How to sign up for Medicare Part B during initial enrollment period as a Thai addressed expat?

[Jingthing]

1 hour ago, ChristianBlessing said:

I suggest continuing to call Medicare or visit/correspond with Manila. I'm nearly certain you will not be automatically enrolled in part B. Two years ago I returned to the US from abroad at age 68 and visited a local Social Security office to ascertain my status as MySS only showed me enrolled in Part A. Despite having a US address I had not been enrolled. Thankfully I was able to demonstrate coverage for the previous 3 years and the 3 month window (from the date at which my private coverage ended) so as to avoid the penalty.

 

I did not apply for Part D until a year later, and believe me, it's painful being stuck with the ensuing penalty.

 

Good luck.

I am assuming you were not claiming Social Security before age 65. I think if you had been that with a U.S. address that you would have been automatically enrolled in A and B. 

Expats with a Social Security claim before 65 based on a foreign address will be enrolled in A but not B.

[wpcoe]

Is there a Social Security and/or Medicare representative at the US Embassy in Bangkok?

 

I turned 65 while living full-time in Mexico, and I'd need to track down any notes I might have to be sure of the exact process, but I know I talked to a SSA representative by calling a USA phone number and she referred me to the US Embassy in Mexico City, since she could only help US residents.  There was some back and forth -- NYC said Mexico City had to process me, and Mexico City initially said NYC had to process me -- but between those two contacts I was finally successfully enrolled in Medicare Part B before my initial enrollment period lapsed.  This was in June or July 2020, so the pandemic was probably already affecting staffing at USA offices.

 

I do remember it took several tries to get a person on the line for the USA phone number (I think it was the generic 1-800 number for the SSA?) but once I got through they were helpful.

[Jingthing]

Manila serves Thailand and much of Asia. No such services in Bangkok.

[bbko]

16 minutes ago, wpcoe said:

Is there a Social Security and/or Medicare representative at the US Embassy in Bangkok?

I found this on the US Embassy's website;

 

If you reside in Thailand and have other questions regarding services provided by the Social Security Administration (SSA), you must contact the SSA Federal Benefits Unit (FBU) located in U.S. Embassy in Manila, Philippines.  For more information on their services and how to contact them, please visit their webpage at: https://ph.usembassy.gov/u-s-citizen-services/social-security/

[ericthai]

56 minutes ago, Jingthing said:

Well let's get specific. 

Social Security doesn't send the proof of life letters to people on record with U.S  addresses. Only expats.

The letters were suspended last year for expats because of Covid-19 and there is strong evidence they will be suspended this year as well.

Many expats lie to Social Security and Medicare and fake being a U.S. resident at least partly to avoid those letters. That can backfire.

Medicare Advantage is not available to honest expats because it's zip code based. Good info there that they send out letters.

The only Medicare parts available to honest expats are A and B.

Snowbird  type part time expats can more legitimately claim US residence.

 

yes allot of people game the system. The plans are setup by zip code due to payment structure. The higher the Medicare population in a zip code the more money available and the better the benefits (No monthly premium, Part B give back, $0 co pay for doctors etc).  I've had clients deicide where to buy a house dependent upon Medicare plans available in that area. The plans are getting so competitive that benefits are increasing each year. 

 

Just make things clear for some of you guys.  The three parts to medicare are 

Part A = Hospital care

Part B = Doctors, ambulance, tests etc

Part D = Medications

 

Most cases Part A is free as long as you have enough working credits (roughly 10 years) 

 

Part B you do a have a premium and as stated it is based on financials. Unfortunately if you make more you pay more.

 

Medicare part D needs to be purchased from a private insurance company. If not enrolled during your initial ICEP then you will incur a penalty of 1% of the national average per month for every month your eligible and didn't enroll. The national average is currently (2021) $31.47 and CMS expects to be $38.18 for 2022.

 

Don't confuse Medicare advantage plans with supplement plans or Medigap plans. 

Medicare advantage plans you are with private healthcare company and in most cases see their doctors. 

Typically this is no or a low monthly premium and you have co-pays.

 

A Medicare Supplement plan or Medigap plan you have a large monthly premium anywhere from $250-$400 per month depending on plan. However you then have no co-pays and can see any doctor that accepts Medicare. You dont have any part D coverage so need to purchase that too.  These plans get costly, but give you freedom. 

 

I hope this helps some of you guys, if you have any questions I'm happy to help. 

 

 

 

[ChristianBlessing]

3 hours ago, Jingthing said:

I am assuming you were not claiming Social Security before age 65. I think if you had been that with a U.S. address that you would have been automatically enrolled in A and B. 

Expats with a Social Security claim before 65 based on a foreign address will be enrolled in A but not B.

You're right. I did not begin drawing SS until age 70 and after my return to the US.

[wpcoe]

9 hours ago, Jingthing said:

Manila serves Thailand and much of Asia. No such services in Bangkok.

Rats.  Sorry to hear that.  I knew Manila was the regional office, but was hoping there was still some sort of local liaison at the Embassy in Bangkok.

[KClark]

13 hours ago, ericthai said:

If you're living in the USA at least 6  months out of the year then you should look into Medicare advantage plans. Some of the plans in some areas in the USA have a part B refund. These plans work with Tri-care too. 

Thanks for the info, and for bringing your work history and knowledge to this forum.  I'm afraid I don't spend that much time in the USA, and even if I did my income would exclude me from any refund of part B.  However, when in the US the medicare/tricare combination works really well, according to some buds of mine who have had recent experience with this.  Relying solely on tricare while living here is a bit more costly but manageable, and the catastrophic cap aspect is very comforting.  Healthcare 'coverage' is just not a concern for my wife and I and for that I'm very grateful.  I know there are many who do struggle finding affordable healthcare.  I wish it were otherwise.  

 

[cmarshall]

14 hours ago, ericthai said:

yes allot of people game the system. The plans are setup by zip code due to payment structure. The higher the Medicare population in a zip code the more money available and the better the benefits (No monthly premium, Part B give back, $0 co pay for doctors etc).  I've had clients deicide where to buy a house dependent upon Medicare plans available in that area. The plans are getting so competitive that benefits are increasing each year. 

 

Just make things clear for some of you guys.  The three parts to medicare are 

Part A = Hospital care

Part B = Doctors, ambulance, tests etc

Part D = Medications

 

Most cases Part A is free as long as you have enough working credits (roughly 10 years) 

 

Part B you do a have a premium and as stated it is based on financials. Unfortunately if you make more you pay more.

 

Medicare part D needs to be purchased from a private insurance company. If not enrolled during your initial ICEP then you will incur a penalty of 1% of the national average per month for every month your eligible and didn't enroll. The national average is currently (2021) $31.47 and CMS expects to be $38.18 for 2022.

 

Don't confuse Medicare advantage plans with supplement plans or Medigap plans. 

Medicare advantage plans you are with private healthcare company and in most cases see their doctors. 

Typically this is no or a low monthly premium and you have co-pays.

 

A Medicare Supplement plan or Medigap plan you have a large monthly premium anywhere from $250-$400 per month depending on plan. However you then have no co-pays and can see any doctor that accepts Medicare. You dont have any part D coverage so need to purchase that too.  These plans get costly, but give you freedom. 

 

I hope this helps some of you guys, if you have any questions I'm happy to help. 

This post is not correct.  Expats are only eligible for Medicare Parts A and B, not Advantage, not Medigap, not Part D, etc. 

 

If you enroll in Medicare for the first time when abroad, you will enroll in Original Medicare Parts A and B, as Medicare Advantage Plans and Part D plans require you to live within the plan service area. If you move back to the U.S., you will have a Special Enrollment Period (SEP) to join an MA Plan or Part D plan. Your SEP begins the month before your move and lasts up to two months after the month you move. For example, if you move back to the U.S. in April your SEP is March through June.

 

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-living-abroad/medicare-advantage-and-part-d-for-those-who-live-abroad

[Jingthing]

22 hours ago, KClark said:

 

However, we are not able to assist you with your inquiry without the following information:

 

-      Last Name:

-      First Name:

-      Middle Name:

-      Date of Birth:

-      Place of Birth:

-      Last four digits of Social Security Number (SSN):

-      Address:

-      Contact Number:

 

 

I sent them all my relevant data in my initial email to them.  Didn't seem to matter as they simply sent me a very short enrollment request back.  I think just the mention of name, address, medicare nbr and your intent would be sufficient for first salvo.  The form they'll send back ask for:

medicare nbr

name

address

phone nbr

check the box that says you want part B.  

 

That's about it.  When they respond they'll acknowledge your request and state "Action was taken to enroll you in Medicare Part B."  

Editing what I just wrote I just learned that if you enroll in Part B before your birthday it starts the same time as Part B.

 

But if within the next three months then it begins later. Presumably you can save some fees starting later

 

 

 

Edited September 23, 2021 by Jingthing

[bobyogi]

Advice please

Recently obtained retirement visa here in Thailand

At age 65 got enrolled part A while still living in Hawaii chose to not choose part B knowing I'd be in Thailand eventually 10 months per year.. question/ advice is it better to rethink joining part B or find affordable insurance in Thailand, age 69 next bday may!

No medical issues, healthy lifestyle etc, tia, any advice!

Btw Google voice is free and all otp from Banks received no prob as well texting and voice to and from USA.  Again thanks!

 

 

 

 

 

 

[Jingthing]

30 minutes ago, bobyogi said:

Advice please

Recently obtained retirement visa here in Thailand

At age 65 got enrolled part A while still living in Hawaii chose to not choose part B knowing I'd be in Thailand eventually 10 months per year.. question/ advice is it better to rethink joining part B or find affordable insurance in Thailand, age 69 next bday may!

No medical issues, healthy lifestyle etc, tia, any advice!

Btw Google voice is free and all otp from Banks received no prob as well texting and voice to and from USA.  Again thanks!

 

 

 

 

 

 

I can't advise you except to say that there is a 10 percent for life penalty for each year you opt out of Part B. I will say if your long term plan is to be be in Hawaii for a fair chunk of time then having Part B would be at least more useful to you than expats like me who don't really plan to ever go back.

 

Google voice may work for you now but I've heard there are big changes coming that will force all banks to reject anything that isn't your personal US cell phone. We shall see.

Edited September 23, 2021 by Jingthing

[ericthai]

5 hours ago, cmarshall said:

This post is not correct.  Expats are only eligible for Medicare Parts A and B, not Advantage, not Medigap, not Part D, etc. 

 

If you enroll in Medicare for the first time when abroad, you will enroll in Original Medicare Parts A and B, as Medicare Advantage Plans and Part D plans require you to live within the plan service area. If you move back to the U.S., you will have a Special Enrollment Period (SEP) to join an MA Plan or Part D plan. Your SEP begins the month before your move and lasts up to two months after the month you move. For example, if you move back to the U.S. in April your SEP is March through June.

 

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-living-abroad/medicare-advantage-and-part-d-for-those-who-live-abroad

please re-read, Where did I say an expat could enroll in a Medicare advantage plan?

[Jingthing]

7 minutes ago, ericthai said:

please re-read, Where did I say an expat could enroll in a Medicare advantage plan?

I didn't think that you did either.

[ericthai]

35 minutes ago, bobyogi said:

Advice please

Recently obtained retirement visa here in Thailand

At age 65 got enrolled part A while still living in Hawaii chose to not choose part B knowing I'd be in Thailand eventually 10 months per year.. question/ advice is it better to rethink joining part B or find affordable insurance in Thailand, age 69 next bday may!

No medical issues, healthy lifestyle etc, tia, any advice!

Btw Google voice is free and all otp from Banks received no prob as well texting and voice to and from USA.  Again thanks!

 

 

 

 

 

 

My advise is to join part B, the longer you wait the more of the penalty. Trying to get affordable healthcare as you age will be difficult to impossible.

 

I would find a local agent in Hawaii and discuss all your options. Medicare wont work outside the USA so when you do travel to Thailand I would get insurance to cover you for your stay. Some advantage plans allow you to stay out of the service area longer than 6 months, so you might find a plan that allows you to stay 10 months in Thailand. 

Almost all the plans in Florida have out of USA coverage that allow 6  months out of the service are and coverage up to $100,000 USD with a $500 co-pay. So you might get lucky. 

[cmarshall]

1 hour ago, ericthai said:

please re-read, Where did I say an expat could enroll in a Medicare advantage plan?

In a discussion of Medicare for expats any mention of Part D, Medigap, or Medicare Advantage is misleading since expats are not eligible for any of them, which you should have taken care to point out, but you didn't.  

[ericthai]

1 hour ago, cmarshall said:

In a discussion of Medicare for expats any mention of Part D, Medigap, or Medicare Advantage is misleading since expats are not eligible for any of them, which you should have taken care to point out, but you didn't.  

Thank you for pointing that out I'm sorry if I mislead you, that was not my intent.

I was providing information about all medicare options not necessarily considering just expats as there are guys that only spend part of the year in Thailand and also guys that used to live in Thailand and still follow this forum.

Next time I'll make sure to be more clear so I dont confuse anyone.

[Bubbha]

My understanding is that if you claim social security in the US, rather than Manila, then you are eligible to purchase and utilize Medigap, Medicare Advantage, and Part D.

 

I have expat friends who do exactly this. And as ericthai points out, some Medicare Advantage plans (and some Medigap plans as well) provide for very decent levels of coverage while overseas.

 

A good book for Medicare knowledge and planning is – Get What’s Yours for Medicare— by Philip Moeller. The book costs about $11 on Amazon and is available on Kindle.

 

Ericthai also suggests finding and working with a local agent, which I think is a really good idea if you are considering coverage beyond Parts A & B.

[ericthai]

 

56 minutes ago, Bubbha said:

My understanding is that if you claim social security in the US, rather than Manila, then you are eligible to purchase and utilize Medigap, Medicare Advantage, and Part D.

 

I have expat friends who do exactly this. And as ericthai points out, some Medicare Advantage plans (and some Medigap plans as well) provide for very decent levels of coverage while overseas.

 

A good book for Medicare knowledge and planning is – Get What’s Yours for Medicare— by Philip Moeller. The book costs about $11 on Amazon and is available on Kindle.

 

Ericthai also suggests finding and working with a local agent, which I think is a really good idea if you are considering coverage beyond Parts A & B.

Thanks for that.

Let me be clear so I dont confuse anyone,  the following I'm talking about the USA.

 

Just one word of precaution on using an agent.  I hate to say this but, I would avoid any agent that works directly for a plan. I would find a broker that is independent and contracted with all or most of the plans in your area. The reason being, an agent working for a company only have their plans to offer and they have pressure on them to get sales so they will try and push you onto one of their plans.

 

However, with a broker they are contracted with everyone and will find the best plan that works for you as all the Medicare advantage plans pay just about the same. Sometimes a plan might look good to you, but once you start looking at medication costs or co-pays things change.

 

A local broker will know what plans are suited for certain health needs, they typically know the doctors in the area and best thing, is if you ever have an issue you have an agent to take care of things. Got a bill you're not suppose to get, a good agent will take care of that for you. 

 

Original Medicare is not bad coverage, but I firmly believe in the advantage plans as they save you so much on your Medicare costs and add benefits not covered by original Medicare, but sometime original Medicare is best for someone. 

 

If anyone has a question or needs some help checking plans available in the USA all I need is a zip code and county. No name or other info.

I'm always happy to help, just pm me!

Edited September 23, 2021 by ericthai
spelling

[ericthai]

1 hour ago, Bubbha said:

My understanding is that if you claim social security in the US, rather than Manila, then you are eligible to purchase and utilize Medigap, Medicare Advantage, and Part D.

 

To be eligible for any Medicare advantage plan or Medicare supplement plan (Medigap plan) you must be a resident in the USA and must remain in the service area (typically no less than 6 months out of the year)

 

Some plans may allow you to be out of the service area longer than 6 months, but you must have US residency no PO boxs are allowed to be used as a resident address.

 

Note: if you are on a Medicare advantage plan and you are out of your service area you are only covered for emergency care.

There is no coverage for routine check ups, preventative etc.

[walt1]

I'm about 2 years away until I have to decide on the part B, so thanks to all that posted, very informative. I live here full time and have insurance coverage now from a Thai company. How does the penalty work? Not taking into consideration premium increases and based on the lowest premium $150/month would it be 1 year late sign up 10% penalty equals $ 15/month forever. Year 2 =$30/month. Year 3 = $45/month etc.. If so I could plan when to start Part B. In my situation I wouldn't go back to The US until my 70's if at all. Say I start Part B 5 years late the penalty would be $75 month but I would have saved $9000 in premiums . That would pay the penalty cost for 10 years? TIA 

[Jingthing]

29 minutes ago, walt1 said:

I'm about 2 years away until I have to decide on the part B, so thanks to all that posted, very informative. I live here full time and have insurance coverage now from a Thai company. How does the penalty work? Not taking into consideration premium increases and based on the lowest premium $150/month would it be 1 year late sign up 10% penalty equals $ 15/month forever. Year 2 =$30/month. Year 3 = $45/month etc.. If so I could plan when to start Part B. In my situation I wouldn't go back to The US until my 70's if at all. Say I start Part B 5 years late the penalty would be $75 month but I would have saved $9000 in premiums . That would pay the penalty cost for 10 years? TIA 

Great question!

I've wondered how they calculate the penalty. I don't know.

 

But you should be aware there is another major problem with starting this upon repatriation. 

 

There is one time window annually to do that. Then you need to wait after that.

 

If you've rushed back to deal with a medical crisis that could be ruinous.

Edited September 24, 2021 by Jingthing

[cmarshall]

15 hours ago, Bubbha said:

My understanding is that if you claim social security in the US, rather than Manila, then you are eligible to purchase and utilize Medigap, Medicare Advantage, and Part D.

 

I have expat friends who do exactly this. And as ericthai points out, some Medicare Advantage plans (and some Medigap plans as well) provide for very decent levels of coverage while overseas.

 

A good book for Medicare knowledge and planning is – Get What’s Yours for Medicare— by Philip Moeller. The book costs about $11 on Amazon and is available on Kindle.

 

Ericthai also suggests finding and working with a local agent, which I think is a really good idea if you are considering coverage beyond Parts A & B.

Your expat friends are committing fraud.  They may get away with it or they may find their insurance rescinded when they make a claim.

[Jingthing]

6 minutes ago, cmarshall said:

Your expat friends are committing fraud.  They may get away with it or they may find their insurance rescinded when they make a claim.

I agree that it's fraud and I'm sure Medicare does too. But as mentioned here before part time snowbird type expats can legitimately present as a U.S. resident. Difficult to pull off these days in Thailand  with travel restrictions.

Edited September 24, 2021 by Jingthing

[Jingthing]

OK, this explains how the Part B penalty is calculated. 

 

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/original-medicare-enrollment/medicare-part-b-late-enrollment-penalties

[Jingthing]

Here's another I'm sure common scenario.

A full-time expat with a current social security claim when they turn 65 using a US address. That is probably fraud too because it avoids the need for social security proof of life letters but it would result in automatic sign up for Parts A and B. I don't think Medicare would have a problem with that as long as the expat doesn't sign up for other parts or Advantage based on zip code.

Edited September 24, 2021 by Jingthing

[walt1]

3 hours ago, Jingthing said:

OK, this explains how the Part B penalty is calculated. 

 

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/original-medicare-enrollment/medicare-part-b-late-enrollment-penalties

Thanks for that link but now even more questions about other choices, original or advantage part c&d etc. For the penalty question it looks like I would be better off waiting to start Part B seeing I can't use it here anyway. I have insurance here renewable to age 99 so am somewhat covered here. 

[Jingthing]

2 minutes ago, walt1 said:

Thanks for that link but now even more questions about other choices, original or advantage part c&d etc. For the penalty question it looks like I would be better off waiting to start Part B seeing I can't use it here anyway. I have insurance here renewable to age 99 so am somewhat covered here. 

As am expat A and B are your ONLY options.

[Jingthing]

This might be a better reason to pay for Part B than even avoiding the penalties. 

 

The enrollment window and delay in starting coverage. 

 

Here's a worst case scenario.

 

Suppose you repatriate due to a medical crisis in April 2022.

 

Then you would need to wait until January 2023 to enroll in Part B and then wait for the coverage to start in July 2023.

 

That's well over a year!

 

https://www.medicare.gov/blog/medicare-part-b-enrollment-sign-up-now

 

Of course the best case scenario would be about a four month wait IF you arrived in March 2022.

 

To add insult to injury my understanding is that you can't sign up for the other parts UNTIL you're enrolled in Part B.

Edited September 24, 2021 by Jingthing

[meechai]

I recently did this process in reverse...

Meaning they automatically gave me Part B & I wanted out

 

They said just return card checking off part saying you opt out but it never went thru

 

So after contacting SS I found the easiest sure fire way was to file form CMS 1763

Again for my case of Opting out of Part B

 

The reason I am telling you this even though you want the opposite is I live in the USA & after speaking a long time with a nice lady at SS she said always on these cases the surefire way is fill the appropriate form & send to SS

 

Reasoning that SS is so backed up it is the only way to assure your covered or opted out with no penalties as you have proof

My Medicare starts Nov 2021 so I had time to re-file it

 

 

In your case just fill in form CMS40B which is the request for part B & send it to SS before your medicare starts

At least that way your protected from any interest/penalty etc

You will have your medicare # well in advance of starting medicare so no problem filling it out

 

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf

 

 

 

 

Edited September 25, 2021 by meechai