U.S. Topic -- Clarification sought about starting Medicare Part B upon repatriation

[Jingthing]

Some background.

I have enrolled in both Part A (free) and Part B (not free and not usable abroad) but am considering dropping Part B.

I well understand there is a 10 percent penalty for the rest of your life for each year Part B isn't paid.

At this point, that is starting to sound OK.

 

HOWEVER, it's also my impression that if repatriating you are subject to the open enrollment period to start or restart Part B which is Jan through March annually which doesn't actually kick in coverage until the following July.

 

So in that case if you repatriated in April you wouldn't have use of Part B until July of the following year!

 

That could easily be financially ruinous.

 

I've googled a bit and that is what seems to be true, though I'm seeking more confirmation.

 

Now IF expats were allowed to a special break to enroll outside the normal open enrollment period, that would be much better, but it doesn't seem to be the case.

 

Why is this a concern?

 

Well it's my impression that in many cases people do repatriate for medical reasons and medical crises can happen anytime not fitting with an ideal time to start with Part B. 

 

That's the point I think of paying Part B to avoid such timing problems.

[jas007]

Have you looked up the actual rule or policy?  Off the top of my head, it would seem as though repatriation might provide an exception to the general rule.  I’ll see what I can find.

 

edit.

 

 I’m having trouble copying a link on my IPad.  So, do this search:  social security and POMS.  when you get to the POMS page, go to the menu and scroll down to enroll in Medicare Part B.  Then, look for a link that takes you to a page that explains when you might be entitled to a “special enrollment period.”  They list a number of scenarios that would qualify a person to enroll outside the usual enrollment period, You can apply if you think it might work. There’s a form to fill out.
 

 

 

[Jingthing]

I'm aware of exceptions if you could prove qualified alternative medical cover while abroad.

Yes I looked but not too deeply.

You're right that the key here is about special enrollment period.

I will check that out.

[dddave]

I opted out of "Plan-B" when I started receiving SSI in 2009. I was living full time in Thailand and had VA Hospital eligibility if needed in the US. 

I have pretty severe osteoarthritis in both knees.  While the VA was willing to perform knee replacement, the waiting list was long and the procedure was not the latest.  Since I had Medicare, I started checking with local orthopedic hospitals in Boston.  What I found out was that without "Part-B", no hospital would touch me.  It was explained that medical billing has become so complex that there is no way that they would receive full compensation without the availability of Part-B.  Apparently, the lines between Part "A" and "B" has become blurred and interdependent. 

That is definitely something OP should consider.  Should the need for surgery or complex treatment arise, he could find himself locked out by the reality that both "A" & "B" are equally necessary.  

[Jingthing]

Yes I agree if you're actually going to use it you need A and B.

[Jingthing]

OK I found this which to me strongly implies that simply moving back to the US does not get you a special enough period. 

 

 

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-living-abroad/medicare-coverage-for-those-who-live-abroad-but-plan-to-move-back-to-the-united-states-or-travel-back-frequently

 

If you do not enroll in Medicare during your IEP or elect to keep Part B if you were already enrolled, you may have to wait until the General Enrollment Period to sign up for Part B coverage. 

[Jingthing]

None of these exceptions are just simply moved back to the US.

 

Possibly but it seems unlikely it could be covered under:

 

Missed a chance to sign up because you experienced other exceptional conditions

 

I say unlikely because if just moving back to the US alone did it they probably would have mentioned that because moving back is common.

 

 

https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start#SEP

[OneZero]

After having not paid Part "B", I don't think that simply being able to obtain enrollment after moving back to US, does not free you from the penalty that you mentioned,

Or does it free you (from the cost penalty you mentioned)?  

 

Quoting you above:  

"I well understand there is a 10 percent penalty for the rest of your life for each year Part B isn't paid.  At this point, that is starting to sound OK."

[Jingthing]

57 minutes ago, OneZero said:

After having not paid Part "B", I don't think that simply being able to obtain enrollment after moving back to US, does not free you from the penalty that you mentioned,

Or does it free you (from the cost penalty you mentioned)?  

 

Quoting you above:  

"I well understand there is a 10 percent penalty for the rest of your life for each year Part B isn't paid.  At this point, that is starting to sound OK."

Sorry but you misunderstood the issue.

I am not asking about the penalty. 

I am asking about the ENROLLMENT PERIOD.

The normal enrollment period is the first quarter of the year with benefits starting in July.

The question if if simply returning after living abroad gives the option of a SPECIAL enrollment period based on the fact that you were living abroad.

I think not but I'm still not 100 percent certain. 

[Etaoin Shrdlu]

I looked into this some years back and I think you're correct about the enrollment period. The only way for most expatriates who did not sign up at age 65 is to enroll during the general enrollment period of January to March each year.

 

But my understanding is that coverage for Part B obtained during the general enrollment period starts the first of the month after the month in which you enrolled.

[Jingthing]

21 hours ago, Etaoin Shrdlu said:

I looked into this some years back and I think you're correct about the enrollment period. The only way for most expatriates who did not sign up at age 65 is to enroll during the general enrollment period of January to March each year.

 

But my understanding is that coverage for Part B obtained during the general enrollment period starts the first of the month after the month in which you enrolled.

Oh Geez, I did recently read about needing to wait until July but I don't have the source now so not sure, perhaps you're right.

In any case, it's a similar big problem if you miss the three month enrollment period.

Perhaps you flee back home in April, in that case you'd have to wait to enroll until January of the next year, effective in February rather than July if you're correct. Still very bad.

 

Of course a way to avoid this timing problem is if you're PLANNING a move rather than making a move based on an emergency.

 

In that case you can enroll in Part B while living abroad during the SEP and have it ready for when you arrive.

[Etaoin Shrdlu]

2 hours ago, Jingthing said:

Oh Geez, I did recently read about needing to wait until July but I don't have the source now so not sure, perhaps you're right.

In any case, it's a similar big problem if you miss the three month enrollment period.

Perhaps you flee back home in April, in that case you'd have to wait to enroll until January of the next year, effective in February rather than July if you're correct. Still very bad.

 

Of course a way to avoid this timing problem is if you're PLANNING a move rather than making a move based on an emergency.

 

In that case you can enroll in Part B while living abroad during the SEP and have it ready for when you arrive.

 

Yes, I don't think there is really a solution for an unplanned move back that does not entail a potential uninsured period if you've not enrolled in Part B.

 

As you point out, repatriating in April could mean that you don't have any coverage until February 1st of the following year, assuming that you enroll in Part B in January.

 

I am contemplating enrolling in Part B next year during the open enrollment period as I may be spending extended periods in the US in the future.

[Jingthing]

Yeah I've been paying Part B and have been considering dropping it.

The two reasons not to drop it if you think there is any chance you're moving back are the penalties and the enrollment period gap issue. I'm less concerned about the penalties but when you add the gap issue I'm more inclined to keep it.

[Etaoin Shrdlu]

12 minutes ago, Jingthing said:

Yeah I've been paying Part B and have been considering dropping it.

The two reasons not to drop it if you think there is any chance you're moving back are the penalties and the enrollment period gap issue. I'm less concerned about the penalties but when you add the gap issue I'm more inclined to keep it.

 

If one is only paying the base Part B amount of $174 per month, then the payment isn't so bad and even with penalties is manageable. If one is paying one of the higher premiums for Part B due to income, then it becomes more of an issue. It makes the penalty for not enrolling seem minor.

 

There's also the issue of wanting to maximize SS income remitted to Thailand due to the exemption from Thai taxation. SSA wants to deduct Part B premiums from SS benefits, therefore reducing tax-exempt income.

[GinBoy2]

I just tried to check it out and as far as I can see expats repatriating have no special exemption from the standard enrollment period, so get sick and want to come home for treatment, that's a problem.

 

On another note, I have part C, an Advantage policy, costs me an extra $64 a month but fills in the gaps and gives me drug, dental and vision. 

 

But the interesting thing is it also gives me emergency coverage overseas for $500K, rather handy when I'm in Thailand

[jas007]

9 hours ago, GinBoy2 said:

I just tried to check it out and as far as I can see expats repatriating have no special exemption from the standard enrollment period, so get sick and want to come home for treatment, that's a problem.

 

On another note, I have part C, an Advantage policy, costs me an extra $64 a month but fills in the gaps and gives me drug, dental and vision. 

 

But the interesting thing is it also gives me emergency coverage overseas for $500K, rather handy when I'm in Thailand

If you have an Advantage policy that includes overseas coverage, that could be an option for some people.  But not all Advantage policies will have that feature, so anyone choosing that option should be careful.

[GinBoy2]

9 hours ago, jas007 said:

If you have an Advantage policy that includes overseas coverage, that could be an option for some people.  But not all Advantage policies will have that feature, so anyone choosing that option should be careful.

True and the policies vary massively by State 

 

I was bombarded with mail and phone calls trying to pitch products.

 

I ended up actually talking to folks who had the 'products'

 

Who knew getting old should be this hard

[jas007]

1 hour ago, GinBoy2 said:

True and the policies vary massively by State 

 

I was bombarded with mail and phone calls trying to pitch products.

 

I ended up actually talking to folks who had the 'products'

 

Who knew getting old should be this hard

Well, the fact that you’re healthy enough to be worried about overseas coverage means you’re doing ok.  Some people don’t even make it to retirement age. Others have so many health problems that they’re in no shape to travel at all. 

[GinBoy2]

On 8/23/2024 at 7:46 AM, jas007 said:

Well, the fact that you’re healthy enough to be worried about overseas coverage means you’re doing ok.  Some people don’t even make it to retirement age. Others have so many health problems that they’re in no shape to travel at all. 

Go to Medicare.gov, enter your zipcode and it will give you the options in your State.

 

I'm not a dumb guy but the options are a little bewildering.

 

I think I opted the best for me. Not sick, fairly healthy but I wanted something pretty seamless covers everything and in addition covers me in Thailand

[GypsyT]

On 8/17/2024 at 6:23 PM, Jingthing said:

Yeah I've been paying Part B and have been considering dropping it.

DON'T drop it!

It's the best bargain 🙂 in case you move back.

I've been paying for 15+ years without using it more than 3 times.

[GinBoy2]

1 hour ago, GypsyT said:

DON'T drop it!

It's the best bargain 🙂 in case you move back.

I've been paying for 15+ years without using it more than 3 times.

Like all insurance it's a crap shoot, you don't need it until you need it!

 

The problem with health insurance is that dirty rotten truth is that the older we get the risk sorta rises exponentially every year that you are going to need that insurance.

 

Roll the dice and hope for the best might be option, but I'm a little too cautious to go down the 'GoFundme' route.

 

If you have Part B, keep it, it's the backstop if the sh***it hits the fan

[TheAppletons]

On 8/16/2024 at 6:00 PM, Jingthing said:

OK I found this which to me strongly implies that simply moving back to the US does not get you a special enough period. 

 

 

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-living-abroad/medicare-coverage-for-those-who-live-abroad-but-plan-to-move-back-to-the-united-states-or-travel-back-frequently

 

If you do not enroll in Medicare during your IEP or elect to keep Part B if you were already enrolled, you may have to wait until the General Enrollment Period to sign up for Part B coverage. 

 

  Hey, maybe this will help JT 

  

"Individuals who do not enroll in Part B or premium Part A when first eligible because they were incarcerated may enroll using this SEP.

 

If a person is eligible because they are not enrolled in Medicare due to being incarcerated, they can sign up anytime within the first 12 months after their release from incarceration.

 

This SEP begins the day an individual is released from the custody of penal authorities and ends the last day of the 12th month after that release."

[ricklev]

17 hours ago, GinBoy2 said:

Go to Medicare.gov, enter your zipcode and it will give you the options in your State.

 

I'm not a dumb guy but the options are a little bewildering.

 

I think I opted the best for me. Not sick, fairly healthy but I wanted something pretty seamless covers everything and in addition covers me in Thailand

Unfortunately, you can only enroll in an Advantage plan if you reside in the USA.  Is that correct?  I am turning 65 in October and just figuring it out.  Can you enroll in an Advantage plan while in the USA and then live in Thailand most of the year?

[Jingthing]

36 minutes ago, ricklev said:

Unfortunately, you can only enroll in an Advantage plan if you reside in the USA.  Is that correct?  I am turning 65 in October and just figuring it out.  Can you enroll in an Advantage plan while in the USA and then live in Thailand most of the year?

Not exactly.

IF your social security has you living in the US this will match your Medicare record (they need to match) whether you are actually living in the US or not.

So yes it is possible to enroll in Advantage while living abroad.

However, you can't tell the insurance provider that you live abroad.

Then with certain but not all Advantage plans you will be covered for acute emergency events in Thailand as it becomes a kind of travel insurance IF you follow the claim rules carefully. It is not of use for chronic diseases.

Is it FRAUD to play such games?

Personally I would say yes but it's so incredibly common especially with US expats in Mexico that there are even Mexican clinics specializing in such claims.

If you're ever honest with the insurer, it's game over though. They would drop you of course.

There are agents that specialize in helping expats pick the right plans for this and of course the choice of specific plans depends on your specific US zip code.

To find such agents, search on youtube for expat information related to Mexico and Panama.

This scheme is not limited to expats those countries but that is where it's most popular.

Agents in Mexico doing this will help expats anywhere.

I'm not suggesting this. I wouldn't do it. But people should know their options including dicey ones.

 

Note if your social security shows you living abroad you would NEED to change that back to the US as again SS and Medicare address MUST match for Advantage.

[ricklev]

21 minutes ago, Jingthing said:

Not exactly.

IF your social security has you living in the US this will match your Medicare record (they need to match) whether you are actually living in the US or not.

So yes it is possible to enroll in Advantage while living abroad.

However, you can't tell the insurance provider that you live abroad.

Then with certain but not all Advantage plans you will be covered for acute emergency events in Thailand as it becomes a kind of travel insurance IF you follow the claim rules carefully. It is not of use for chronic diseases.

Is it FRAUD to play such games?

Personally I would say yes but it's so incredibly common especially with US expats in Mexico that there are even Mexican clinics specializing in such claims.

If you're ever honest with the insurer, it's game over though. They would drop you of course.

There are agents that specialize in helping expats pick the right plans for this and of course the choice of specific plans depends on your specific US zip code.

To find such agents, search on youtube for expat information related to Mexico and Panama.

This scheme is not limited to expats those countries but that is where it's most popular.

Agents in Mexico doing this will help expats anywhere.

I'm not suggesting this. I wouldn't do it. But people should know their options including dicey ones.

 

Note if your social security shows you living abroad you would NEED to change that back to the US as again SS and Medicare address MUST match for Advantage.

Thanks!

[gamb00ler]

On 8/17/2024 at 10:42 PM, Etaoin Shrdlu said:

There's also the issue of wanting to maximize SS income remitted to Thailand due to the exemption from Thai taxation. SSA wants to deduct Part B premiums from SS benefits, therefore reducing tax-exempt income.

The deduction of Medicare premiums does not reduce your income.  It's just a convenience for both the recipient and SSA.  Your SSA-1099 shows the total benefit as income.  It doesn't show the net amount paid to the recipient.  Theoretically, the TRD should give you an exemption equal to the total on the SSA-1099.

[Jingthing]

35 minutes ago, ricklev said:

Thanks!

An example of the sort of agent I was speaking of.

If you maintain the narrative that you're a US resident but just "travelling" then there is really nothing wrong with this in theory.

 

 

[Etaoin Shrdlu]

15 minutes ago, gamb00ler said:

The deduction of Medicare premiums does not reduce your income.  It's just a convenience for both the recipient and SSA.  Your 1099-R shows the total benefit as income.  It doesn't show the net amount paid to the recipient.  Theoretically, the TRD should give you an exemption equal to the 1099-R total.

 

My concern would be that the TRD would limit the exemption to the amount that could be shown as having been remitted to a Thai bank by the SSA, which would be net of the Part B deduction. Or perhaps from a US account that is used only for receiving SSA benefits. Replacing the deduction with other funds may entail co-mingling SSA benefits with funds from other (potentially taxable) sources. But I admit this issue isn't clear.

[GinBoy2]

10 hours ago, Jingthing said:

An example of the sort of agent I was speaking of.

If you maintain the narrative that you're a US resident but just "travelling" then there is really nothing wrong with this in theory.

 

 

That was actually a pretty informative video.

 

I think it looks like Advantage overseas is pretty doable, and for your initial post JT, I think he pretty succinctly laid out why you shouldn't cancel Part B!

 

 

[ricklev]

 Off topic, but I guess the argument against providing Medicare benefits to expats is that Medicare would be unable to deter fraudulent claims.  That does make sense, but they could certify regional hospitals around the world for expat Medicare claims or something like that, if they wanted to...