US Medicare - what do most expats do?

[ding]

I'm turning 65 next year and have lived here with my Thai wife for 1.5 years. We don't have plans to return to the US but things can change, especially with age.

I'm thinking of getting Medicare Premium-free Plan A, keeping my AIA big ticket expense medical insurance, and pay out of pocket for routine care.

Can people chime in with their experience please? What are US expats doing for medical over 65?

[lopburi3]

A very good question for US expats.

 

If there is a chance you will return (married or not) to USA would give consideration to paying for Medicare plan B if able.  But admit have not considered for myself as have partially subsidized insurance worldwide that is better than Medicare so would not be worthwhile.

[HappyExpat57]

I kept part B. I had cataract surgery in one eye last year, out of pocket cost was $145 USD.  Would have cost a lot more than that here in Thailand. The money I saved easily paid for the price of a business class round trip ticket (which I do annually anyway). Part B cost is negligible if you compare what it will pay for. Again, my favorite Thai phrase - "up to you"

[Keep Right]

Of course I keep the Part B of Medicare going even though I have not been back to the good-ol-USA for several years. I self-insure while in Thailand. It is a good idea to have the resources necessary on hand to book a return flight on the drop of a dime as needed in case of a medical emergency.

 

https://www.medicaltransportinternational.com/?gad_source=1&gclid=EAIaIQobChMI79igk9XFggMVh6hmAh3coAlDEAAYAiAAEgJ-tvD_BwE

 

https://www.flyambu.com/?gad_source=1&gclid=EAIaIQobChMI79igk9XFggMVh6hmAh3coAlDEAAYASAAEgKny_D_BwE

 

 

[QuantumQuandry]

I can see where it *might* make sense if you go home a lot, anyway.

 

As I don't go back home, for it to make sense, for me, I would need to:

- Have a condition that isn't an emergency and that I can fly with.  This is probably the biggest reason I would never use it.

- Pay for hotels and increased food prices, as well as a business class ticket, round trip, plus miscellaneous items like transport and re-entry.  Possibly buy some weather appropriate clothes, too, depending on where I needed to go.  Food/hotel could actually add up to a large amount, if there is significant recovery time before flying back.

- Be willing to spend 20+ hours on a flight with a problem that may or may not be causing pain/discomfort the whole way.

- Make arrangements for my significant other to be taken care of, while I am away.

- Have someone there to care about me, if things go wrong.  Or to help in the recovery phase of whatever the problem is.

 

That said, there ARE a few big ticket, catastrophic non-emergency items that could make it worth it.  Basically, something like cancer...or maybe end stage kidney disease?

 

[Sheryl]

You get part A automatically (assuming you qualify; most people do). No need to pay any premium.  It s Part B that you need to opt into, and there is a cost for that. Currently I think around $170 a month. Can be automatically deducting from your SS.

 

Important to note that if you do not get Part B when you first turn 65, and then later enroll, there is a penalty in the form of higher premium and it is applied for life. I enrolled in part B because of this though have virtually never used it so far ... I like keeping options open and I may return to live in the US at some point though not imminently.

 

I mainly use Part A preventive care benefits (annual check-ups, periodic colonoscopy, mammogram etc etc) , though on occasion have had to dip into Part B for a few preventive services not covered under A. I have not used ti for any illnesses thus far but good to know it is there as a back up to my international insurance especially as this includes an exclusion.

 

Under both parts A and B there are deductibles and copays such that if fulltime living in US it is advisable to get a Medicare supplemental insurance or Medicare Advantage Plan, former is better but more costly. Neither is possible while living abroad. One would also need to get a Part D plan (to cover drugs), not necessary when living abroad.

[ibjoe]

I understand that USA Medicare does not pay for out of country medical expenses. I have Medicare Advantage (sometimes called Part C) HMO plan, it also covers Part D. My provider Evidence Of Coverage document (also verbal confirmation) says they will pay for all critical / emergency care, including ambulance, etc. anywhere in the world - though I might have to pay first and file for reimbursement. I don't have any local coverage, just the USA Medicare Advantage HMO plan. I keep a card with details in Thai and English (along with emergency phone numbers) in my wallet, just in case. For non-critical issues I pay out-of-pocket, and prices for those tend to be relatively low compared to USA.

[swm59nj]

Different people are in different situations of course pertaining to what type of insurance they have if any.

When I recently lived in Bangkok for three years  I collected social security and a pension.  It was mandatory to take Medicare  when I turned 65. .  I also took part B because I had no idea how long I would live overseas.  And didn’t want to pay a penalty afterwards.  I was able to carry over my health insurance after retiring from my previous job. Which covers me both domestically and internationally.  

[KhunLA]

After having for first year, Plan A, and even B, cancelled B, as knowing I wasn't going to return to USA.   Plan A is still in place, JIC, I need some high tech surgery that might actually be successful, not offered here/TH, and enough warning, that it's elective, time wise, and life saving of course, with prolonged results.  Actually worth hopping on a plane for 30 hrs.  Really can't see that happening though.

[Prubangboy]

I'm a high earner, so it's $367 a month for me for Part B. I also have Cigna here for about $450 a month(I'm 71) with a $7,500 deductible. I have a dedicated fund to cover 2 big ticket health disasters at the same time.

 

My odds of ever going back to the states are low. But a very esteemed poster here told of being glad he kept his home country national insurance because he needed a kind of chemotherapy that was not available in Thailand.

 

I think the odds of having his bad luck are very low, and India has a chemo-industry at discount pricing. Still, Cancer can really wipe you out financially. So I follow his example and consider my $367 a month as a second wall against a health catastrophe.

 

But then, the guy above makes the point that going back home when near death -to a hospital where they don't know you, while staying at a motel- is probably unrealistic. The US Healthcare system is in a free fall even for people who live there and are willing and able to fight with their insurers to get their bills paid. Just hopping off a plane? Sounds tough.

 

I've researched the various cancers that might compel me to do this and had genetic testing which rules out 99.9% of them as likely on that basis. So for me, that $367 a month is sort of overkill. It's not a 100% rational decision. Were I to toss that $4,200 a year into a health savings fund, I'd bet I do better in terms of outcomes.

 

I also view it as a charitable contribution to the very stressed Medicare general fund back home. Let some poor dialysis patient live high on the hog on my unused $367 payment.

Edited November 16, 2023 by Prubangboy

[sirineou]

16 hours ago, HappyExpat57 said:

I kept part B. I had cataract surgery in one eye last year, out of pocket cost was $145 USD.  Would have cost a lot more than that here in Thailand. The money I saved easily paid for the price of a business class round trip ticket (which I do annually anyway). Part B cost is negligible if you compare what it will pay for. Again, my favorite Thai phrase - "up to you"

Same here. 

I had a aortic valve replacement that at the time under my private insurance had cost  close to a quarter of a million dollars. 

I was told that after about 15 years it might need to be done. No way that I would pay that kind of money out of pocket. So when it came time for me to retire, I kept my Medicare. 

I have never used it, but early next month we are going to the US for Christmas, andI will see if I can establish a relationship with a heart doctor in my area and have a few tests done.

Edited November 16, 2023 by sirineou

[EVENKEEL]

1 hour ago, swm59nj said:

Different people are in different situations of course pertaining to what type of insurance they have if any.

When I recently lived in Bangkok for three years  I collected social security and a pension.  It was mandatory to take Medicare  when I turned 65. .  I also took part B because I had no idea how long I would live overseas.  And didn’t want to pay a penalty afterwards.  I was able to carry over my health insurance after retiring from my previous job. Which covers me both domestically and internationally.  

I was able to keep my international Blue Cross/Blue Shield after retiring. I turned down the Part B. When you start drawing your 401 every year the Part B increases depending on your income.

[lopburi3]

2 hours ago, ibjoe said:

I have Medicare Advantage (sometimes called Part C) HMO plan, it also covers Part D. My provider Evidence Of Coverage document (also verbal confirmation) says they will pay for all critical / emergency care

From my understanding this is not Medicare, but private insurance to work with Medicare and only provides after the fact emergency medical coverage while overseas.  Not a replacement for foreign medical coverage.

[Tropposurfer]

Ya better hurry up there Sparkey ... cause if the nutter dark-ages GOP and their poster boy traitor Trump get there way shortly after January 2024 there won't be any Medicare ... unless of course the dumb as rocks people of the US wake up and send both him and his sicko cronies to jail and the political wilderness.

[rwill]

First off Medicare will not cover anything outside of the US.

 

So for me it seems silly to pay for the other parts that you will probably never use.

 

But say if you don't pay for part B at 65 you can still get it later if you returned to live in the states but it would cost more.

 

Part A you are going to get automatically anyway.

[Sheryl]

18 minutes ago, lopburi3 said:

From my understanding this is not Medicare, but private insurance to work with Medicare and only provides after the fact emergency medical coverage while overseas.  Not a replacement for foreign medical coverage.

Part C is a Medicare advantage plan. Basically a private HMO which covers whatever Medicare would cover (but often with restrictions like needing a referral for a specialist or limited number of doctors/hospitals you can use which in turn can mean longer waits to be seen). Sometimes these plans have some added benefits not in Medicare but these are usually not much in substance. On the whole Medicare Advanatage plans are inferior to basic Medicare coverage and certainly to basic Medicare plus a supplemental.... but they may suit some on very tight budgets.

 

Medicare Advantage  Plans, if they cover care overseas at all, will do so only for emergencies. Also note that you must live in the plan's US coverage area at least 6 months of the year. If it is discovered you are actually resident on Thailand the plan is void.

[BKK57]

17 hours ago, HappyExpat57 said:

I kept part B. I had cataract surgery in one eye last year, out of pocket cost was $145 USD.  Would have cost a lot more than that here in Thailand. The money I saved easily paid for the price of a business class round trip ticket (which I do annually anyway). Part B cost is negligible if you compare what it will pay for. Again, my favorite Thai phrase - "up to you"

Cataract surgery (done in 2017) at Rutnin Eye Hospital (best Eye Hospital in Thailand) was 70,000 Baht, other eye (done in 2020) was 75,000 Baht which included everything before and after the surgery. That's 2-3K depending on exchange rate. Much less than a round trip in business class plus hotels, rental cars, meals, etc.

If you go back every year to the states, and have a house and car there when you arrive, then it might make sense. But $2000 USD you save on Part B premiums can buy a lot of out-patient services in Thailand with out all the hassle.

[BKK57]

22 minutes ago, rwill said:

First off Medicare will not cover anything outside of the US.

 

So for me it seems silly to pay for the other parts that you will probably never use.

 

But say if you don't pay for part B at 65 you can still get it later if you returned to live in the states but it would cost more.

 

Part A you are going to get automatically anyway.

I just want to make a comment about Part B. Although there is a penalty for Part B, the amount you save by not signing up for Part B can be used to pay for the additional penalty when and if you do sign up for Part B. Every year you do not have part B you save about $2000, it is this savings that you can use to pay the additional 10% yearly penalty ($200/year). For example, if you wait 5 years (age 70) to sign up for Part B, that is a savings of $10,000. Even though you will pay an additional 50% penalty (an additional $1000/year) every year the savings will pay the penalty for the next 9 years (age 79). If you wait 10 years (age 75) the savings is $20,000 and the savings will pay the penalty of $2000/year until age 84.

So, if you don't go back home you save quite a bit. If you do go back home later on, the penalty is covered for quite a few years. I generated these numbers from an excel spreed sheet, you can do the same to see how this works.

The only other consideration is that you may have a gap in coverage as the Part B open enrollment is only available Jan-March of each year (except the initial enrollment at age 65).

[JimTripper]

2 hours ago, Prubangboy said:

But then, the guy above makes the point that going back home when near death -to a hospital where they don't know you, while staying at a motel- is probably unrealistic. The US Healthcare system is in a free fall even for people who live there and are willing and able to fight with their insurers to get their bills paid. Just hopping off a plane? Sounds tough.

yes, people need to play things out in their head like you say before deciding. most don't do that as they are to rushed or whatever.

 

you usually can't drive yourself after treatment as well. so you need to arrange transportation back to your motel. add in difficulty getting food and necessities if your solo just lying in a motel somewhere not able to move around well 😗. what if someone takes your atm card from a cheap motel room and you don't have a stable address to get replacements? the problems are endless.

 

i think some hospitals do have nice attached recovery accomodations, but in the usa prices would be through the roof unless insurance pays.

 

so having a property you own in the area and some sort of support sytem like friends or family nearby would be important considerations whether i kept the plan b or not.

 

 

Edited November 16, 2023 by JimTripper

[newnative]

     I am doing the same as the OP.  I have the free Medicare and I have a hospitalization health insurance policy with April International.  I pay out-of-pocket for routine care, check-ups, etc.

[Cory1848]

On 11/16/2023 at 8:08 AM, EVENKEEL said:

I was able to keep my international Blue Cross/Blue Shield after retiring. I turned down the Part B. When you start drawing your 401 every year the Part B increases depending on your income.

Exactly -- I have Blue Cross also and it works just great in Thailand, and pays some private Thai hospitals directly after preapproving the procedure. There’s a 15 percent copay, and on most outpatient visits I pay cash and then get reimbursed by Blue Cross after submitting paperwork. If the procedure were so pricey that the 15 percent might make a real difference, and Medicare Part A would pick up a lot of it (in tandem with Blue Cross) in the US, I would consider flying back and doing it there, but that hasn’t happened yet ... Medicare Part B seems unnecessary at this point.

[HappyExpat57]

On 11/16/2023 at 9:09 AM, BKK57 said:

Cataract surgery (done in 2017) at Rutnin Eye Hospital (best Eye Hospital in Thailand) was 70,000 Baht, other eye (done in 2020) was 75,000 Baht which included everything before and after the surgery. That's 2-3K depending on exchange rate. Much less than a round trip in business class plus hotels, rental cars, meals, etc.

If you go back every year to the states, and have a house and car there when you arrive, then it might make sense. But $2000 USD you save on Part B premiums can buy a lot of out-patient services in Thailand with out all the hassle.

 

As I explained, I go back to visit family/friends every year, so travel expenses are inconsequential. 100k baht to have it done in Thailand vs $145 USD in the US. 

[thailand49]

There is really not answer in my book. Sheryl and other pretty much laid it out. If you opt out now to save I pay now 164, goes up each year you want to join later there is a penalty.

There are two types of plans Original medicare and Advantages like this time of year in Advantage you can switch if original you can switch anytime.

Originally, at 65, for my needs I chose a Anthem Blue Cross zero monthly since I was here it is a HMO, it is only offer in certain zip codes. You need to have a primary and he/she refers you to other specialties. Timing is everything once or twice a year knowing Im coming home I call ahead for an appointment from there I get blood test squezz in as many test I can get in two week period that can be tough at times. The drawback if something major deductiable is 8500.00.

I was actually happy with the Anthem providing alot of free checkups  they are real proactive with your care 

Last year, Do to circumstances I looked into a Supplement it is unusual for someone 70 to switch but being healthy I went into a underwriting process and Humana accepted me into Humana Plan G, High Deductible, 2500.00 52.00 a month, with a Plan D by Aetna 5.00 a month.

It is really all a gamble we think if something happens here like a heart attack one survived fly home for second opinion Sheryl once noted what if you can't!

AIA, what is coverage. they basically a life insurance company? Thai companies want our money even the writing say cant cancel they have a habit of raising your premien and reducing your coverage so you leave. If possible affordable I would consider as one poster suggested a company outside of Thailand  that covers Thailand.

Personally I wouldnt give it up until I need to I will get to a point I cant until then.

[Jingthing]

I don't plan on repatriating.

I don't travel to the U.S.

HOWEVER, I recognize there might come a time where I will change my plans and end up repatriating.

If that happens, I will be on a horribly tight budget and would need to radically lower my quality of life just to have a roof over my head. 

So saving the penality than would be a big deal.

Paying the Part B now based on my budget in Thailand is totally painless.

So maybe not the most logical reason to pay for Part B but it works for me. 

[jas007]

I kept Medicare Part B, just in case.  I also have a Federal Blue Cross Blue Shield plan that works all over the world.  I guess I also pay for that.  Maybe around $400 a month. Anyway, that plan has an overseas coordinator that will arrange payment at a preferred provider. I recently had an occasion to try it out for a few appointments and tests at Bumrungrad hospital in Bangkok.  It worked great.  When it came time to pay, I didn’t have to pay anything. For treatment at non-preferred providers, you still have coverage, but you pay first and submit a clam later, unless other arrangements are made.

 

I’m thinking about getting some sort of Thai accident insurance, just in case something weird happens and I have to go to the nearest medical facility.

 

As for Thai health insurance, I looked into that and for me, the cost was over $500. Not cheap. 
 

I guess there’s also the option of hopping on a plane back to the US if anything major ever comes up.  So far, I’ve been lucky.  They never find anything wrong with me.
 

 

[lopburi3]

30 minutes ago, jas007 said:

For treatment at non-preferred providers, you still have coverage, but you pay first and submit a clam later, unless other arrangements are made.

Actually all overseas providers are preferred - but only some have GOB (direct payment) for FEP/Blue.  And some providers are likely to change again in January as they will change overseas coverage company.

[ding]

On 11/15/2023 at 4:16 PM, Sheryl said:

You get part A automatically (assuming you qualify; most people do). No need to pay any premium.  It s Part B that you need to opt into, and there is a cost for that. Currently I think around $170 a month. Can be automatically deducting from your SS.

 

Important to note that if you do not get Part B when you first turn 65, and then later enroll, there is a penalty in the form of higher premium and it is applied for life. I enrolled in part B because of this though have virtually never used it so far ... I like keeping options open and I may return to live in the US at some point though not imminently.

 

I mainly use Part A preventive care benefits (annual check-ups, periodic colonoscopy, mammogram etc etc) , though on occasion have had to dip into Part B for a few preventive services not covered under A. I have not used ti for any illnesses thus far but good to know it is there as a back up to my international insurance especially as this includes an exclusion.

 

Under both parts A and B there are deductibles and copays such that if fulltime living in US it is advisable to get a Medicare supplemental insurance or Medicare Advantage Plan, former is better but more costly. Neither is possible while living abroad. One would also need to get a Part D plan (to cover drugs), not necessary when living abroad.

Thanks as always Sheryl. I took the same route for the same reasons - things change drastically. $2,096.40/yr for Plan B is affordable even with my AIA inpatient insurance here because the cost of living is lower here. With my US situation the return on investment, usability, probability -it makes the possible waste of money a good risk management expense. That's what insurance is in the end.

 

The bolded section of your quote has me wondering if there's a way to use Medicare here, or did you travel back on a visit?

[ding]

On 11/16/2023 at 7:40 AM, Prubangboy said:

But then, the guy above makes the point that going back home when near death -to a hospital where they don't know you, while staying at a motel- is probably unrealistic. The US Healthcare system is in a free fall even for people who live there and are willing and able to fight with their insurers to get their bills paid. Just hopping off a plane? Sounds tough.

 

I've researched the various cancers that might compel me to do this and had genetic testing which rules out 99.9% of them as likely on that basis. So for me, that $367 a month is sort of overkill. It's not a 100% rational decision. Were I to toss that $4,200 a year into a health savings fund, I'd bet I do better in terms of outcomes.

 

I also view it as a charitable contribution to the very stressed Medicare general fund back home. Let some poor dialysis patient live high on the hog on my unused $367 payment.

Thanks for the thoughtful comment Prubangboy. We had genetic testing in the US by Color Genomics, $398 for both of us 2 years ago . From what I've researched genomic testing may catch 12-17% of cancer risks. There could be better data but still, 12% is well worth it. My wife had zero genomic risk and extremely low lifetime environmental risk but has breast cancer.

 

I still own a house in the US and my daughter is doing well with a mother-in-law space if necessary. So I could reasonably return. 

The medical system in the US is broken, I agree and have many experiences to confirm that.

Returning with a terminal condition: Japan Airlines cancelled our ticket when I asked for a wheelchair for my wife and gave 'cancer' as the reason. But then a buddy accompanied a friend with cancer back in lieu of a nurse on a different airline. So, I'd pay for the urgent treatment and travel back for ongoing care, like dialysis for example.

[ding]

On 11/16/2023 at 9:30 AM, BKK57 said:

Although there is a penalty for Part B, the amount you save by not signing up for Part B can be used to pay for the additional penalty when and if you do sign up for Part B. Every year you do not have part B you save about $2000, it is this savings that you can use to pay the additional 10% yearly penalty ($200/year). For example, if you wait 5 years (age 70) to sign up for Part B, that is a savings of $10,000. Even though you will pay an additional 50% penalty (an additional $1000/year) every year the savings will pay the penalty for the next 9 years (age 79). If you wait 10 years (age 75) the savings is $20,000 and the savings will pay the penalty of $2000/year until age 84.

Yep! That's the calculus that caused me to post the question. I have a house and adult daughter in the US so could feasibly go back. I've had direct experience with a serious medical issue popping up and the option/peace of mind is worth the $2,096.40/yr for Plan B. I save more than that living cheaper here, even with my AIA inpatient insurance policy.

 

I'm a saver by nature and your dollar-cost averaging is doable, I just went the safe route given my situation and took Plan B too. This way, if fortunes change or the unforeseen happens, it's more affordable to have the option up and running -and usable with any doctor in America that takes Medicare.

Edited January 2 by ding

[Sheryl]

1 hour ago, ding said:

 

The bolded section of your quote has me wondering if there's a way to use Medicare here, or did you travel back on a visit?

 N, you cannot use it here.

 

I return to the US for anywhere from 1-3 months every year