Medicare enrolment for Thai expats advice

[sirineou]

In five months I will be 65 and qualify for Medicare. so many options , it is hard to decide especially for us who live outside the country,

I have one more complication. So a little advice from those  already in the system, 

No need to rediscover the wheel ????.

so here is my situation. i will be splitting our time between Thailand and Greece, (Summers in Greece, winters in Thailand, with the occasional trip to the US) , For those of you who have insurance outside the US and don't plan to use Medicare a lot, what is the best option so that if later on I decided to return to the US , I was not locked out of the Medicare system. 

 

[taxout]

You're going to be in the US on occasion. Things happen, even on a short trip. Unless you're exceptionally flush you cannot afford risking a US hospital stay without insurance, especially as you get older. Would you dare drive a car without insurance? Same same.

 

So take free Part A of course and pony up for Part B. It'll also let you move back at some point without an insurance gap.

[Jingthing]

If you think there is even a smallish chance.that you will repatriate pay for Part B.

Edited February 3, 2022 by Jingthing

[sirineou]

9 hours ago, taxout said:

You're going to be in the US on occasion. Things happen, even on a short trip. Unless you're exceptionally flush you cannot afford risking a US hospital stay without insurance, especially as you get older. Would you dare drive a car without insurance? Same same.

 

So take free Part A of course and pony up for Part B. It'll also let you move back at some point without an insurance gap.

Good advice , Thank you

8 hours ago, Jingthing said:

If you think there is even a smallish chance.that you will repatriate pay for Part B.

There is always a chance , who knows what will happen in Thailand, and I have only experience Greece on vacations, living there could be an entirely different thing. I asked the question because I don't know what I don't know and it is always good to hear other people's opinion.

Thank you for that reply. 

[cmarshall]

As a US citizen you will never be "locked out" of the US Medicare system, but if you don't sign up for Part B at age 65 and later repatriate for whatever reason you will have a lifelong penalty for the years after age 65 that you weren't paying for Part B.  So, it is prudent to sign up for Part B at age 65 as expected.

 

For all the other other Medicare options such as Part D, Medicare Advantage, etc. you are not eligible for them unless you reside in the US.  However, unlike Part B, if you do repatriate at some point you will have a 60-day period to sign up for any of the other Medicare packages without penalty and without exclusion of pre-existing conditions.  

[sirineou]

2 minutes ago, cmarshall said:

As a US citizen you will never be "locked out" of the US Medicare system, but if you don't sign up for Part B at age 65 and later repatriate for whatever reason you will have a lifelong penalty for the years after age 65 that you weren't paying for Part B.  So, it is prudent to sign up for Part B at age 65 as expected.

 

For all the other other Medicare options such as Part D, Medicare Advantage, etc. you are not eligible for them unless you reside in the US.  However, unlike Part B, if you do repatriate at some point you will have a 60-day period to sign up for any of the other Medicare packages without penalty and without exclusion of pre-existing conditions.  

Thank you for that explanation, I had read something like that some place but I was not exactly sure. 

I wonder, is it possible to sign up for part B, so that as you said I can move back without penalty,

and later on in life if it seems like I am never moving back to the US drop it? 

[cmarshall]

8 minutes ago, sirineou said:

Thank you for that explanation, I had read something like that some place but I was not exactly sure. 

I wonder, is it possible to sign up for part B, so that as you said I can move back without penalty,

and later on in life if it seems like I am never moving back to the US drop it? 

Yes, you can sign up for Part B at age 65.  In fact, if you are already collecting SS benefits, you will be signed up for it automatically.  If you aren't collecting SS, then you fill out this form to sign up:

 

https://www.cms.gov/cms40b-application-enrollment-part-b

 

There is an exception to the penalty for not paying into Part B at age 65.  If you are covered by an employer's insurance package at that time, which may not be very likely, you will not have to pay any penalty if you later enroll in Part B.  Perhaps a more likely exception is if you are covered by the national insurance of any other country, which would also exempt you from the subsequent penalty for late enrollment in Part B.  You might look into the possibility of getting coverage in the Greek national insurance plan.

 

I am planning to move to France next year where, after a short initial period, I will be covered by the French Sécurité Sociale.   At that point I will quit paying into Part B.  

 

You can delay Medicare enrollment in Part B (and avoid its premiums) if you have health care coverage from: 

• An employer for which you (or your spouse) actively work and which provides group health insurance for you (or both of you)
• The public national health service of the country where you live — regardless of whether you or your spouse works for an employer or are self-employed 
• The sponsoring organization of voluntary service you provide abroad (for example, the Peace Corps)

https://www.aarp.org/health/medicare-qa-tool/medicare-if-living-outside-united-states/

 

[sirineou]

2 minutes ago, cmarshall said:

Yes, you can sign up for Part B at age 65.  In fact, if you are already collecting SS benefits, you will be signed up for it automatically.  If you aren't collecting SS, then you fill out this form to sign up:

 

https://www.cms.gov/cms40b-application-enrollment-part-b

 

There is an exception to the penalty for not paying into Part B at age 65.  If you are covered by an employer's insurance package at that time, which may not be very likely, you will not have to pay any penalty if you later enroll in Part B.  Perhaps a more likely exception is if you are covered by the national insurance of any other country, which would also exempt you from the subsequent penalty for late enrollment in Part B.  You might look into the possibility of getting coverage in the Greek national insurance plan.

 

I am planning to move to France next year where, after a short initial period, I will be covered by the French Sécurité Sociale.   At that point I will quit paying into Part B.  

 

You can delay Medicare enrollment in Part B (and avoid its premiums) if you have health care coverage from: 

• An employer for which you (or your spouse) actively work and which provides group health insurance for you (or both of you)
• The public national health service of the country where you live — regardless of whether you or your spouse works for an employer or are self-employed 
• The sponsoring organization of voluntary service you provide abroad (for example, the Peace Corps)

https://www.aarp.org/health/medicare-qa-tool/medicare-if-living-outside-united-states/

 

That's very interesting and would have to look into it. 

I have the option of buying into the Greek national health case system , which is one among many reasons why we are considering moving our retirement base there. 

So I need to see if that would qualifying me to delaying buying into Part B without penalty. 

Thank you for that reply and link????

[cmarshall]

14 minutes ago, sirineou said:

That's very interesting and would have to look into it. 

I have the option of buying into the Greek national health case system , which is one among many reasons why we are considering moving our retirement base there. 

So I need to see if that would qualifying me to delaying buying into Part B without penalty. 

Thank you for that reply and link????

I should add that AARP's link is the only reference that I have found that mentions a national health insurance as the basis for an exemption to the late enrollment penalty for Part B.  AARP is generally well-informed, but they are not the authoritative source for Medicare's regulation.  So, you should verify this strategy if you can with Medicare itself.  I will do that, but haven't done it yet.

[GypsyT]

I'm thinking same; if I stop paying when I move out this year and later return and get in again.

Looks like a lot! But I don't what they mean and how to calculate...

Part B late enrollment penalty

If you didn't get Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. In most cases, you'll have to pay this penalty each time you pay your premiums, for as long as you have Part B. And, the penalty increases the longer you go without Part B coverage.

Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period. Read more about different situations that may affect when you decide to get Part B. 

Link; https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-late-enrollment-penalty

 

[GypsyT]

PS. Just found this and it looks No Penalty IF you have foreign insurance (like EU) but I can't say I understand it all.

"The Affordable Care Act
Beginning in 2019, there is no individual shared responsibility payment due if an individual fails to maintain minimum essential coverage; however, as an American living overseas you should be aware of the need to declare yourself not subject to the Affordable Care Act "shared responsability" provision by indicating that you benefit from "deemed covered" status from a foreign health plan and that you do not need to participate in a US plan or pay a possible penalty fee."

 

[sirineou]

17 minutes ago, GypsyT said:

PS. Just found this and it looks No Penalty IF you have foreign insurance (like EU) but I can't say I understand it all.

"The Affordable Care Act
Beginning in 2019, there is no individual shared responsibility payment due if an individual fails to maintain minimum essential coverage; however, as an American living overseas you should be aware of the need to declare yourself not subject to the Affordable Care Act "shared responsability" provision by indicating that you benefit from "deemed covered" status from a foreign health plan and that you do not need to participate in a US plan or pay a possible penalty fee."

 

It sounds like you need a Medicare layer just to understand what your responsibilities are. LOL

[RegularGuy77]

Just some additional information about Medicare enrollments for Part B, D, Medigap etc.:

 

Regarding ACA/ Obamacare. If you only have Part A coverage, it is considered that you have  minimum essential coverage. This means you can not enroll in any ACA/ Obamacare plans to cover any gap period until your Part B covers you.

 

Medigap plan enrollment window. To avoid medical underwriting where an insurer can’t deny you coverage due to pre-existing conditions etc., you have a 6 month window once Part B start date is effective. For a special enrollment situation, such as a US citizen returning to the US, once you have landed and got your US residential address to provide the insurance carrier, then the 6 month special enrollment window starts.

 

For Part D drug coverage, once you land back in the US you can sign up for Part D with an US address: Your chance to join lasts for 2 full months after the month you move back to the U.S.

 

Below is helpful link form Medicare enrollment windows and special situations:

 

https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf
 

 

[Yellowtail]

On 2/8/2022 at 6:47 AM, cmarshall said:

Perhaps a more likely exception is if you are covered by the national insurance of any other country, which would also exempt you from the subsequent penalty for late enrollment in Part B. 

 

Does this mean that because  I am currently covered by Thai Social Security, I will not be penalized for not signing up for part B in the event I repatriate to the US?

[cmarshall]

4 hours ago, Yellowtail said:

Does this mean that because  I am currently covered by Thai Social Security, I will not be penalized for not signing up for part B in the event I repatriate to the US?

It might be possible, but I don't know if all national health coverage qualifies.  Here is the quote from AARP on the subject:

 

If you or your spouse is working while abroad:

You can delay Medicare enrollment in Part B (and avoid its premiums) if you have health care coverage from: 

• An employer for which you (or your spouse) actively work and which provides group health insurance for you (or both of you)
• The public national health service of the country where you live — regardless of whether you or your spouse works for an employer or are self-employed 
• The sponsoring organization of voluntary service you provide abroad (for example, the Peace Corps)

https://www.aarp.org/health/medicare-qa-tool/medicare-if-living-outside-united-states/

[Jingthing]

I reckon there are specific rules about continuous coverage for that government coverage exception.

I would make a formal request to the enrollment authorities. It would be so easy to assume you're exempt when you're not.

[Yellowtail]

29 minutes ago, Jingthing said:

I reckon there are specific rules about continuous coverage for that government coverage exception.

I would make a formal request to the enrollment authorities. It would be so easy to assume you're exempt when you're not.

I think that's a good idea. I'm happy to keep paying the $7.25 a month to Thailand either way, but it would be nice to not suffer any penalty for not signing up for B unless I repatriate. 

[Yellowtail]

49 minutes ago, cmarshall said:

It might be possible, but I don't know if all national health coverage qualifies.  Here is the quote from AARP on the subject:

 

If you or your spouse is working while abroad:

You can delay Medicare enrollment in Part B (and avoid its premiums) if you have health care coverage from: 

• An employer for which you (or your spouse) actively work and which provides group health insurance for you (or both of you)
• The public national health service of the country where you live — regardless of whether you or your spouse works for an employer or are self-employed 
• The sponsoring organization of voluntary service you provide abroad (for example, the Peace Corps)

https://www.aarp.org/health/medicare-qa-tool/medicare-if-living-outside-united-states/

Thanks, that look promising...

[taxout]

I'll let others do the digging to verify, but I'm pretty sure that exemption in question applies to insurance provided as part of employment to you or your spouse.

 

[cmarshall]

3 hours ago, taxout said:

I'll let others do the digging to verify, but I'm pretty sure that exemption in question applies to insurance provided as part of employment to you or your spouse.

 

It's true that that text references employment abroad, but that may only be because of an assumption that Americans working abroad would eventually return to live in the US during retirement.  So, it employment abroad may not be an actual condition of the exemption.  After all, coverage is coverage.  It shouldn't matter if the foreign national coverage is provided as a condition of employment or not.

 

[hereforgood]

no need to sign up they will send you a letter before you turn 65 asking you if you wish to enroll in part b. If you do not respond you will be automatically be enrolled. They offer at that time a chance to turn it down as well. 

 

I live here in Thailand and am covered on the Thai SS coverage which covers me better than the US SS part B would but despite that I still opted for the part B never know if I will be forced home for one reason or another so  I am covered in any event.

[Jingthing]

4 hours ago, hereforgood said:

no need to sign up they will send you a letter before you turn 65 asking you if you wish to enroll in part b. If you do not respond you will be automatically be enrolled. They offer at that time a chance to turn it down as well. 

 

I live here in Thailand and am covered on the Thai SS coverage which covers me better than the US SS part B would but despite that I still opted for the part B never know if I will be forced home for one reason or another so  I am covered in any event.

No!

If you've got a SS claim with a foreign address before age 65 you will be automatically enrolled in Part A only!

If you want B you must take explicit action to request it via Manila FBU.

If not, no automatic enrollment.

Enrollment is through SS, not Medicare.

[hereforgood]

2 hours ago, Jingthing said:

No!

If you've got a SS claim with a foreign address before age 65 you will be automatically enrolled in Part A only!

If you want B you must take explicit action to request it via Manila FBU.

If not, no automatic enrollment.

Enrollment is through SS, not Medicare.

Ok thanks for the correction I have a US address and it was automatic. I was unaware it was different for those outside the US that were not using a US address.

[sirineou]

3 hours ago, Jingthing said:

No!

If you've got a SS claim with a foreign address before age 65 you will be automatically enrolled in Part A only!

If you want B you must take explicit action to request it via Manila FBU.

If not, no automatic enrollment.

Enrollment is through SS, not Medicare.

Don't put too much stock on the below, I am just as confused as most of us are about Medicare. All my information is from watching YouTube videos on the subject. 

  But the  way I understand it, is that if you are on disability or you have being receiving SS a few  months before you automatically enrolled in  Part B Medicare  (I think it's  3 months or more  but could be wrong)  and you will receive your Medicare card in the mail about three months before your 65th birthday . But there could be a special provision for those who live outside the US, so if by 2 months before your B-day you have not received your card, I would be make sure to call.

I think that even if you don't do that by your 65th B-day , you have 3 months after your B-day to enroll . 

If everything goes ok when I go to Greece  next month,  and indeed I am able to buy into their national health plan , I will still enroll in part B , because I would want to experience the Greek  system before I decide to depend on it.

(According to the W.H.O. when considering al criteria, Greece ranked 14th in the world , with the US 37th, Thailand 47th  in 2021 ) 

https://www.who.int/healthinfo/paper30.pdf

 

But that does not mean that the delivered product is better for all , because   cost and total outcomes are considered.  

 

but if indeed I can defer joining if I am enroll in a foreign national plan then it would be more desirable not to , and save $170 per month. .  

I am  wondering, If one enrolls in Part B at age 65 Is it possible to later on drop out and not pay the Part B premium? 

Edited February 26, 2022 by sirineou

[Jingthing]

55 minutes ago, hereforgood said:

Ok thanks for the correction I have a US address and it was automatic. I was unaware it was different for those outside the US that were not using a US address.

Sure.

It is.

[taxout]

POMS, the Social Security bible of rules and procedures, is clear that the group health plan exemption depends on employment status.

 

"If the individual did not enroll in the initial enrollment period (IEP), he or she must be covered under a group health plan (GHP) based on his or her own or a spouse’s current employment status in the first month of eligibility for SMI and for all months thereafter."

 

https://secure.ssa.gov/apps10/poms.nsf/lnx/0600805270

 

[cmarshall]

13 hours ago, taxout said:

POMS, the Social Security bible of rules and procedures, is clear that the group health plan exemption depends on employment status.

 

"If the individual did not enroll in the initial enrollment period (IEP), he or she must be covered under a group health plan (GHP) based on his or her own or a spouse’s current employment status in the first month of eligibility for SMI and for all months thereafter."

 

https://secure.ssa.gov/apps10/poms.nsf/lnx/0600805270

 

Yes, that's what the text says, but it could just reflect an assumption that the only acceptable alternative to Part B would have to come from an employer's health insurance.  Also, the author of that text may have assumed that scope of the provision was the US, since why would an American expat even have Part B.  

 

I am just guessing here, but, after all, why would a national health plan qualify as an exemption from the Part B penalty for late enrollment only during employment abroad and not afterward.  So, an expat working in France for instance would not face the Part B late enrollment penalty while employed there, but if he then remained there during retirement he would suddenly face the penalty if he were to return to the US.  There doesn't seem to be a logical reason for it.

 

But that may still be the rule.  The question is is there any other provision in the POMS that would modify it?

[sirineou]

2 minutes ago, cmarshall said:

Yes, that's what the text says, but it could just reflect an assumption that the only acceptable alternative to Part B would have to come from an employer's health insurance.  Also, the author of that text may have assumed that scope of the provision was the US, since why would an American expat even have Part B.  

 

I am just guessing here, but, after all, why would a national health plan qualify as an exemption from the Part B penalty for late enrollment only during employment abroad and not afterward.  So, an expat working in France for instance would not face the Part B late enrollment penalty while employed there, but if he then remained there during retirement he would suddenly face the penalty if he were to return to the US.  There doesn't seem to be a logical reason for it.

 

But that may still be the rule.  The question is is there any other provision in the POMS that would modify it?

That is  sound reasoning, but since when has logic being part of American politics? 

So who knows? 

I am following This subject with great interest as I will find myself in the above situation in the next couple of months.    

[taxout]

If wishful thinking is making you doubt the black-and-white of those words, then take the time yourself to go wading through POMS trying to find the answer you want. Actually contribute here for a change.

 

Hint: Start not at POMS but at 42 U.S.C. Sec. 1395p.

Edited February 27, 2022 by taxout

[Jingthing]

Is it possible to make a formal request for a clarification or do you need a lawyer for that?