US Medicare - what do most expats do?

[sirineou]

On 11/16/2023 at 9:05 AM, 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.

That is not entirely true.

There are Medicare advantage plans that would cover you outside the US

Medicare advantage plans are plans offered by private companies that contracts with Medicare.

There HMOs and PPOs 

HMO: have lover monthly fees . many non at all , but you have to use the doctors and institutions that are with in system.

PPO: have higher  monthly fees but you have the flexibility to use our of system doctors and institutions. 

I have an HMO because all my US doctors and hospitals I go to were included in their program. It is the Humana 5 star program and I have no monthly fees, in fact I get less money deducted my medicare from my monthly social security income. Obviously since I have to use their doctors and institutions I am not covered   outside the US , since they don't contract with doctors and institutions outside the US but I am reimbursed for emergency situations (I have never used it so not sure how easy it is)

 

[Jingthing]

8 hours ago, sirineou said:

That is not entirely true.

There are Medicare advantage plans that would cover you outside the US

Medicare advantage plans are plans offered by private companies that contracts with Medicare.

There HMOs and PPOs 

HMO: have lover monthly fees . many non at all , but you have to use the doctors and institutions that are with in system.

PPO: have higher  monthly fees but you have the flexibility to use our of system doctors and institutions. 

I have an HMO because all my US doctors and hospitals I go to were included in their program. It is the Humana 5 star program and I have no monthly fees, in fact I get less money deducted my medicare from my monthly social security income. Obviously since I have to use their doctors and institutions I am not covered   outside the US , since they don't contract with doctors and institutions outside the US but I am reimbursed for emergency situations (I have never used it so not sure how easy it is)

 

Medicare Advantage can be used (some would say abused) by expats if they tell Social Security and Medicare that they live in the U.S.

This is because MA options are based on your U.S. zip code.

Foreign address -- not possible.

So at that point with a MA an expat would be covered (depending on the specifics of their company) for a LIMITED type of care (in general acute emergencies) abroad similar to travel insurance. It can be life saving depending on the medical event but if you get something serious and chronic, it will NOT work. 

 

There is DECEPTION involved. You cannot tell the company you're an expat or they won't even accept you in the first place.

[Thailand J]

On 11/15/2023 at 12:59 PM, ding said:

We don't have plans to return to the US but things can change, especially with age.

You can get Part B, cancel when you are sure of not returning to US, doesn't matter what other expats do.

[sirineou]

2 hours ago, Jingthing said:

Medicare Advantage can be used (some would say abused) by expats if they tell Social Security and Medicare that they live in the U.S.

This is because MA options are based on your U.S. zip code.

Foreign address -- not possible.

So at that point with a MA an expat would be covered (depending on the specifics of their company) for a LIMITED type of care (in general acute emergencies) abroad similar to travel insurance. It can be life saving depending on the medical event but if you get something serious and chronic, it will NOT work. 

 

There is DECEPTION involved. You cannot tell the company you're an expat or they won't even accept you in the first place.

 

Thank you capitalizing the deception part, As I get older mu eyesight is not what it used to be and I appreciate your effort. 

Nonetheless my point that Medicare can cover you outside the US in some instances remains valid. 

Edited January 2 by sirineou

[mudcat]

I am working through this issue with a friend who is turning 65 soon.  He is planning to move overseas for an indeterminate time (he may not think so, but I have known him for more than 25-years and expect changes). 

 

My recommendation to him is to enroll in Medicare Part B and a MediGap plan now even though he is not planning to expat until the fall, as MediGap plans offer a 6-month guaranteed enrollment without exclusions for pre-existing conditions (he has had both knees worked on).   

 

The most important feature is that, unlike Medicare Advantage plans, your coverage does not end when you go expat.  You can return to the U.S. at any time and immediately receive treatment, unlike some options where you need to declare your return as permanent under 'special enrollment period' conditions to pick up Part B and enroll in a Medicare Advantage plan.   I would certainly not recommend hiding your non-U.S. residence from a Medicare Advantage plan as that could come back to bite you should your care get expensive.

 

My recommendation to him is to budget for Medicare Part B (2024 $174.70) and MediGap Plan G - High Deductible (2024 $35-70).  I attach what that plan offers, including coverage for foreign travel emergencies (you pay $250 deductible, then the plan picks up 80%).   If you budget can afford 

 

I am currently enrolled in Part B which comes out of my Social Security benefit payment.  When I retired I kept my HMO from work at their rates, and when I turned 65 I got the Medicare Advantage plan that work had negotiated for their retirees.  In between retirement and Medicare eligibility I married my Thai wife and we lived together in the U.S. under the work sponsored plans for the next 8-years until she received her U.S. citizenship and Covid drove us to Thailand full time.  As we were no longer living in the U.S. we needed to drop our U.S. health plans with the exception of Medicare Part B where we have Thai based health insurance for local care and purchase travel insurance for trips back to the U.S. both for the treatment coverage but also for the repatriation/evacuation - my Medicare Part B serves as an reinsurance plan should I need expensive treatment in the U.S.   Relocation to the U.S. would probably mean enrolling in a Medicare Advantage plan in my new location as a MediGap plan would entail underwriting that would lead to exclusions for some of my pre-existing conditions. 

Supplement Insurance (Medigap) Plan G-high deductible details.pdf

[Sheryl]

16 hours ago, sirineou said:

That is not entirely true.

There are Medicare advantage plans that would cover you outside the US

Medicare advantage plans are plans offered by private companies that contracts with Medicare.

There HMOs and PPOs 

HMO: have lover monthly fees . many non at all , but you have to use the doctors and institutions that are with in system.

PPO: have higher  monthly fees but you have the flexibility to use our of system doctors and institutions. 

I have an HMO because all my US doctors and hospitals I go to were included in their program. It is the Humana 5 star program and I have no monthly fees, in fact I get less money deducted my medicare from my monthly social security income. Obviously since I have to use their doctors and institutions I am not covered   outside the US , since they don't contract with doctors and institutions outside the US but I am reimbursed for emergency situations (I have never used it so not sure how easy it is)

 

To have a Medicare Advantage Plan you must live at least 6 months of the year not only in the US, but in their coverage area. Giving false info on that can invalidate the policy.

[sirineou]

56 minutes ago, Sheryl said:

To have a Medicare Advantage Plan you must live at least 6 months of the year not only in the US, but in their coverage area. Giving false info on that can invalidate the policy.

I never said anything concerning that, only that the statement that medicare would not cover you outside the US.is not entirely correct , medicare advantage can in some cases cover you outside the US.

This is a factual statement containing no false info.  

 

 

[ding]

UPDATE: just a heads-up for those interested.

 

AIA Insurance declined to pay for an expensive procedure despite their documents specifically covering this (English and Thai). 

400,000B plus whatever they try to add on later ofc.

Glad I went Medicare Plan B for $174.70/mo as a placeholder and for an emergency. 

 

I haven't dropped by AIA to read their policy to them yet because the medications seem to be working well.

And the proposed treatment carries significant risk so I need to research it first.

 

[Sheryl]

10 hours ago, ding said:

UPDATE: just a heads-up for those interested.

 

AIA Insurance declined to pay for an expensive procedure despite their documents specifically covering this (English and Thai). 

400,000B plus whatever they try to add on later ofc.

Glad I went Medicare Plan B for $174.70/mo as a placeholder and for an emergency. 

 

I haven't dropped by AIA to read their policy to them yet because the medications seem to be working well.

And the proposed treatment carries significant risk so I need to research it first.

 

I gather this was AIA Thailand?

 

If you believe the denial is contrary to terms of the policy, make a complaint with the OIC

 

• 0-2515-3999
• Call Center 1186
•  [email protected]
• [email protected]

[TallGuyJohninBKK]

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

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.

 

Sheryl, so, you're talking about scheduling those kind of preventive and diagnostic procedures covered by Medicare specifically when you're traveling back to the U.S. periodically for whatever reasons?

 

And here, silly me, as a soon to be eligible for Medicare person, I've always thought of my trips back to the U.S. as vacation and having fun times -- not going for colonoscopies!!!  🙂

 

I guess I'm going to have to reconsider that outlook, once I get my Medicare card!!!

 

[TallGuyJohninBKK]

On 11/16/2023 at 7:49 AM, sirineou said:

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

 

For that episode you recount, was that the U.S. price at the time for that procedure, or the price for having it done here in Thailand?

 

[Sheryl]

5 minutes ago, TallGuyJohninBKK said:

 

Sheryl, so, you're talking about scheduling those kind of preventive and diagnostic procedures covered by Medicare specifically when you're traveling back to the U.S. periodically for whatever reasons?

 

And here, silly me, as a soon to be eligible for Medicare person, I've always thought of my trips back to the U.S. as vacation and having fun times -- not going for colonoscopies!!!  🙂

 

I guess I'm going to have to reconsider that outlook, once I get my Medicare card!!!

 

Yes that is what I do.

 

And believe me that is fun compared to the family headaches  that occupy most of my annual trips back....!

 

[TallGuyJohninBKK]

On 1/3/2024 at 12:05 PM, Sheryl said:

To have a Medicare Advantage Plan you must live at least 6 months of the year not only in the US, but in their coverage area. Giving false info on that can invalidate the policy.

 

But.... a similar requirement to be a "U.S. resident" also applies to the Medicare Part B coverage that you have and have used, correct?

 

Not geographically specific like Medicare Advantage plans, but general U.S. residency for Part B (technically) as opposed to being an "expat"?

 

[Jingthing]

27 minutes ago, TallGuyJohninBKK said:

 

But.... a similar requirement to be a "U.S. resident" also applies to the Medicare Part B coverage that you have and have used, correct?

 

Not geographically specific like Medicare Advantage plans, but general U.S. residency for Part B (technically) as opposed to being an "expat"?

 

No.

For Part B you don't have to be in the U.S. EVER.
You can pay for it then.

But you can't use it abroad.

ENJOY!

 

[Jingthing]

On 1/3/2024 at 12:05 PM, Sheryl said:

To have a Medicare Advantage Plan you must live at least 6 months of the year not only in the US, but in their coverage area. Giving false info on that can invalidate the policy.

Giving false information if discovered WILL end the policy.

But it's a big trend now in Mexico and Panama for expats with U.S. addresses on record with SS and Medicare (must be the same) to pose as part time expats and use Advantage for emergency coverage. It's no good for chronic illnesses.

I don't endorse this. Just reporting about it.