US Medicare options for CNX residents

[PFV]

Apologies if this is not the proper forum to post this message. I trust a Moderator to change forum if necessary.

 

With eligibility for Medicare a few months away, I am trying to figure out if it is worth enrolling due to lack of coverage outside the US, or if it is even possible without a US address.

 

In my situation with pre-existing conditions, buying insurance in Thailand has been impossible, which would suggest the need for Medicare. On the other hand, traveling to the US for anything but a major issue could be uneconomical due to hotel/apartment rental costs, transportation costs, etc. Furthermore, I would also need to sign up for Medigap coverage due to the 80% limit.

 

I expect to be able to bear the cost of almost any service here in Thailand, including heart bypass surgery, although I am not excited at the idea of spending >1M baht and have doubts about the quality of treatment.

 

Some options I have considered are delaying enrollment in Part B, despite the penalty, and choosing a high-deductible (plans G-HD or K) to limit costs for services that I would use very rarely (fingers crossed). Then again, if I were forced to return permanently to the US for health reasons, all of it would have been very worthwhile.

 

I was hoping that a kind reader in a similar situation could share their thoughts and provide some guidance.

 

Thank you

[Jingthing]

Hmm.

I just signed up for Medicare B during the initial enrollment period to avoid a later penalty.

Because I had a current early social security claim I was automatically enrolled in the free part A.

If you're living abroad your ONLY options are A and B.

If you're living abroad and claim you're living in the US that is definitely fraud.

Every part other than A and B including advantage are based on zip code.

Expats don't have a US zip code.

You can enroll in A or A and B as an expat by emailing the FBU in the US embassy in Manila. The US embassy in Thailand can't help.

If repatriate there are ways to enroll in other parts but there are specific rules about that.

If you opt out of B it can take as long as 15 months to get enrolled in that upon repatriation on top of the severe penalties.

 

 

[cmarshall]

I enrolled in Parts A and B at age 65, even though I don't plan on returning to live in the US.  Nevertheless, I pay for Part B against the possibility that there might be a reason to repatriate at some point in the future.

[PFV]

Thank you Jingthing and cmarshall for your replies. Since the only time you are guaranteed enrollment in Medigap is immediately after enrolling in Part B, if you have pre-existing conditions that is, the best course of action for me is probably to delay enrollment in Medicare until I have a place in the US where to spend at least part of the year (if ever) and to rely on travel insurance for short visits. The 10% penalty is roughly equivalent to the monthly premium saved.

Edited November 29, 2021 by PFV

[Jingthing]

1 hour ago, PFV said:

Thank you Jingthing and cmarshall for your replies. Since the only time you are guaranteed enrollment in Medigap is immediately after enrolling in Part B, if you have pre-existing conditions that is, the best course of action for me is probably to delay enrollment in Medicare until I have a place in the US where to spend at least part of the year (if ever) and to rely on travel insurance for short visits. The 10% penalty is roughly equivalent to the monthly premium saved.

You're forgetting the worse part of not taking B. It can take as long as 15 months to get enrolled in it upon repatriation. Thats what convinced me to pay for it more than penalties.

[cmarshall]

9 hours ago, PFV said:

Thank you Jingthing and cmarshall for your replies. Since the only time you are guaranteed enrollment in Medigap is immediately after enrolling in Part B, if you have pre-existing conditions that is, the best course of action for me is probably to delay enrollment in Medicare until I have a place in the US where to spend at least part of the year (if ever) and to rely on travel insurance for short visits. The 10% penalty is roughly equivalent to the monthly premium saved.

How do you figure that?  You pay the 10% premium for each year after 65 that you did not enroll in Part B.  But you pay the 10% penalty not once, but forever.

[olfu]

With preexisting conditions you better stay in Florida, US. Cost of living same as in Thailand.

SSA never bother me--its opposite. Establish your presence with direct deposit and use credit/debit card for payments so you can travel. To properly apply for Medicare part B it have to be in January. But I never applied to cover 20%  as I take my chances. 

Impression is travel will be restricted for another year.

[Jingthing]

6 hours ago, cmarshall said:

How do you figure that?  You pay the 10% premium for each year after 65 that you did not enroll in Part B.  But you pay the 10% penalty not once, but forever.

Yes and its cumulative.

 

Example.

 

Original year. 170

Penalty year one. 187

Penalty year two based on 187 not 170.

Etcetera.

Edited November 30, 2021 by Jingthing

[Jingthing]

4 hours ago, olfu said:

With preexisting conditions you better stay in Florida, US. Cost of living same as in Thailand.

SSA never bother me--its opposite. Establish your presence with direct deposit and use credit/debit card for payments so you can travel. To properly apply for Medicare part B it have to be in January. But I never applied to cover 20%  as I take my chances. 

Impression is travel will be restricted for another year.

During the IEP Initial Enrollment Period at your 65th birthday you have about seven months to enroll in B surrounding that date.

 

Cost of living same as Thailand? No way that's true on rentals.

Edited November 30, 2021 by Jingthing

[cmarshall]

1 hour ago, Jingthing said:

Yes and its cumulative.

 

Example.

 

Original year. 170

Penalty year one. 187

Penalty year two based on 187 not 170.

Etcetera.

I didn't know that.  So, it compounds.  You pay penalties on the penalties.  Nasty.

[Jingthing]

7 minutes ago, cmarshall said:

I didn't know that.  So, it compounds.  You pay penalties on the penalties.  Nasty.

Extremely.

 

Plus of course the part B fee goes up every year anyway without the penalties.

 

Wait long enough and it could wipe out a lower level social security check.

Edited November 30, 2021 by Jingthing

[1FinickyOne]

I can't imagine I will ever go back... 

 

I self insure and can handle an illness financially probably better then emotionally. 

[Jingthing]

3 minutes ago, 1FinickyOne said:

I can't imagine I will ever go back... 

 

I self insure and can handle an illness financially probably better then emotionally. 

I don't plan it either but it's not hard to imagine. "Stuff" happens  I reckon there are many American expats in the world repatriating every day that didn't plan it.

[flexomike]

18 hours ago, cmarshall said:

I enrolled in Parts A and B at age 65, even though I don't plan on returning to live in the US.  Nevertheless, I pay for Part B against the possibility that there might be a reason to repatriate at some point in the future.

recently read that Medicare premium will be going up 15.9% next year

[retiree]

18 hours ago, cmarshall said:

I enrolled in Parts A and B at age 65, even though I don't plan on returning to live in the US.  Nevertheless, I pay for Part B against the possibility that there might be a reason to repatriate at some point in the future.

Likewise.  I figure that if it's to get treated for something serious, probably not a good time to be dealing with Part B signup, too. 

 

And, crazy as it sounds, I'm proud that I can pay my fair share to support a system that has done so much to benefit my family, friends, and all other Americans.  

--Retiree 

[PFV]

10 hours ago, cmarshall said:

How do you figure that?  You pay the 10% premium for each year after 65 that you did not enroll in Part B.  But you pay the 10% penalty not once, but forever.

I am assuming that once you enroll, you stop paying additional penalties. For instance, if you delay enrollment until full reterment age at 67, your new premium will be approximately 21% higher and remain 21% higher going forward. This extra 21% is offset by the 200% you saved while not paying premiums at 65 and 66, until you reach 76, when you will have broken even.

[PFV]

4 hours ago, Jingthing said:

...During the IEP Initial Enrollment Period at your 65th birthday you have about seven months to enroll in B surrounding that date...

 

I believe that the only exceptions are the 4 "Guaranteed Issue" states in the Northeast. Consequently, they have higher premiums. I think I would prefer delaying enrollment than renting a pied-a-terre there due to the weather. Another option could be Medicare Advantage where I don't believe they can deny coverage, but I might be wrong.

[lopburi3]

9 hours ago, olfu said:

US. Cost of living same as in Thailand.

Do you actually believe that????  

 

Quote

Consumer Prices in Miami, FL are 93.59% higher than in Chiang Mai (without rent)
Consumer Prices Including Rent in Miami, FL are 161.62% higher than in Chiang Mai
Rent Prices in Miami, FL are 409.77% higher than in Chiang Mai
Restaurant Prices in Miami, FL are 260.35% higher than in Chiang Mai
Groceries Prices in Miami, FL are 70.31% higher than in Chiang Mai
Local Purchasing Power in Miami, FL is 193.32% higher than in Chiang Mai

https://www.numbeo.com/cost-of-living/compare_cities.jsp?country1=Thailand&country2=United+States&city1=Chiang+Mai&city2=Miami%2C+FL

[Jingthing]

23 minutes ago, PFV said:

I believe that the only exceptions are the 4 "Guaranteed Issue" states in the Northeast. Consequently, they have higher premiums. I think I would prefer delaying enrollment than renting a pied-a-terre there due to the weather. Another option could be Medicare Advantage where I don't believe they can deny coverage, but I might be wrong.

You can't enroll in Advantage unless you're enrolled in B.

[Jingthing]

34 minutes ago, PFV said:

I am assuming that once you enroll, you stop paying additional penalties. For instance, if you delay enrollment until full reterment age at 67, your new premium will be approximately 21% higher and remain 21% higher going forward. This extra 21% is offset by the 200% you saved while not paying premiums at 65 and 66, until you reach 76, when you will have broken even.

Again it can take as long as FIFTEEN MONTHS to get enrolled in B upon repatriation.

[flbkk]

As others have stated, you could enroll in Medicare a and B through the American Embassy in the Philippines, even without a US address. I looked at all this at length, and decided to enroll in Medicare B, pay the premiums, as well as take a high F Medigap policy. It’s expensive, and part B is going up a lot in 2022, ostensibly for some unproven Alzheimer’s drug. If you have the ability to self insure as you say, surely you could pay for a high deductible Medigap, perhaps G, F is no longer available. And I would definitely pay for the part B.

 

You don’t wanna get into a position where you return to United States sick, but have no availability of any insurance at all for a while. I do have a US address, so easily enrolled in a Humana Medigap policy. For other readers going on US Medicare with a US address, you should absolutely get a Medigap policy within the six months to avoid medical underwriting, and avoid Medicare advantage, which are HMOs. They limit your care to the county which US as a US address, except for emergencies, and to certain doctors.

[CMBob]

I can understand expats that truly believe they'll never go back to the US opting out of Part B of Medicare but for all others it could be foolish.  While I won't return to the US for a long while and never for some quick medical procedure (likely regardless of cost), I've enrolled in Part B for the simple reason that (1) perhaps for a serious long-term medical situation I would return and would want the full Medicare benefits and (2) while I don't expect it, I do have a minor distrust of the Thai authorities that they might make living in Thailand for expats either practically impossible or prohibitively expensive (for one example only., making medical insurance mandatory for all long-term extensions and reaching an age where it's not available at any cost for that age).

In Vietnam, expat retirees could live there with a one-year visa provided they did a border run 4 times a year; however, they changed that over a year ago to require them to leave and return every 30 days.  That alone (regardless of inability to get back due to covid or other problems) would be a deal killer for me.

[Sheryl]

22 hours ago, cmarshall said:

I enrolled in Parts A and B at age 65, even though I don't plan on returning to live in the US.  Nevertheless, I pay for Part B against the possibility that there might be a reason to repatriate at some point in the future.

Ditto.

 

In addition, I take advantage of yearly visits to the US to get annual wellness check and associated preventive tests (colonoscopy, mammogram etc). These have no copay...though I have found I have to be on top of, and occasionally appeal, "creative" coding of visits buy providers to avoid being wrongly assigned a copay.

[Jingthing]

3 hours ago, flexomike said:

recently read that Medicare premium will be going up 15.9% next year

A big increase for 2022 from 148 to.

172.

 

 

https://www.cms.gov/newsroom/press-releases/cms-announces-2022-medicare-part-b-premiums

 

 

[PFV]

37 minutes ago, Jingthing said:

Again it can take as long as FIFTEEN MONTHS to get enrolled in B upon repatriation.

I realize this, but being able to enroll in Medigap as a diabetic is my primary concern, and therefore cannot enroll in Part B until I decide where to live in the US, since I don't believe that the mile-high city (where I moved from 15 years ago)  is appropriate for aging folks. 

[Sheryl]

Just now, PFV said:

I realize this, but being able to enroll in Medigap as a diabetic is my primary concern, and therefore cannot enroll in Part B until I decide where to live in the US, since I don't believe that the mile-high city (where I moved from 15 years ago)  is appropriate for aging folks. 

 

I don't follow that.

 

You can enroll in Pasrt B wiht a foreign address, I did it.

 

it is only for MediGap and Medicare Advantage policies that you need a US address. And, for those, you need to be resident in the US at least 6 months of the year.  People have gotten around that by essentially lying, but this is fraudulent and if discovered could invalidate the policy.

[PFV]

20 minutes ago, flbkk said:

As others have stated, you could enroll in Medicare a and B through the American Embassy in the Philippines, even without a US address. I looked at all this at length, and decided to enroll in Medicare B, pay the premiums, as well as take a high F Medigap policy. It’s expensive, and part B is going up a lot in 2022, ostensibly for some unproven Alzheimer’s drug. If you have the ability to self insure as you say, surely you could pay for a high deductible Medigap, perhaps G, F is no longer available. And I would definitely pay for the part B.

 

You don’t wanna get into a position where you return to United States sick, but have no availability of any insurance at all for a while. I do have a US address, so easily enrolled in a Humana Medigap policy. For other readers going on US Medicare with a US address, you should absolutely get a Medigap policy within the six months to avoid medical underwriting, and avoid Medicare advantage, which are HMOs. They limit your care to the county which US as a US address, except for emergencies, and to certain doctors.

I agree entirely, except that you need a permanent, as in life-long, US address to enroll in Medigap that I am currently lacking. I was specifically looking at a high-deductible G, since F is no longer available, or perhaps a K or N. 

 

[PFV]

3 minutes ago, Sheryl said:

 

I don't follow that.

 

You can enroll in Pasrt B wiht a foreign address, I did it.

 

it is only for MediGap and Medicare Advantage policies that you need a US address. And, for those, you need to be resident in the US at least 6 months of the year.  People have gotten around that by essentially lying, but this is fraudulent and if discovered could invalidate the policy.

For me, getting MediGap is almost more important than Part B. Here in Chiang Mai, my cardiologist told be that I will probably need bypass surgery at some point in the future, given current calcification issues, and without MediGap it would be very expensive. At that point in time I would have no problem in moving back to the US, but would not want to move now just waiting for something bad to happen. So postponing enrollment in part B seems to be the only option for now.

[Sheryl]

Just now, PFV said:

For me, getting MediGap is almost more important than Part B. Here in Chiang Mai, my cardiologist told be that I will probably need bypass surgery at some point in the future, given current calcification issues, and without MediGap it would be very expensive. At that point in time I would have no problem in moving back to the US, but would not want to move now just waiting for something bad to happen. So postponing enrollment in part B seems to be the only option for now.

Again, you can enrol in Part B now.

 

It is MediGap that is the issue.

 

Or is there a time limit to apply for MediGap after enrolling in Part B?

[1FinickyOne]

4 hours ago, Jingthing said:

I don't plan it either but it's not hard to imagine. "Stuff" happens  I reckon there are many American expats in the world repatriating every day that didn't plan it.

Why? Is there one main or top reason? I am talking about people with choice, not ones who can no longer get the liars letter and do not meet the visa qualifications.

 

USA, my beloved home country, seems like an angry, dangerous and expensive place... I have no desire to even visit there...