Question for American Expats on Medicare.

[LALes]

I'm 72 living in Thailand for all but 6 weeks a year in the States.  I've been on Medicare for 7 years and didn't use it once

until a recent PCR test to come back home.  Is it worth it?  I have no coverage in Thailand so my only hope is that if I get

sick, I can hopefully crawl on a plane back to the States.   Seriously thinking of dropping Medicare for a Thai plan.

[lopburi3]

2 minutes ago, LALes said:

I'm 72 living in Thailand for all but 6 weeks a year in the States.  I've been on Medicare for 7 years and didn't use it once

until a recent PCR test to come back home.  Is it worth it?  I have no coverage in Thailand so my only hope is that if I get

sick, I can hopefully crawl on a plane back to the States.   Seriously thinking of dropping Medicare for a Thai plan.

You really should have a local coverage plan (even if only hospital and high deductible) and time is running out at your age.  Most have to be obtained prior to 75 at the latest I believe.  Perhaps a plan valid for Thailand but sourced outside.  Medicare A for most is free so you would keep that in any case.  

[ericthai]

11 hours ago, LALes said:

I'm 72 living in Thailand for all but 6 weeks a year in the States.  I've been on Medicare for 7 years and didn't use it once

until a recent PCR test to come back home.  Is it worth it?  I have no coverage in Thailand so my only hope is that if I get

sick, I can hopefully crawl on a plane back to the States.   Seriously thinking of dropping Medicare for a Thai plan.

When back in the states look for an advantage plan that has coverage outside the USA for emergencies.

Not all plans have this coverage on their plans it depends on the state and county if this is available.

 

If you want you can PM me your zip code I can check if anything is available in your area. Some plans offer a part B rebate so might even reduce your part B cost. 

[HawaiianBlues]

As another data point, I am a BKK resident 50%+ of the time each year and am momentarily moving away from a Medicare Advantage plan (which in the base case requires Parts A and B) and additionally subscribing to Plan G (Medigap Supplement Plan), Part D (prescription) and Dental.  My longer term plans recognize eventual greater presence in the US (vs Thailand).  I separately have local medical insurance coverage for Thailand which also provides emergency medivac and emergency coverage for most countries while travelling overseas including the US (the international coverage is a benefit as I do enjoy international travels).   In my process of researching US and Thailand insurance coverage, I've learned: (a) the overlooked value of having a Plan G Medicap Supplement Plan (vs going with a Medicare Advantage plan) but which also depends on each retiree's circumstance and time in the US, (b) the need to recognize the eligibility timing window to enroll in a Medigap Supplement Plan and bypass the recognition of pre-existing conditions should that be a consideration and (c) the importance to plan/purse early one's Thailand insurance coverage (i.e., the earlier the better before turning 65) acknowledging the greater cost exposure and lesser insurance coverage eligiblity once you have turned 65.  Also as shared by others, the Medigap Supplement Plan G does provide some overseas (non-US) travel coverage with limiting provisions (ref Medicare website:  https://www.medicare.gov/supplements-other-insurance/medigap-travel).  Am sure there are likely many lower cost approaches than my eventual choices but for myself, I wanted to ensure the flexibility in coverage and hopefully less stress too.   

Edited February 13, 2022 by HawaiianBlues

[Sheryl]

16 hours ago, ericthai said:

When back in the states look for an advantage plan that has coverage outside the USA for emergencies.

Not all plans have this coverage on their plans it depends on the state and county if this is available.

 

If you want you can PM me your zip code I can check if anything is available in your area. Some plans offer a part B rebate so might even reduce your part B cost. 

As far as I know, with exceptions of some plans not available to the general public (i.e. limited to ex military or ex foreign service etc) Medicare Advantage plans are not available to persons who do not maintain a residence in the US. In fact, I believe you are required to be physically present in the state for at least 6 months of the year.  You have to state, in the application, not only that you reside in the US but that you meet a residency requirement in the relevant state coverage area. i

 

Now, I would not worry too much about exact number of days in US and abroad as long as you in fact maintain a home in the US in the state listed and spend at least a few months of each year there, regularly.

 

But for those of us living full-time in Thailand, there is no way to get a Medicare Advantage plan that would not entail fraud -- fraud very likely to come out in the event of trying to claim care received abroad. Those Medicare Advantage Plans which cover anything abroad, clearly do so only for emergencies occurring during short visits. They are not designed or intended to cover people living abroad.

[Sheryl]

On 2/12/2022 at 10:21 AM, LALes said:

I'm 72 living in Thailand for all but 6 weeks a year in the States.  I've been on Medicare for 7 years and didn't use it once

until a recent PCR test to come back home.  Is it worth it?  I have no coverage in Thailand so my only hope is that if I get

sick, I can hopefully crawl on a plane back to the States.   Seriously thinking of dropping Medicare for a Thai plan.

 

If by a "Thai plan" you mean locally issued insurance - very bad idea in my opinion and you'd be hard pressed to find much available at your age anyway.

 

If you mean an expatriate insurance plan that will cover you in Thailand, there are several issued out of western countries, your age will reduce but not eliminate choice (assuming otherwise healthy) and certainly you should get such coverage without delay.

 

However that has nothing to do with medicare and I don't understand why you would drop Medicare. Part A is free. If you mean Part B, keep in mind that if you drop it and in subsequent years have to return to the US you would face a lifelong penalty premium when getting back on Part B.

 

By the way if you return to the US for a visit each year, you can get a number of preventive services at that time: annual wellness check,  periodic colonoscopy etc. I do, I basically shifted all my preventive care to the US when I came of Medicare age even though I only come for brief visits each year.

 

The preventive services have no copay.

[jerrymahoney]

On 2/11/2022 at 8:51 AM, flbkk said:

I do have a US residential address in Florida.

It is getting for many purposes that a bona fide residential address in Florida or elsewhere is where you maybe own a house, or have your name on a utility bill, or other Patriot Act-type compliances.

 

Just having an address to use of a friend or relative when you do not actually live there for a major part pf the year for many purposes any more will not be considered bona fide.

 

... as I note Ms. Sheryl has referenced above

Edited February 13, 2022 by jerrymahoney

[ericthai]

10 hours ago, HawaiianBlues said:

As another data point, I am a BKK resident 50%+ of the time each year and am momentarily moving away from a Medicare Advantage plan (which in the base case requires Parts A and B) and additionally subscribing to Plan G (Medigap Supplement Plan), Part D (prescription) and Dental.  My longer term plans recognize eventual greater presence in the US (vs Thailand).  I separately have local medical insurance coverage for Thailand which also provides emergency medivac and emergency coverage for most countries while travelling overseas including the US (the international coverage is a benefit as I do enjoy international travels).   In my process of researching US and Thailand insurance coverage, I've learned: (a) the overlooked value of having a Plan G Medicap Supplement Plan (vs going with a Medicare Advantage plan) but which also depends on each retiree's circumstance and time in the US, (b) the need to recognize the eligibility timing window to enroll in a Medigap Supplement Plan and bypass the recognition of pre-existing conditions should that be a consideration and (c) the importance to plan/purse early one's Thailand insurance coverage (i.e., the earlier the better before turning 65) acknowledging the greater cost exposure and lesser insurance coverage eligiblity once you have turned 65.  Also as shared by others, the Medigap Supplement Plan G does provide some overseas (non-US) travel coverage with limiting provisions (ref Medicare website:  https://www.medicare.gov/supplements-other-insurance/medigap-travel).  Am sure there are likely many lower cost approaches than my eventual choices but for myself, I wanted to ensure the flexibility in coverage and hopefully less stress too.   

I'm not sure why you would switch to Medicap plan, this is increasing you health care cost. The G plan will have a monthly premium and depending on age and location that can be anywhere between $100 to $350 a month, then you still need to get a part D plan (medications) this ranges anywhere from $25-$70 per month. 

 

Also you will have to go through underwriting and pre-existing conditions can be an issue. The only time you are able to enroll in a Medicap also called a Medicare supplement plan without underwriting is when you first enroll in Medicare. 

 

I'm not saying a medigap or supplment plan is not a good thing, it's great but costly. If someone travels around the USA allot or has allot of medical issues, or just wants to the freedom to go where they want then this is a good plan. If someone is in generally good health and happy with the plans network of doctors then in my opinion an advantage plan is a better choice. 

 

 

[ericthai]

7 hours ago, Sheryl said:

As far as I know, with exceptions of some plans not available to the general public (i.e. limited to ex military or ex foreign service etc) Medicare Advantage plans are not available to persons who do not maintain a residence in the US. In fact, I believe you are required to be physically present in the state for at least 6 months of the year.  You have to state, in the application, not only that you reside in the US but that you meet a residency requirement in the relevant state coverage area. i

 

Now, I would not worry too much about exact number of days in US and abroad as long as you in fact maintain a home in the US in the state listed and spend at least a few months of each year there, regularly.

 

But for those of us living full-time in Thailand, there is no way to get a Medicare Advantage plan that would not entail fraud -- fraud very likely to come out in the event of trying to claim care received abroad. Those Medicare Advantage Plans which cover anything abroad, clearly do so only for emergencies occurring during short visits. They are not designed or intended to cover people living abroad.

yes you are correct plans require you to reside in the service area at least 6 months a year and doing otherwise would be fraud.

I thought the poster stated they spent most of their time in the USA.  

 

Also correct, the worldwide coverage that the plans provide are for emergences situations only.  

 

[ericthai]

7 hours ago, Sheryl said:

As far as I know, with exceptions of some plans not available to the general public (i.e. limited to ex military or ex foreign service etc) Medicare Advantage plans are not available to persons who do not maintain a residence in the US. In fact, I believe you are required to be physically present in the state for at least 6 months of the year.  You have to state, in the application, not only that you reside in the US but that you meet a residency requirement in the relevant state coverage area. i

 

Now, I would not worry too much about exact number of days in US and abroad as long as you in fact maintain a home in the US in the state listed and spend at least a few months of each year there, regularly.

 

But for those of us living full-time in Thailand, there is no way to get a Medicare Advantage plan that would not entail fraud -- fraud very likely to come out in the event of trying to claim care received abroad. Those Medicare Advantage Plans which cover anything abroad, clearly do so only for emergencies occurring during short visits. They are not designed or intended to cover people living abroad.

yes you are correct, to be on a Medicare advantage plan you must reside at your residence minim 6 months of the year. 

Maybe I misunderstood the poster as I thought he stayed in the USA  part of the year.

 

Plans do check and will send out address verification letters from time to time to make sure the member is living at stated address.

[HawaiianBlues]

On 2/13/2022 at 10:14 PM, ericthai said:

I'm not sure why you would switch to Medicap plan, this is increasing you health care cost. The G plan will have a monthly premium and depending on age and location that can be anywhere between $100 to $350 a month, then you still need to get a part D plan (medications) this ranges anywhere from $25-$70 per month. 

 

Also you will have to go through underwriting and pre-existing conditions can be an issue. The only time you are able to enroll in a Medicap also called a Medicare supplement plan without underwriting is when you first enroll in Medicare. 

 

I'm not saying a medigap or supplment plan is not a good thing, it's great but costly. If someone travels around the USA allot or has allot of medical issues, or just wants to the freedom to go where they want then this is a good plan. If someone is in generally good health and happy with the plans network of doctors then in my opinion an advantage plan is a better choice. 

 

 

Thanks for your feedback.  What you wrote in the last paragraph ("travels alot") applies to me (except I don't have medical issues).  With the travels, being able to pick your doctors anywhere in the US vs. having to be in-network was a big plus.   My one-off claims experiences have shown that my 20% deductible share in aggregate can still be high and I expect in time will readily exceed the Medigap premiums (which monthly for me are around $145, at least for now).   My Plan D is less than $9/mo.  I ran the total numbers and in my personal case anticipate being ahead in monthly costs (and risk/exposure) - particularly as I no longer qualify for Medicare Advantage coverage.    On qualifying for Medigap, in my case, I learned that being disenrolled from one's Medicare Advantage program due to change in their regional coverage (i.e., living overseas) does permit one only at time of disenrollment to enroll in a Medigap program without physician's review or being approved for pre-existing conditions.  So, felt best to do it now than having any surprises or potential roadblocks when pursuing a Medigap plan later.  In the end, it came down to planning ahead and just trying to minimize coverage issues in the US - particularly if/when I return fulltime (and for those later short visits outside the US).  

[Sheryl]

On 2/11/2022 at 6:00 AM, 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.

 

I have never seen such advice from SSA.

 

On the contrary, they earn that failing to enrol in Part B when you turn 65 will lead to a lifelong penalty (higher premium) of you sign up later.

 

Perhaps you mean a Medicare Advantage or Medi-Gap plan, that is an altogether different matter and indeed someone who lives full time abroad is nto eligible for these. (And these are likely what the OP is getting ads for).

 

OP: I have Medicare Parts A and B, and an international expat plan that covers me not only in Thailand but in most other countries as well (exceptions of US, and some other expensive places - but these too are covered for emergencies during short trips). I take advantage of medicare for all my preventive health needs as I visit the US annually. (No Medicare copays for approved preventive services)

 

I generally warn people against insurance with a Thai company as these have in general a bad record for payment and other issues (e.g. they will raise your rates based on claims history, which most internationally issued expat policies are nto allowed to do), and weaker regulatory framework here compared to western countries.  This said, some Thai companies are better than others so depending on which your policy is with and how long you have had the policy, and also given that at 65 your choices for a new international expat policy is more limited than it was before turning 65, you might be better off keeping it.

 

You can always take out a travel insurance policy for trips to other than the US.

 

Note that Medicare co-pays (for other than preventive services) can be considerable.

 

 

[Jingthing]

On 2/11/2022 at 6:00 AM, 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.

No!

Part A will be free for most.

Its nuts not join A at 65 if free.

I was signed up automatically for A as an open expat.

For B the enrollment organization which happens to be social.security same as A wants expats to know the rules. Expats not included in benefits but big issues if you move back. 

Typical advice is if you're certain you won't move back then don't take B.

But as we all know plans change.

Edited February 18, 2022 by Jingthing

[Bubbha]

If you’re an expat here with no plans to return to the US, it’s good to study and understand end-of-life care in Thailand. I have been through this with several (now deceased) expat friends.

 

In my opinion, and from my experience, palliative care is underdeveloped and inadequate compared to the US and many western countries. Also, there are a real lack of hospice care options. There are also many cultural issues (differences) to consider regarding treatment of terminally ill patients for pain management.

 

If you plan to die here, it’s best to understand the Thai legal system’s framework for death and dying.  This is what your Thai hospital and doctors will be required to follow.

 

For myself and my own experience, these are some of the important issues to consider regarding end of life care here in Thailand when weighing the cost versus benefits of enrolling in and maintaining Medicare.

[Sheryl]

44 minutes ago, Bubbha said:

If you’re an expat here with no plans to return to the US, it’s good to study and understand end-of-life care in Thailand. I have been through this with several (now deceased) expat friends.

 

In my opinion, and from my experience, palliative care is underdeveloped and inadequate compared to the US and many western countries. Also, there are a real lack of hospice care options. There are also many cultural issues (differences) to consider regarding treatment of terminally ill patients for pain management.

 

If you plan to die here, it’s best to understand the Thai legal system’s framework for death and dying.  This is what your Thai hospital and doctors will be required to follow.

 

For myself and my own experience, these are some of the important issues to consider regarding end of life care here in Thailand when weighing the cost versus benefits of enrolling in and maintaining Medicare.

Absolutely true. Hospice care such as we know it in the West is unavailable here and there are few palliative psecialists.