Questions regarding Medicare for US expat

[Y Chang]

My husband and I live in Thailand and we travel to the US couple months each year. He is turning 65 and is considering signing up for Medicare Part A+B.  We have some questions and hope that other US expats with similar experience can share their insights.

1.       Part C & Medigap:  My understanding is that Part C (Medicare Advantage) requires one to live in the service area of a Medicare Advantage insurance provider.  Does Medigap have the same requirement?

2.       Medigap:  Assume Medigap does have the above residency requirement, which means that he will have Part A+B only, then I have the following sub-questions:

a.    I google on doctors and hospitals who accept Medicare, but I wonder if they refer to Part A+B, Part A+B+Medigap, or Part C.  Any thoughts?

b.   Does Medigap allow immediate sign-up for expats upon repatriation?  If not, is there an annual sign-up window? 

3.       Drugs:  It is my understanding that Part A covers drugs used during an inpatient hospital stay or at a skilled nursing facility, while Part B covers drugs that cannot be “self-administered”, like those one gets at a doctor's office or hospital outpatient setting.  If I interpret correctly, in an outpatient setting, drugs that are not covered under Part B will be those “self-administered” drugs such as blood pressure or diabetes drugs (i.e. prescription medications you would normally take on your own).  Please confirm my understanding.

4.       Please feel free to provide any additional information I may have overlooked.  I look forward to hearing your thoughts.  

[ChristianBlessing]

Given the limited time you spend in the US you might wish to consider signing up for only Parts A, B and D (outpatient prescription drug benefit). For parts B and D, unless your husband is enrolled in a qualified plan (eg employee provided group coverage), he will have a signup window which opens 3 months before and closes 3 months after his 65th birthday to sign up for both. If he is not currently covered signing up upon eligibility serves to avoid future penalties which, over time, can be substantial (10% for each 12 month period for which he ought to have been enrolled but was not). The penalty for not signing up for Part D when eligible is based on a complex formula, but it too can be substantial over time. Since Part D is with a private provider he can later change his plan during the annual "open enrollment" period. I suggest signing up for the cheapest possible plan with the highest deductable until such time as you're repatriated. If he later signs up with a Medigap/Advantage plan he can drop the Part D coverage as it will likely be covered.

 

You likely know that Medicare coverage does not extend to Thailand, and that would include Medigap/Medicare Advantage plans, so enrolling in either would be pointless and costly. But by signing up for A, B and D upon eligibility you needn't be concerned about being "in plan" while you're in the US, and if you move back you'll be able to enroll in a Medigap/Advantage during the normal open enrollment period. 

Edited December 18, 2021 by ChristianBlessing
clarity

[Sheryl]

1. As far as I know, yes

 

2. a. Normally doctors that accept Medicare will accept "original" (Parts A+B, no 3rd party plan) Medicare as well as those with supplementals. The main impact of not having a supplemental is on you i.e. you will have more copays.

 

   b.  I'm not sure on this. I knwo there are "open seasons" but there may be exceptions in such cases.

 

3.  Correct. All medications you take yourself are not covered unless you have part D.

 

 

 

 

[KhunLA]

Or, if possible (I plead ignorance), using your Thai address as home address, avoid all the silly overpriced Medicare plans, as you get Plan A (free) no matter on arrival, if needing.  Simply get a good travel insurance policy when planning on visiting. 

 

If possible and probably cheaper than a year of monthly alphabet plan premiums, and you won't have to Q up at a public hospital.

[Jingthing]

Only Parts A and B are available to expats!

 

You should definitely enroll in A at 65 as its free.

 

If you don't enroll in B at 65 there is a 10 percent penalty for life for each year of delay.

 

The enrollment period for B if you don't enroll at 65 is Jan through March.

 

So if you try to sign up in April your coverage won't start until JULY of the NEXT YEAR!

Edited December 19, 2021 by Jingthing

[Y Chang]

ChristianBlessing, Sheryl, KhunLA, Jingthing, thank you for your input.  You all have very good points; I will certainly consider them.

ChristianBlessing, you suggested getting Part D.  If I understand correctly, Part D is similar to Part C, it requires the applicant to live within the plan service area.  However, if my understanding is incorrect, please feel free to point that out.

Like many others, my husband and I want to be prepared in case of a serious illness.  As US expats, it seems that Medicare is a fallback option.  We probably all know that coverage provided by Medicare Part A+B is very limited.  As such, additional coverage is crucial.  The reason we explore Medigap is because during the open enrollment period (i.e. when one turns 65), an insurance company can't use medical underwriting.

I came across this article (https://www.pbs.org/newshour/economy/retiring-abroad-what-medicare-plan-should-i-get) which seems to answer some of my questions regarding Medigap.  The article states that “you need to be a resident of a state when you first buy a Medigap plan. After that, if you moved outside the U.S., your Medigap plan would continue in effect so long as you paid the premiums.”  This leads to a question:  is filing a state tax return adequate to claim residency of that state?  Are there any other requirements?

For the US expats who are covered under:

1.                   - Part A only;

2.                  - Part A+B;

3.                   - Part A+B+Medigap and/or Part D;

and have received services under the corresponding coverage, would you share your experience in terms of the services provider options, billing, payment, your share of payment, and the application process (for Medigap)?

Thanks for your time!

[Sheryl]

20 hours ago, KhunLA said:

Or, if possible (I plead ignorance), using your Thai address as home address, avoid all the silly overpriced Medicare plans, as you get Plan A (free) no matter on arrival, if needing.  Simply get a good travel insurance policy when planning on visiting. 

 

If possible and probably cheaper than a year of monthly alphabet plan premiums, and you won't have to Q up at a public hospital.

If he does not enrol in Part B now, he faces a lifelong financial penalty if he needs to do so later e.g. returns to live in the US

 

Medicare is not specific to public hospitals and there are very, very  few such in the the US.

[Sheryl]

16 hours ago, Y Chang said:

I came across this article (https://www.pbs.org/newshour/economy/retiring-abroad-what-medicare-plan-should-i-get) which seems to answer some of my questions regarding Medigap.  The article states that “you need to be a resident of a state when you first buy a Medigap plan. After that, if you moved outside the U.S., your Medigap plan would continue in effect so long as you paid the premiums.”  This leads to a question:  is filing a state tax return adequate to claim residency of that state?  Are there any other requirements?

 

For the US expats who are covered under:

 

1.                   - Part A only;

2.                  - Part A+B;

 

3.                   - Part A+B+Medigap and/or Part D;

 

and have received services under the corresponding coverage, would you share your experience in terms of the services provider options, billing, payment, your share of payment, and the application process (for Medigap)?

 

Thanks for your time!

 

1. To my understanding the rule of thumb re residence is that you are physically present in the area at least 6 months of the year. While people do sometimes lie about this, it is fraudulent to do so.

 

2. I have Parts A and B, I use them for preventive services e.g. yearly wellness check, mammogram/bone density scan, periodic colonoscopy. Preventive services have no copy or deductible but be forewarned that in the case of colonoscopy, if they find a polyp(s) and remove it (as is often the case) it is then no longer considered a preventive service and the whole cost is under Part B so subject to deductible and copay.

 

Other than colonoscopy with polyp removal (which I had not anticipated would come under Part B), I have so far not used Medicare for anything else.

 

I have found that providers often deliberately miscode things to try to get more out of Medicare and I have had to carefully review my Medicare statements and in several instances make an appeal (for example, the place where I go for annual wellness visit routinely charged 2 separate visits for the one visit - one coded as a wellness check and the other as an OPD vsit, even though there were no other services given). This may be specific to the provider I have been using which is part of a large for-profit entity.

[Boomer2020]

While abroad you can only sign up for parts A and B.    That cover is not so limited as it covers most expenses in hospital (after deductible) and 100% lab fees and 80% doctor.  Also it limits the bill that doctors charge.  

 

When you return to the United States you will be able to sign up for part D prescriptions.  

 

You can also at that time sign up for any  Medicare Advantage Programs that you want.  (I dont like these as original medicare is accepted my nearly every doctor.  HMOs are quite limited and PPOs can leave huge bills when outside plan. )  

 

To get a medigap plan you need to undergo medical underwriting if it is outside the time period for your signups.

 

I had about $10000 of doctor part 2 bills.  Medicare only allowed the doctors to Charge about $5000 and medicare paid $4000 and I would have paid $1000.  I have a supplemental plan G and it costs me $160 per month but it covered that $1000.

 

Note that the  supplemental plan I have covers me 80% for the first 60 days of travel outside the USA lifetime benefit max $50000.

 

Since you can enroll in Medicare Advantage in the first month or two you move back to the USA.

 

Manila US Embassy  is where I sent all my enrollment material for Parts A and B.

 

I got Part D immediately when I qualified but since I was 3 months past my enrollment window I have to  pay 3%more.  But you do qualify without underwriting when you return to USA must be done within 60 days I think.

 

I got a medigap policy at that time also.  I had to answer a lot of questions..  Which were reviewed  before approval.  Some companies have more questions  than others.   I used a broker who knew which companies to avoid etc.  

 

I think you should sign up for both A and B.   IF you plan on staying mostly in Thailand, don't get a supplemental plan.   The cost v amount of cover if you live overseas is not worth it in my opinion.   If you do plan on getting cover in medigap, do it before underwriting.  The best plan is now G.   If you get a deductible  G called a High G, you can save on monthly dues as   Regular G is about $200 month and High G might only be $60.   You would probably need a  US post address to maintain billing.  Etc.  This might affect taxes. 

 

Good luck.   

[Y Chang]

Sheryl, Boomer2020, thank you so much for sharing the valuable information, and thank you everyone else for your input.  Your information and input are tremendously helpful in our decision making.  Happy holidays!  Hope 2022 will be a  great year for you all!

[Y Chang]

On 12/20/2021 at 10:12 AM, Boomer2020 said:

I had about $10000 of doctor part 2 bills.  Medicare only allowed the doctors to Charge about $5000 and medicare paid $4000 and I would have paid $1000.  I have a supplemental plan G and it costs me $160 per month but it covered that $1000.

Boomer2020, I have a follow up question regarding payment procedure for the bill you mentioned above:  for both the medicare and the supplemental plan portions, did you pay out of pocket first then got reimbursement?  Or, did the doctor bill medicare and the supplemental insurance directly?  Thanks and look forward to your reply.

[Sheryl]

Normally in the US they bill the provider bills Medicare & the supplemental first and you only if there is a balance.

 

 

[Y Chang]

Thanks Sheryl.  Appreciate the info.