

Part B is not granted--you have to apply in January and it will start from July.

Part B is only for use in US unless you are ex-military.

In short do your home work.

Yes, I know.

I claimed early. 

I'm talking about starting Medicare while living abroad with an existing social security claim.

People living abroad can't access Medicare at all while living abroad.

But I do know for a fact that many expats PAY for Part B so that they don't have to pay the PENALTY if they happen to repatriate.

I didn't start this to get lectured. I'm looking for people that know more than I do. 

[keemapoot]

There are a lot of members here with experience with this issue. Yes, Part A is automatic at age 65 and you do not need to enroll I think. However, Part B is something you have to specifically sign up for, and pay for each month. And, if you miss your 6 month window to sign up, you are penalized with higher premia (unless you have current US health insurance which tolls the time to sign up), so it's important that you do this right. Medicare has a very informative site giving all info. 

 

This issue of whether or not to sign up for Part B is a big issue to consider, even if no plans to repatriate. It might be a good idea for treatment of things like cancer, etc.. I'm going to do the same cost-benefit analysis when my I finally retire and no longer have private global insurance. In my case, I am just past 65, but I do not have to sign up for Part B yet, nor do I get penalized for not signing up as I have US-issued global insurance but live abroad.

[ubonjoe]

You should get a letter in the mail a few months before you turn 65. If your registered address is for here the letter will state you have the option of enrolling in part B by sending a form to medicare.

Part B automatic enrollment is only for those with a US address since medicare does not cover you if living outside the country.

[GinBoy2]

On 4/22/2021 at 6:05 PM, ubonjoe said:

You should get a letter in the mail a few months before you turn 65. If your registered address is for here the letter will state you have the option of enrolling in part B by sending a form to medicare.

Part B automatic enrollment is only for those with a US address since medicare does not cover you if living outside the country.

Part B is the tough one if you are outside the US.

 

It buys you nothing outside of the US, but if at some time down the road, and none of us can predict the future, you do end up repatriating that decision will come back to potentially haunt you.

 

So crack out the crystal ball and try to see what's in your future!

[fearless1]

You are correct. If you are already collecting SS before you turn 65 you will automatically be enrolled in medicare part A and B. You will receive a card in the mail to that effect. If you do nothing, the part B premium will be automatically deducted from your SS payment at the appropriate date. If you do not want the part B you have to notify them and they will issue you a new card that states you have part A only.

[GinBoy2]

9 minutes ago, fearless1 said:

You are correct. If you are already collecting SS before you turn 65 you will automatically be enrolled in medicare part A and B. You will receive a card in the mail to that effect. If you do nothing, the part B premium will be automatically deducted from your SS payment at the appropriate date. If you do not want the part B you have to notify them and they will issue you a new card that states you have part A only.

I think @ubonjoe is correct that automatic Part B enrollment is only for those with a US mailing address. 

Anyone with an overseas address has to make an affirmative option to enroll or decline

[ubonjoe]

19 minutes ago, fearless1 said:

You are correct. If you are already collecting SS before you turn 65 you will automatically be enrolled in medicare part A and B.

That is only correct if you have a US address you are using for the SSA.

If using a foreign address it is not automatic. You have to enroll for part B.

I can say that from my own experience when I was near to my 65th birthday.

 

[EVENKEEL]

How much is Part A & B?

[GinBoy2]

13 minutes ago, EVENKEEL said:

How much is Part A & B?

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

 

[EVENKEEL]

13 minutes ago, GinBoy2 said:

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

 

Seems like Part B is just the beginning, dang.

[GinBoy2]

21 minutes ago, EVENKEEL said:

Seems like Part B is just the beginning, dang.

Well, ain't that the truth.

 

If you have any ongoing medication  you will need Part D.

 

I have a sustaining asthma prescription, which without insurance would cost me $400/month

 

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans

 

[fearless1]

2 hours ago, ubonjoe said:

That is only correct if you have a US address you are using for the SSA.

If using a foreign address it is not automatic. You have to enroll for part B.

I can say that from my own experience when I was near to my 65th birthday.

 

I use a USA address so I was unaware of the process when using a Thailand address. Simplification of doing my taxes and social security are two of the reasons that I use the address that I do.

[Jingthing]

On 4/27/2021 at 8:39 PM, GinBoy2 said:

Well, ain't that the truth.

 

If you have any ongoing medication  you will need Part D.

 

I have a sustaining asthma prescription, which without insurance would cost me $400/month

 

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans

 

Can people on record with a foreign address even sign up for Part D?

My understanding is that people with foreign addresses can only get Part A (standard) and Part B (extra fee).

[Jingthing]

On 4/27/2021 at 9:05 PM, fearless1 said:

I use a USA address so I was unaware of the process when using a Thailand address. Simplification of doing my taxes and social security are two of the reasons that I use the address that I do.

Yes, I know many people do that. 

But as stated in the O.P., this is about the situation of using a Thai address and already having a claim going with social security before age 65.

[cmarshall]

4 hours ago, Jingthing said:

Can people on record with a foreign address even sign up for Part D?

My understanding is that people with foreign addresses can only get Part A (standard) and Part B (extra fee).

 

No.  You must be a US resident to sign up for any Medicare part, except parts A and B.  No doubt there are expats who do sign up for some of these options, but they are committing fraud and might be denied reimbursement if Medicare ever learned of it.

[Jingthing]

1 hour ago, cmarshall said:

 

No.  You must be a US resident to sign up for any Medicare part, except parts A and B.  No doubt there are expats who do sign up for some of these options, but they are committing fraud and might be denied reimbursement if Medicare ever learned of it.

Thanks.

It's my understanding that even telling Social Security that you live in the US when you don't is considered fraud as well. I know lots of people do that. It prevents the need for the notorious  "proof of life" letters.

[taxout]

There's another issue.

 

Medigap, Medicare Advantage and Part D premiums all vary depending on where you live (unlike Part B premiums). So accurately reporting your actual residential address does matter for everyone on those plans.

[Jingthing]

12 minutes ago, taxout said:

There's another issue.

 

Medigap, Medicare Advantage and Part D premiums all vary depending on where you live (unlike Part B premiums). So accurately reporting your actual residential address does matter for everyone on those plans.

Makes sense. 

I assume many expats are using their virtual mailbox as their address.

Do you think they're setting themselves up for headaches if they repatriate?

Of course if you're lying about your reside and there are never any bad consequences I guess that's a win.

[taxout]

I haven't time to find it, but somewhere in POMS, the SS operations manual, there's a whole section dealing with residency determinations. As said, it's an issue that comes up a lot as people try to establish a residency where premiums are lower.

[Jingthing]

3 hours ago, taxout said:

I haven't time to find it, but somewhere in POMS, the SS operations manual, there's a whole section dealing with residency determinations. As said, it's an issue that comes up a lot as people try to establish a residency where premiums are lower.

I recall reading a report here of an expat being caught by SS as faking US residence while living in Thailand. The benefits were cut off and very hard to reinstate and I think it was mentioned that SS considered it serious fraud and could have even prosecuted it.

[frantick]

I just went through this in December last year. Retired from my job the last day of 2019 at 64 years old. Moved here late Jan, 2020, yeah, right when covid showed up. First SS check in February. Kept my US address; mostly for banking.

 

Turned 65 in December last year and received the Medicare card a couple months before. Part B was automatic. I assume because of my US address. I don't do drugs or visit doctors so I didn't look into advantage plans. I decided to take part B, after much thought, because it's only about $150 and I didn't want the 10% penalty for each year knowing that I'll probably be forced back to the USA some day due to old age illnesses. What's ฿4000 a month, right?

 

Because I made good money in 2019, they were taking double or more for the part B even though my post-retirement 2020 income was much less. Once I filed my 2020 taxes, this Feb, and got my refunds, I sent the info to SS/Medicare to get the premium reduced, which they've done and already refunded my over payments.

 

As Medicare is NOT applicable in Thailand, ie they won't pay, I see no reason that they would be concerned that you have a US address, but living in Thailand. I'm not talking about advantage plans that may have travel options.

 

It's not like the UK where you have to reestablish residency and start paying taxes again to get healthcare. But, I could be wrong and would like to see something official if it exists.

 

I'd have no problem changing my address on file with SS, other than those dead letters having to send every year. (Mail here sucks.) I could still maintain a US address for my banks I suppose.

 

Also, in my part B premium reduction packet, I did tell them I was living in Thailand until this covid situation is over.

 

Anyway, that's my experience so far.

 

C

 

 

 

 

[keemapoot]

14 hours ago, taxout said:

There's another issue.

 

Medigap, Medicare Advantage and Part D premiums all vary depending on where you live (unlike Part B premiums). So accurately reporting your actual residential address does matter for everyone on those plans.

 

I've looked into this issue quite a bit and was even considering returning to the US long enough to establish a real residence (may still do that) so that I could qualify to purchase a Medigap policy which fills in the gaps. My analysis is that if you want to keep Medicare as a backup major event/illness (requiring you to return to the US for maybe long term treatment) insurance plan, that it really only makes sense to combine Part B with a Medigap G policy. The total cost for this is about $200/month, and once you get approved as a US resident, there is no penalty at all if you move back to Thailand or anywhere else abroad. Paying about $150/mo. for Part B only is not really a good deal in my view, as you still have all the deductibles and other stuff where you would still be out of pocket a lot in a major event. 

 

So, for me, with a permanent home in Thailand, my analysis is that I am thinking that unless I can sign up for a cheap medigap policy, it doesn't make sense to waste $150/mo. for Part B long term if no intention of repatriating to the US. Fortunately, I am still covered on a large employer's policy, so even though past 65, I do not yet have to decide whether to sign up for Part B or not.

 

With respect to Part D drugs, it makes no sense to sign up for that unless you are in the US all the time.

[cmarshall]

1 hour ago, keemapoot said:

 

I've looked into this issue quite a bit and was even considering returning to the US long enough to establish a real residence (may still do that) so that I could qualify to purchase a Medigap policy which fills in the gaps. My analysis is that if you want to keep Medicare as a backup major event/illness (requiring you to return to the US for maybe long term treatment) insurance plan, that it really only makes sense to combine Part B with a Medigap G policy. The total cost for this is about $200/month, and once you get approved as a US resident, there is no penalty at all if you move back to Thailand or anywhere else abroad. Paying about $150/mo. for Part B only is not really a good deal in my view, as you still have all the deductibles and other stuff where you would still be out of pocket a lot in a major event. 

 

So, for me, with a permanent home in Thailand, my analysis is that I am thinking that unless I can sign up for a cheap medigap policy, it doesn't make sense to waste $150/mo. for Part B long term if no intention of repatriating to the US. Fortunately, I am still covered on a large employer's policy, so even though past 65, I do not yet have to decide whether to sign up for Part B or not.

 

With respect to Part D drugs, it makes no sense to sign up for that unless you are in the US all the time.

 

No, no, no, no, no.  This is idiocy.  In the first case you are recommending committing fraud.  If you don't reside in the US you are not eligible to buy a Medigap policy and if you claim to be living in the US when you are not, that is fraud.  If the insurer decides to investigate before paying your claim, it will be refused.

 

Secondly, there is no need to buy Medigap or any other Medicare product while you live in Thailand.  At any time when you return to live in the US after having been living abroad you have sixty days to buy any Medicare-related product without penalty and without excluding pre-existing conditions.  The only exception is Part B for which you would have a lifelong penalty if you decided to resume coverage after having dropped it.  

[keemapoot]

Just now, cmarshall said:

 

No, no, no, no, no.  This is idiocy.  In the first case you are recommending committing fraud.  If you don't reside in the US you are not eligible to buy a Medigap policy and if you claim to be living in the US when you are not, that is fraud.  If the insurer decides to investigate before paying your claim, it will be refused.

 

Secondly, there is no need to buy Medigap or any other Medicare product while you live in Thailand.  At any time when you return to live in the US after having been living abroad you have sixty days to buy any Medicare-related product without penalty and without excluding pre-existing conditions.  The only exception is Part B for which you would have a lifelong penalty if you decided to resume coverage after having dropped it.  

 

First, there is no fraud involved. In the first instance, I believe you are referring to Medicare ADVANTAGE plans, which do require you to live in the US and for which there could be fraud claims. Medigap plans are different. There is no fraud so long as when you first enroll you are living in the US. You are then free to move abroad and keep your medigap policy.

 

Second, I am considering this as a permanent expat only, not one who intends to repatriate at some time in the future. And, insofar as guaranteed issue (cannot be declined for pre-existing conditions), I believe this can only be guaranteed during the SEP (special enrollment period) after signing up for Part B.

 

So, again, for me the calculus is to either not sign up for Part B or Medigap and self insure abroad, or to return briefly to the US, sign up for Part B and medigap and then return to Thailand permanently. In either event, I will self insure for normal health care events, and the medicare is a backup for major illness or major treatment events where I could return to the US for treatment.

[cmarshall]

6 minutes ago, keemapoot said:

 

First, there is no fraud involved. In the first instance, I believe you are referring to Medicare ADVANTAGE plans, which do require you to live in the US and for which there could be fraud claims. Medigap plans are different. There is no fraud so long as when you first enroll you are living in the US. You are then free to move abroad and keep your medigap policy.

 

Second, I am considering this as a permanent expat only, not one who intends to repatriate at some time in the future. And, insofar as guaranteed issue (cannot be declined for pre-existing conditions), I believe this can only be guaranteed during the SEP (special enrollment period) after signing up for Part B.

 

So, again, for me the calculus is to either not sign up for Part B or Medigap and self insure abroad, or to return briefly to the US, sign up for Part B and medigap and then return to Thailand permanently. In either event, I will self insure for normal health care events, and the medicare is a backup for major illness or major treatment events where I could return to the US for treatment.

 

Oh yes, what you have described is indeed fraud.  If you change your address you are obligated to inform the SSA.  If you don't believe me, ring up Medicare and ask their opinion.  Be sure to identify yourself fully and include your SS number.

 

 If you receive benefits from Social Security, you have a legal obligation to report changes, which could affect your eligibility for disability, retirement, and Supplemental Security Income (SSI) benefits. You must report any changes that may affect your benefits immediately, and no later than 10 days after the end of the month in which the change.

 

https://blog.ssa.gov/reporting-changes-is-your-responsibility/

 

The SSA will be happy to inform Medicare for you.

 

A returning expat who is a US citizen indeed has his own Special Enrollment Period for sixty days after returning.  This has nothing to do with the annual SEP that all US residents have each year.  So, if you get sick or just decide to move back to the US, then you go back and sign up within sixty days for whatever Medicare programs you want and you are covered.  So, in addition to committing fraud you will have been wasting money by buying coverage you can use while living in Thailand.

 

So, idiocy.

[keemapoot]

1 minute ago, cmarshall said:

 

Oh yes, what you have described is indeed fraud.  If you change your address you are obligated to inform the SSA.  If you don't believe me, ring up Medicare and ask their opinion.  Be sure to identify yourself fully and include your SS number.

 

 If you receive benefits from Social Security, you have a legal obligation to report changes, which could affect your eligibility for disability, retirement, and Supplemental Security Income (SSI) benefits. You must report any changes that may affect your benefits immediately, and no later than 10 days after the end of the month in which the change.

 

https://blog.ssa.gov/reporting-changes-is-your-responsibility/

 

The SSA will be happy to inform Medicare for you.

 

A returning expat who is a US citizen indeed has his own Special Enrollment Period for sixty days after returning.  This has nothing to do with the annual SEP that all US residents have each year.  So, if you get sick or just decide to move back to the US, then you go back and sign up within sixty days for whatever Medicare programs you want and you are covered.  So, in addition to committing fraud you will have been wasting money by buying coverage you can use while living in Thailand.

 

So, idiocy.

 

Must be having a bad morning to be using idiocy so often in such childishly condescending and misinformed posts.

 

There is no fraud whatsoever in someone, who is already enrolled in Part A, and who, by virtue of continuing to be covered by health insurance, is not yet required to sign up for Part B, and then upon termination of employment - returns to the US and establishes residency - and thereupon exercises the Special Enrollment Period for THIS TYPE of person and enrolls in both Part B, and at the same time signs up for a Medigap policy, who then elects to move back to Thailand. There is absolutely no prohibition anywhere in any SSA or Medicare regulations that would prohibit this.

 

Furthermore, whether it's wasting money or not is a calculation to be done. For a person with pre-existing conditions which would be excluded by health insurance procured in Thailand, it may not be a waste of money to pay 6,000 Baht a month for those as a backup plan.

 

 

[cmarshall]

29 minutes ago, keemapoot said:

 

Must be having a bad morning to be using idiocy so often in such childishly condescending and misinformed posts.

 

There is no fraud whatsoever in someone, who is already enrolled in Part A, and who, by virtue of continuing to be covered by health insurance, is not yet required to sign up for Part B, and then upon termination of employment - returns to the US and establishes residency - and thereupon exercises the Special Enrollment Period for THIS TYPE of person and enrolls in both Part B, and at the same time signs up for a Medigap policy, who then elects to move back to Thailand. There is absolutely no prohibition anywhere in any SSA or Medicare regulations that would prohibit this.

 

Furthermore, whether it's wasting money or not is a calculation to be done. For a person with pre-existing conditions which would be excluded by health insurance procured in Thailand, it may not be a waste of money to pay 6,000 Baht a month for those as a backup plan.

 

Did you inform Medicare via the Social Security Administration that your current address is now in Thailand as required?

 

A returning expat has his own Special Enrollment Period which applies to all Medicare-related products EXCEPT Part A and B for which he would have wait for the standard SEP period to come around.  Perhaps that's what you did.

 

Since you are eligible to sign up for Medigap during your own sixty-day SEP without penalties and without exclusions when you have returned to the US as long as you already have Part B, what benefit do imagine you are getting by paying the premiums now?  

 

You are giving out bad information here.

[taxout]

"So, if you get sick or just decide to move back to the US, then you go back and sign up within sixty days for whatever Medicare programs you want and you are covered."

 

This is plain wrong and dangerously bad advice to other posters here.

 

First, if you don't take and pay for Part B when you turn 65, then on returning to the U.S. and enrolling at a later time you will pay the penalty and you will wait for it to take effect, with the wait possibly over a year.

 

Second, the 60-day grace period for returning expats does NOT apply to Medigap. It only applies to Medicare Advantage and Part D.