Question for American Expats on Medicare.

[FarmerJoe]

Hello, I'm just turning 65 and getting bombarded by offers from Medical Insurance companies here in the states. I live in Thailand and come back here to visit family and friends for a couple of months each year. Do any of you have both Medicare and an alternative provider or just have a good international insurance company? I have insurance with a Thai company, but it does not cover overseas travel. I really don't want to pay for 2 insurance policies. Did most of you not sign up for Medicare and go with a good international insurance provider or have both? And what insurance companies do you recommend for all around coverage?

Thanks for whatever help you can provide.

[NakhonR]

You should already be aware of the fact that SSA does not pay medical benefits outside the USA. They advise you not to pay or join Medicare if you reside outside USA.

[Etaoin Shrdlu]

Medicare Part A (hospitalization cover) does not require payment of a premium. I don't see any downside to signing up for Part A when you turn 65.

 

Part B (outpatient) does require payment of a premium. If you don't sign up during your enrollment period at age 65, it will cost an additional 10 percent for every 12 months that you did not participate and pay the premium. Premiums are based upon your income. You will have to decide if it is worth the monthly premium to have cover for visits to the US and for the possibility that you will repatriate some day in the future and wish to avoid paying the penalty.

 

If you do not take Part B during your initial enrollment period, you would have to wait for an open enrollment period if you do decide to join. I think there is one open enrollment period each year for a limited time, so you would have to time a late enrollment properly to avoid a gap if you did return to the US and wanted cover.

 

Some rely upon travel insurance for visits to the US, but travel policies can become difficult to obtain in later years.

[cmarshall]

The only Medicare programs for which an expat can register are Parts A and B.  All other programs require a US residential address.  If an expat were nevertheless to register for Part D, Medicare Advantage, etc. by using a US address where he does not reside, he would be committing fraud.

[FarmerJoe]

2 hours ago, NakhonR said:

You should already be aware of the fact that SSA does not pay medical benefits outside the USA. They advise you not to pay or join Medicare if you reside outside USA.

Just saw this on Google. " Can I still purchase a US health care insurance policy if I reside outside the United States? No. In order to buy the insurance as an individual, you must be living in the US." So, I'm guessing it's probably better to just get travel insurance before I head back to the states. I just saw that as of 2022, you will not get penalized for not having insurance. I'll just upgrade my Thai Insurance.

[FarmerJoe]

1 hour ago, Etaoin Shrdlu said:

Medicare Part A (hospitalization cover) does not require payment of a premium. I don't see any downside to signing up for Part A when you turn 65.

 

Part B (outpatient) does require payment of a premium. If you don't sign up during your enrollment period at age 65, it will cost an additional 10 percent for every 12 months that you did not participate and pay the premium. Premiums are based upon your income. You will have to decide if it is worth the monthly premium to have cover for visits to the US and for the possibility that you will repatriate some day in the future and wish to avoid paying the penalty.

 

If you do not take Part B during your initial enrollment period, you would have to wait for an open enrollment period if you do decide to join. I think there is one open enrollment period each year for a limited time, so you would have to time a late enrollment properly to avoid a gap if you did return to the US and wanted cover.

 

Some rely upon travel insurance for visits to the US, but travel policies can become difficult to obtain in later years.

I think I'll just turn down the part B. I saw travel insurance to the states for 4 months for $750 for $150,000 coverage. Might try that when I have to come back. Thank you.

[lopburi3]

As said you should have part A (free) and B (reasonable charge) if you do not have US insurance better than part B.  If you opt out there will be a penalty (forever) if you later want part B.  As you never know the future best not to think will never be used in most peoples opinion.  The other options are not available to those living overseas anyhow.  

[flbkk]

I’ve been here for a few years, and in that time got on Medicare. I explored all the options carefully. I do have a US residential address in Florida. I found try insurance for the elderly to be near any useless. The amount they would pay for a serious hospitalization is about equal to your annual premium, so you may as well self insure. I had Aetna for a year, then dropped it after a 30% increase. This is before Covid. Do not get a US Medicare advantage plan under any circumstances. It is only good in the county in which you live, although it does cover emergencies and the rest of the United States. I have a Medigap plan, also called Medicare supplement. It covers the 20% that Medicare does not cover, in the United States. By law, Medicare plans can only offer a limited 60 day travel cover overseas. So in summary, I go without trying insurance, but keep myself covered in the United States. If I needed an elective procedure, such as knee surgery, I could return to the US. If I became ill, or just wanted to relocate back to the US, I would have my coverage in place. As others have mentioned, there are waiting periods and medical underwriting involved if you want to take coverage later. If I get seriously ill in Thailand, I have told my partner to have them take me to a government hospital, where the price is less.

[FarmerJoe]

40 minutes ago, lopburi3 said:

As said you should have part A (free) and B (reasonable charge) if you do not have US insurance better than part B.  If you opt out there will be a penalty (forever) if you later want part B.  As you never know the future best not to think will never be used in most peoples opinion.  The other options are not available to those living overseas anyhow.  

Yeah. I guess your right. 

 

42 minutes ago, flbkk said:

I’ve been here for a few years, and in that time got on Medicare. I explored all the options carefully. I do have a US residential address in Florida. I found try insurance for the elderly to be near any useless. The amount they would pay for a serious hospitalization is about equal to your annual premium, so you may as well self insure. I had Aetna for a year, then dropped it after a 30% increase. This is before Covid. Do not get a US Medicare advantage plan under any circumstances. It is only good in the county in which you live, although it does cover emergencies and the rest of the United States. I have a Medigap plan, also called Medicare supplement. It covers the 20% that Medicare does not cover, in the United States. By law, Medicare plans can only offer a limited 60 day travel cover overseas. So in summary, I go without trying insurance, but keep myself covered in the United States. If I needed an elective procedure, such as knee surgery, I could return to the US. If I became ill, or just wanted to relocate back to the US, I would have my coverage in place. As others have mentioned, there are waiting periods and medical underwriting involved if you want to take coverage later. If I get seriously ill in Thailand, I have told my partner to have them take me to a government hospital, where the price is less.

Yeah. I think I'll keep the medicare. If something does happen while in the states, I don't want to have a problems with bills and all. I plan on taking the dirt nap in Thailand surrounded by the wife and kids, but Ya never know. Thank you for the advice.

[NancyL]

We pay for Part B although we travel to the U.S. rarely, if ever.  You never know what the future may bring, we can afford it and it's good to have in place, for example I made a trip to the U.S. last year that I wasn't planning.  We also have international health insurance in Thailand, with a high deductible.  People say that the premiums are high and that health care is cheap, but I've known of bills in excess of 3 or 4 million baht for accidents or heart attacks, strokes, etc here and you can hop on a plane and return to the U.S. with those conditions.  Paying $4000 - $6000 a year for health insurance in Thailand starts to look like a bargain then.  

[Fortean1]

There are always exceptions.  We retired U.S. military use TRICARE (the military HMO).  To keep your TRICARE coverage you must enroll in Medicare Part B.  My wife and I have had major surgeries in the last five years.  TRICARE covered 60-70% up to $3,000; then 100% after that amount.

 

Terry in Hua Hin

[statman78]

You will automatically be signed up for Medicare part A.  If you are getting Social Security benefits your premium for part B will automatically be deducted from your monthly benefit if you used a US address to register for Social Security benefits.  If you used a foreign address you would need to sign up for part B.  When I retired and moved to Thailand before I became eligible for Medicare I purchased a Thai health insurance policy which has set premium adjustments every 5 years until I turn 95.

[DFPhuket]

I recently turned 65 and while I live in Thailand, I have no idea what the next decades will bring and if or when I might move to the US. I have kept a US address. 

 

I signed up for Part A, Part B, Part D (drugs - less than $10/month) and Plan G Medigap. Right now I spend a couple of months in the US each year and will be covered while I'm there. The peace of mind of knowing I have coverage while I'm there and in the future, should I return or have a major medical condition, is worth it to me. Thankfully I'm in a position where the cost isn't an issue.

 

I also have a health policy in Thailand, but like many policies, it doesn't cover me in the US. 

[cardinalblue]

Crazy not to sign up for part A of Medicare…as for part B and drugs, really depend on how much time of the year you spend in the USA and want to use their services when in US or plan a trip to use their services driven by need vs what you get in Thailand (insurance and services)…

 

my understanding is you cannot sign up for part B (not sure for other parts) anytime you want… you must sign up at the time you qualify…can’t wait say 2 years and then say I want to sign up….I think you would be forced to pay the premiums for the time you were not covered…

Edited February 11, 2022 by cardinalblue

[dlclark97]

In 1979 Medicare use was denied for Americans living in Thailand.  The reasons this was denied at that time included difficulty getting exchange rate information and difficulty obtaining related documents in English.  It should be revisited as these conditions no longer apply.  I believe there are some exceptions today for a very few international locations where Medicare can be used, Canada and Mexico come to mind.  Part B coverage is required for U.S. military retirees living overseas areas to maintain their Tricare coverage.  And, for a reasonable amount their spouse and their children (even step children) up to certain ages depending on their school participation can also be covered.      

[sghanchey]

9 hours ago, Etaoin Shrdlu said:

Medicare Part A (hospitalization cover) does not require of a premium. I don't see any to signing up for Part A when you turn 65.

 

Part B (outpatient) does require of a premium. If you don't sign up during your enrollment period at age 65, it will cost an additional 10 for every 12 that you did not participate and pay the premium. Premiums are based upon your . You will have to decide if it is worth the monthly premium to have cover for visits to the US and for that you will repatriate some in the future and wish paying .

 

If you do not take Part B during your initial enrollment period, you would have to wait for an open enrollment period if you do decide to join. I think there is one open enrollment period each for a limited time, so you would have to time a late enrollment properly a gap if you did return to the US and wanted cover.

 

Some rely upon travel insurance for visits to the US, but travel policies can become difficult to obtain in later years.

Medicare Part B issued by United Healthcare through AARP (the biggest insurer in the U.S.) covers 80% of emergency treatment during the first 60 days of an overseas trip. I used it for emergency surgery and was reimbursed later (I had to pay the upfront cost using a credit card). Hospitals in Thailand cannot bill Medicare directly. If someone just visits here a couple of times a year, they should definitely enroll in Medicare in the U.S., because hospital costs in the U.S. are exorbitant, but Medicare pays 80% upfront in the U.S. Part B pays the difference. 

[dingdongrb]

Some good info here. I am making this post so I can follow it to see what other info might come about.

[swm59nj]

I’m 66 years old , retired at 62.  I’m from the states,  living in Bangkok a little over two years now.  
Part of the decision depends on you. If you plan to live in Thailand for ever, then you don’t need B.  If you do don’t plan to live here take B.  But you never know what the future might bring. Because if you don’t you will be paying a high ongoing late penalty.  
I didn’t plan to live overseas forever.  So I took B to avoid any future penalties.  

I carried over my health plan from my previous job.  It covers me anywhere overseas and domestically .  Also since I pay for Part B now, but can’t use it overseas.  As of age 65 my health plan pays any medical expenses 100%.  And all copays are waived.  I pay $ 250 usd per month deducted from my monthly pension payment for the insurance plan.  That is for a single person. Plus of course the charge for Part B deducted from Social Security. 

When I eventually move back to USA.  Medicare becomes my primary coverage at 80%.  My health insurance then covers me at 20%.  Also my health plan requires me to have part B for coverage in the states at age 65. 

 

 
 

 

Edited February 11, 2022 by swm59nj

[Jingthing]

I don't plan either frequent travel or repatriation to the US but I decided to enroll in B anyway. Just in case. You never know. The fee while not cheap and its a shame to flush it down the toilet won't really change my quality of life in Thailand.

[thaibook]

I opted for United Healthcare/AARP's Medicare Advantage programme in Florida.  It provides parts A  and B and some drug beefits.  In Florida in network PCP visits are free; thre is a copayment for specialists.  Annual check-up plus a ew other things periodically free.  I asked about cover overseas and was told that it covers emergencies in all US states and all countries.  One has to pay first and is reimbursed.  It also covers repatriation in case of emergency.  It does not cover run of the mill or elective treatments.  

 

As others have said, I think it is well worth having if you spend time in the USA, even for visits.  I have no insurance in Thailand.  When my wife has needed treatment (I have not needed anything) we paid out of pocket.

 

Remember we will all live a long time in superb health and one day wake up in another world, so no need to worry.

[RayOday]

As an adjunct to this discussion, Democrats abroad are lobbying for Medicare reimbursement for expats. After all you paid in you should reap a benefit. It doesn't matter your political allegiance if any. Medicare is not a hand out. You paid taxes and for Medicare /Medicade. I don't hold out hope yet everyone should write their congress person advocating for international Medicare reimbursement regardless where you live. Lost causes remain lost unless effort is applied. 

[ericthai]

2 hours ago, thaibook said:

I opted for United Healthcare/AARP's Medicare Advantage programme in Florida.  It provides parts A  and B and some drug beefits.  In Florida in network PCP visits are free; thre is a copayment for specialists.  Annual check-up plus a ew other things periodically free.  I asked about cover overseas and was told that it covers emergencies in all US states and all countries.  One has to pay first and is reimbursed.  It also covers repatriation in case of emergency.  It does not cover run of the mill or elective treatments.  

 

As others have said, I think it is well worth having if you spend time in the USA, even for visits.  I have no insurance in Thailand.  When my wife has needed treatment (I have not needed anything) we paid out of pocket.

 

Remember we will all live a long time in superb health and one day wake up in another world, so no need to worry.

This is a good move.

Did you check some other plans that have a part B refund?

If you're not really using the plan I would look at a plan that provides a partial refund on the part B premium. Almost all counties in Fla have a refund (give-back) plan. 

 

Also beware that the plan will send out an address verification letter to your address in the USA. (rule is your not suppose to be out of your service area for more than 6 months) If this is not completed and returned they assume you moved and will drop you from the plan so make sure relatives look out for that (i've had this happen to people that only live in Fla 6 months and then up north for 6 months). 

[Dan O]

17 minutes ago, ericthai said:

This is a good move.

Did you check some other plans that have a part B refund?

If you're not really using the plan I would look at a plan that provides a partial refund on the part B premium. Almost all counties in Fla have a refund (give-back) plan. 

 

Also beware that the plan will send out an address verification letter to your address in the USA. (rule is your not suppose to be out of your service area for more than 6 months) If this is not completed and returned they assume you moved and will drop you from the plan so make sure relatives look out for that (i've had this happen to people that only live in Fla 6 months and then up north for 6 months). 

The AARP United Advantage plan has a couple of levels or options available for an additional fee. Base plan include part B and drug, eye and dental at no additional cost. I say no additional as the regular Medicare Part A is mandatory and deducted from your SSI payments so that money goes out even if you just enroll in Part A Medicare. You're better off taking an advantage plan as a minimum and have that coverage available in the USA. 

[wwest5829]

2 hours ago, RayOday said:

As an adjunct to this discussion, Democrats abroad are lobbying for Medicare reimbursement for expats. After all you paid in you should reap a benefit. It doesn't matter your political allegiance if any. Medicare is not a hand out. You paid taxes and for Medicare /Medicade. I don't hold out hope yet everyone should write their congress person advocating for international Medicare reimbursement regardless where you live. Lost causes remain lost unless effort is applied. 

I encourage all Americans to support equity for full military retirees and full Medicare retirees on the same basis. Both are earned and paid for medical benefits for retirees. They should be extended and processed on an equal basis. At age 65, we are automatically registered for Medicare, Part A. I have continued to pay the monthly premium for Part B. My retirement included  BC/BS policy that will cover up to $5K annually for overseas care.

[thailand49]

I don't want to start a debate but there is an excellent article possible Google for those who reside outside U. S. For keeping Medicare,  part B runs this year 170.00 a month.  My thinking is don't burn your bridges too fast I will add legal or not if the U. S. can spend and throw money around no accountability worry about small fraud.

I use a family member address,  depending on your zip code there are plans HMO with high deductibles that have zero monthly payments I have such a plan with Blue cross. Whenever I know I'm returning I call the Doctor schedule a visit and get all necessary paperwork for blood test etc. So far it has worked out but I'm thinking of switching to Kaiser they have a 15.00 a month plan HMO but I can get everything done at one place. These plans you basically pay 15,00-20.00 for Doctor visit blood test,  you can google a Medicare and pretty much all the plans will come up with the fine print. 

[ericthai]

1 hour ago, Dan O said:

The AARP United Advantage plan has a couple of levels or options available for an additional fee. Base plan include part B and drug, eye and dental at no additional cost. I say no additional as the regular Medicare Part A is mandatory and deducted from your SSI payments so that money goes out even if you just enroll in Part A Medicare. You're better off taking an advantage plan as a minimum and have that coverage available in the USA. 

If you have 40 working quarters then part A is no cost (if you dont have enough working credits then you can pay for part A which if you have credits of 30+ quarters then you would pay $274 for part A, if you have less than 30 quarters then you would pay $499 per month for part A.  Again most people have enough earned credits (about 10yrs) for a premium free part A.   

 

You might be thinking part B, as part B everyone has to pay for which was increased this year to $170.10 per month. This is higher if you earn more. Some Medicare advantage plans offer rebates on the part B in main markets.  The rebate can be anywhere from $50 up to $148.50 and these plans still provide low copays, with extra coverage (non-emergency transportation, Over the counter, Dental, Vision, hearing, etc. 

 

Your next trip back to the USA. you might want to reach out to an insurance broker to see if you have better options. United is a great company, but very big and sometimes difficult to deal with. Also their plans are not as rich as some other companies.  

You can go to Medicare.gov put you zip code in and it will show all plans in your area. Very good tool!!

 

Additionally if you have questions you can PM me, I'm a Licensed Medicare insurance agent in the USA so I can answer any questions someone may have. 

 

 

[ericthai]

3 hours ago, RayOday said:

As an adjunct to this discussion, Democrats abroad are lobbying for Medicare reimbursement for expats. After all you paid in you should reap a benefit. It doesn't matter your political allegiance if any. Medicare is not a hand out. You paid taxes and for Medicare /Medicade. I don't hold out hope yet everyone should write their congress person advocating for international Medicare reimbursement regardless where you live. Lost causes remain lost unless effort is applied. 

Their are several issues.

First being fraud is a big issue in the USA with Medicare, if it was made available worldwide their would be rampant fraud. (what do you think the Thai hospital's would charge US Medicare....normal rates or added fees? ) The other issue is Medicare is pushing physicians / Hospitals on preventive care, this would not work outside the USA.  Medicare is almost out of funds, impossible for them to implement worldwide. 

 

However, there are Medicare advantage plans that do cover outside the USA. Some cover up to $100,000 USD others cover up to $200,000 USD, but this is more or less travel coverage not meant for living outside the USA. 

[Bohemianfish]

2 hours ago, ericthai said:

If you have 40 working quarters then part A is no cost (if you dont have enough working credits then you can pay for part A which if you have credits of 30+ quarters then you would pay $274 for part A, if you have less than 30 quarters then you would pay $499 per month for part A.  Again most people have enough earned credits (about 10yrs) for a premium free part A.   

 

You might be thinking part B, as part B everyone has to pay for which was increased this year to $170.10 per month. This is higher if you earn more. Some Medicare advantage plans offer rebates on the part B in main markets.  The rebate can be anywhere from $50 up to $148.50 and these plans still provide low copays, with extra coverage (non-emergency transportation, Over the counter, Dental, Vision, hearing, etc. 

 

Your next trip back to the USA. you might want to reach out to an insurance broker to see if you have better options. United is a great company, but very big and sometimes difficult to deal with. Also their plans are not as rich as some other companies.  

You can go to Medicare.gov put you zip code in and it will show all plans in your area. Very good tool!!

 

Additionally if you have questions you can PM me, I'm a Licensed Medicare insurance agent in the USA so I can answer any questions someone may have. 

 

 

Do you know if spouses with less than 40 quarters and get Social Security based off their spouse are eligible for Medicare?

Looks like I found the answer and a spouse can get Medicare.

Edited February 11, 2022 by Bohemianfish

[RayOday]

7 hours ago, ericthai said:

Their are several issues.

First being fraud is a big issue in the USA with Medicare, if it was made available worldwide their would be rampant fraud. (what do you think the Thai hospital's would charge US Medicare....normal rates or added fees? ) The other issue is Medicare is pushing physicians / Hospitals on preventive care, this would not work outside the USA.  Medicare is almost out of funds, impossible for them to implement worldwide. 

 

However, there are Medicare advantage plans that do cover outside the USA. Some cover up to $100,000 USD others cover up to $200,000 USD, but this is more or less travel coverage not meant for living outside the USA. 

As I understand it Medicare would be reimbursed. You wouldn't have to pay first. Fraud is fraud. I am retired yet the last 15 years of a 35 year career was spent turning around acquired  organizations that were fraudulent in China. I get it. Haven't seen much detail yet not getting any repayment of what you may have paid in is not acceptable to me.

[lopburi3]

7 hours ago, ericthai said:

First being fraud is a big issue in the USA with Medicare, if it was made available worldwide their would be rampant fraud. (what do you think the Thai hospital's would charge US Medicare....normal rates or added fees? )

Actually my understanding of most major fraud is payment of false claims rather than overpayments and at least in the past very much a Russian controlled mob thing.  And family have been visited by mob lawyers when they refused to subject such claims onward.  The medical confidentiality rules makes it very hard to police - most foreign countries do not have as strict rules. 

 

As for international opening up to more fraud do not agree it would be major - I have BCBS/GMMI international insurance and they have local ability to check claims so Medicare could easily do the same.  As for normal rates expect most insurance payments will be more; but in almost all cases less than US prices.