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

[GinBoy2]

6 hours ago, ricklev said:

 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...  

So maybe Medicare should learn from Tricare where it appears there is no problems paying for vets healthcare overseas!

 

Never have quite understood what the difference is, both government funded (subsidized) healthcare under a different name

[Jingthing]

8 hours ago, ricklev said:

 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...  

They could.

But will they?

Probably not but these guys in the Philippines are trying.

 

Home - Home (usmedicareph.org)

[ricklev]

2 hours ago, Jingthing said:

They could.

But will they?

Probably not but these guys in the Philippines are trying.

 

Home - Home (usmedicareph.org)

Interesting!  

[GinBoy2]

9 hours ago, ricklev said:

Interesting!  

 

9 hours ago, ricklev said:

Interesting!  

It is interesting, but the proposed legislation is simply defined at Philippines

[Jingthing]

5 hours ago, GinBoy2 said:

 

It is interesting, but the proposed legislation is simply defined at Philippines

Yes and with interesting reasons of so many repatriating American Filipinos. Perhaps this will become a good reason to move the Philippines over Thailand!

[Jingthing]

Here's another fun thing to consider.

Suppose you do have Parts A and B and move back.

Apparently finding doctors willing to take new Medicare patients can be a big problem.

 

 

[GinBoy2]

20 hours ago, Jingthing said:

Here's another fun thing to consider.

Suppose you do have Parts A and B and move back.

Apparently finding doctors willing to take new Medicare patients can be a big problem.

 

 

He kinda makes some valid points, and  I think he probably validates why keeping an Advantage policy in the US probably makes sense.

 

Stuff happens and in an emergency most Advantage policies will pay to at least fix you up enough to get you back home and utilize that Medicare Part B

 

Interesting thing that he talks about Philippine Hospitals holding you hostage. 

 

I think any of us that have been in a Thai Hospital recognize the being walked to the ATM to get the cash before you can be discharged!.

 

I have never been to in Thai Hospital, but my wife has for emergency surgery.

 

Before she was discharged I was literally frogmarched to the hospital ATM and then to the cashier before she could be released

[GypsyT]

On 8/28/2024 at 5:03 AM, GinBoy2 said:

Apparently finding doctors willing to take new Medicare patients can be a big problem.

It is a problem but not a big one.

I've found when needed but yes, it took some calling and asking at Senior Center. They were very good source of local information.

A&B is all you need. A is free, B is only $ 177/mo for me . Very cheap.

 

[GinBoy2]

54 minutes ago, GypsyT said:

It is a problem but not a big one.

I've found when needed but yes, it took some calling and asking at Senior Center. They were very good source of local information.

A&B is all you need. A is free, B is only $ 177/mo for me . Very cheap.

 

My point about having an Advantage plan, is generally they have emergency overseas coverage, which Part B doesn't, to get you fixed up enough to get home.

 

As for Doctors not accepting Medicare, thats a nonsense. Most Dr accept Medicare patients, it's easy guaranteed money for them

[ricklev]

I am thinking of forgoing Part B for a year or 2 after I turn 65 in October.  $4000 dollars just about covers my Thai insurance for two years which gives me 5 million baht hospital coverage, but not such great outpatient coverage for cancer.  It is a small risk, I guess, but tempting.   

 

However, I don't know how much they will jack up my insurance this year though...

[GinBoy2]

8 minutes ago, ricklev said:

I am thinking of forgoing Part B for a year or 2 after I turn 65 in October.  $4000 dollars just about covers my Thai insurance for two years which gives me 5 million baht hospital coverage, but not such great outpatient coverage for cancer.  It is a small risk, I guess, but tempting.   

 

However, I don't know how much they will jack up my insurance this year though...

The thing to remember about Thai insurance, is it's a true insurance system. The policy will increase exponentially  every year because of your age, because the older you get the likelihood of you you needed insurance increases.

 

Thats why Medicare in the US exists, it eliminates that exponential increase and caps it it regardless of how old you are

 

So then you back to the thorny question.

 

Do I continue to pay ever escalating insurance policies in Thailand, if you can even find anyone to insure you, or throw the dice and hope for the best

 

Very few of us actually get through end of life without having some serious medical intervention

[jas007]

On 8/27/2024 at 12:16 PM, Jingthing said:

Here's another fun thing to consider.

Suppose you do have Parts A and B and move back.

Apparently finding doctors willing to take new Medicare patients can be a big problem.

 

 

For sure, some doctors may be unwilling to accept Medicare patients, but in my experience, that’s not usually the case, especially in most parts of the U.S.  What seems to be a bit more common is the situation where the doctor will not accept assignment. Instead, you’re on the hook for the entire amount, and it’s up to you to file the claim for reimbursement. Mostly, though, doctors will see Medicare patients and will accept assignment, because Medicare makes payment for the allowed amount almost immediately. The doctor doesn’t have to worry about billing the patient.

 

Anyway, the one provider that will for sure not see Medicare patients is the Mao Clinic.  It seems strange, right? Even if you’re willing to pay the entire bill out of pocket, they won’t see you.  At least that was the case the last time I looked.

[Jingthing]

It's questionable whether Advantage is a panacea either and keep in mind you need to be on record as a US resident to have that option.

 

 

[ricklev]

Just curious, I applied for SS on 16 August and it is still under review in the Philippines. How long did it take for you before they approved it and you got your first payment?  Did anyone contact you for further information?  And did they contact you to get the information for direct deposit into your Thai bank.  Thanks.   

[Jingthing]

1 minute ago, ricklev said:

Just curious, I applied for SS on 16 August and it is still under review in the Philippines. How long did it take for you before they approved it and you got your first payment?  Did anyone contact you for further information?  And did they contact you to get the information for direct deposit into your Thai bank.  Thanks.   

Others may answer but I can say even after full approval there will be a one month delay before the payments start. In other words, best case it will start in October not September.

 

Here's Exactly When Your First Social Security Check Will Arrive | The Motley Fool

[TallGuyJohninBKK]

On 8/22/2024 at 11:25 PM, GinBoy2 said:

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

 

@GinBoy2

 

Hey, can you clarify a couple things re your comment above?

 

--When you say "emergency" coverage, I'm assuming that means for things like accidents and such?  Not that you go to the doctor for tests and find out  you have cancer, right?

 

--Is the $500,000 a lifetime policy cap for that coverage, and did you really mean $500K?  That seems very high. I've seen other mentions of Medicare Advantage overseas coverage that talked about a $50,000 maximum overseas benefit.

 

[TallGuyJohninBKK]

On 8/25/2024 at 6:36 PM, 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.

 

 

 

@ricklev and I are in the same situation, with the same upcoming important choices to make...

 

Thus your post above re Medicare Advantage and the follow-up video links are VERY helpful and appreciated!  🙂

 

@Jingthing

[TallGuyJohninBKK]

On 8/30/2024 at 1:21 PM, GinBoy2 said:

My point about having an Advantage plan, is generally they have emergency overseas coverage, which Part B doesn't, to get you fixed up enough to get home.

 

One thing I'm confused about...if anyone knows the answer....

 

--for the initial open enrollment period just before and after a person turns 65, and you sign up for Medicare Parts A and B then...

 

Do you also HAVE TO sign up for a Medicare Advantage plan during that same open enrollment period?  Or, you can add on a Medicare Advantage sometime time later without any penalties? Anytime, or only during the annual open enrollment period at the start of the calendar year?

 

TIA!

 

 

[TallGuyJohninBKK]

On 8/30/2024 at 1:53 PM, GinBoy2 said:

The thing to remember about Thai insurance, is it's a true insurance system. The policy will increase exponentially  every year because of your age, because the older you get the likelihood of you you needed insurance increases.

 

Thats why Medicare in the US exists, it eliminates that exponential increase and caps it it regardless of how old you are

 

So then you back to the thorny question.

 

Do I continue to pay ever escalating insurance policies in Thailand, if you can even find anyone to insure you, or throw the dice and hope for the best

 

Very few of us actually get through end of life without having some serious medical intervention

 

I have an existing, decent Thai private med insurance policy that I've paid for and kept ever since I moved to Thailand, but one that is getting increasingly more expensive as I get into my mid 60s and beyond... Never really had to use it for anything big yet, fingers crossed.

 

But now I'm looking at probably keeping the Thai policy for the time I'm continuing to live in Thailand, but also getting and paying for Medicare (some combination of A, B and beyond), just to cover in case I move back any time in the future or need to go back for some kind of treatment I want or can only get in the U.S.

 

Then layer on top of that, the issues related to the Thai government's plans to start taxing worldwide income of anyone living here for more than half the year, and that at least creates some planning scenarios where I might decide to be out of Thailand for some periods of time... Who knows how all that's going to turn out.

 

[TallGuyJohninBKK]

On 8/30/2024 at 1:31 PM, ricklev said:

However, I don't know how much they will jack up my insurance this year though...

 

I have Pacific Cross Maxima, and this year they did an 8% general rate increase (apart from age bands) at my recent annual renewal.

 

[Jingthing]

18 minutes ago, TallGuyJohninBKK said:

 

One thing I'm confused about...if anyone knows the answer....

 

--for the initial open enrollment period just before and after a person turns 65, and you sign up for Medicare Parts A and B then...

 

Do you also HAVE TO sign up for a Medicare Advantage plan during that same open enrollment period?  Or, you can add on a Medicare Advantage sometime time later without any penalties? Anytime, or only during the annual open enrollment period at the start of the calendar year?

 

TIA!

 

 

You'd need to change to Advantage during open enrollment. 

[TallGuyJohninBKK]

Just now, Jingthing said:

You'd need to change to Advantage during open enrollment. 

 

But from what I've read (I think), you can't actually sign up for a Medicare Advantage plan until AFTER you're already enrolled in basic Medicare?

 

I didn't get the impression, a newbe could do A, B and Advantage all in one sign-up at the same time.

 

[Jingthing]

53 minutes ago, TallGuyJohninBKK said:

 

But from what I've read (I think), you can't actually sign up for a Medicare Advantage plan until AFTER you're already enrolled in basic Medicare?

 

I didn't get the impression, a newbe could do A, B and Advantage all in one sign-up at the same time.

 

Medicare advantage REPLACES B.

As you're talking about initial signup at anytime when you turn 65, it make sense that during that exemption time period (open enrollment not needed) you could somehow enroll in Advantage at that time. I don't know how.

But I didn't see that as your question.

Your question seemed to be that you already signed up for A and B during initial exemption period and then wanted Advantage. People can only change programs during the open enrollment period unless under an exemption. 

[GinBoy2]

6 hours ago, TallGuyJohninBKK said:

 

@GinBoy2

 

Hey, can you clarify a couple things re your comment above?

 

--When you say "emergency" coverage, I'm assuming that means for things like accidents and such?  Not that you go to the doctor for tests and find out  you have cancer, right?

 

--Is the $500,000 a lifetime policy cap for that coverage, and did you really mean $500K?  That seems very high. I've seen other mentions of Medicare Advantage overseas coverage that talked about a $50,000 maximum overseas benefit.

 

$500k was a typo, yes $50K so is a fix you up and get you home.

 

I was just reading through my Advantage info book, something occurred to me

 

My plan pays for Telehealth Virtual visits with zero copay.

 

That might be much more usual for expats than it would be for me

[KhunLA]

Holy crap ... I just figured out how much Medicare A, B, D would cost me per month, plus late registrations.   And the yearly deductible, before they even kick in.

 

What a joke ...  Base monthly + 60 month penalty

Base rate for B & D ($174.70 & $34.70)

$317.22 monthly Plan A (free) B D

$3806.64 yearly  Plan A (free) B D

$1632 plan A yearly deductible + $408 per day, for 60+ per day in hospital

$240 plan B yearly deductible + 20% deductible when using

$7550 plan D yearly deductible ... meds not covered under plan B

 

Annual deductible of $13,228.24 / ฿445,451 before coverage kicks in, then deductibles for actually using, for specialist & drugs needed, if have an oops or ongoing issue.

 

I don't think I can get that sick in Thailand.  And meds cost about the same price in TH as the monthly deductible per script.  

 

Gave up getting info for Plan C monthly cost ... Dental & Eye coverage  

Aside from the ฿8081 annual deduction paid before coverage even starts.

 

edit ... if I returned to USA to live.  Obviously, never going to happen.  Too expensive to get sick 

[Jingthing]

5 minutes ago, KhunLA said:

Holy crap ... I just figured out how much Medicare A, B, D would cost me per month, plus late registrations.   And the yearly deductible, before they even kick in.

 

What a joke ...  Base monthly + 60 month penalty

$317.22 monthly Plan A (free) B D

$3806.64 yearly  Plan A (free) B D

$1632 plan A yearly deductible + $408 per day, for 60+ per day in hospital

$240 plan B yearly deductible + 20% deductible when using

$7550 plan D yearly deductible ... meds not covered under plan B

 

Annual deductible of $13,228.24 / ฿445,451 before coverage kicks in, then deductibles for actually using, for specialist & drugs needed, if have an oops or ongoing issue.

 

I don't think I can get that sick in Thailand.  And meds cost about the same price in TH as the monthly deductible per script.  

 

Gave up getting info for Plan C monthly cost ... Dental & Eye coverage  

Aside from the ฿8081 annual deduction paid before coverage even starts.

 

 

Expats can only do A and B. 

[KhunLA]

2 minutes ago, Jingthing said:

Expats can only do A and B. 

That's if I returned to USA (edited)

[GinBoy2]

So this is the telehealth option I was talking about. Might be great option to talk to your US Doctor via zoom for free

 

[GinBoy2]

1 hour ago, KhunLA said:

Holy crap ... I just figured out how much Medicare A, B, D would cost me per month, plus late registrations.   And the yearly deductible, before they even kick in.

 

What a joke ...  Base monthly + 60 month penalty

Base rate for B & D ($174.70 & $34.70)

$317.22 monthly Plan A (free) B D

$3806.64 yearly  Plan A (free) B D

$1632 plan A yearly deductible + $408 per day, for 60+ per day in hospital

$240 plan B yearly deductible + 20% deductible when using

$7550 plan D yearly deductible ... meds not covered under plan B

 

Annual deductible of $13,228.24 / ฿445,451 before coverage kicks in, then deductibles for actually using, for specialist & drugs needed, if have an oops or ongoing issue.

 

I don't think I can get that sick in Thailand.  And meds cost about the same price in TH as the monthly deductible per script.  

 

Gave up getting info for Plan C monthly cost ... Dental & Eye coverage  

Aside from the ฿8081 annual deduction paid before coverage even starts.

 

edit ... if I returned to USA to live.  Obviously, never going to happen.  Too expensive to get sick 

Well thats a little bit alarmist.

 

That why most people add Medigap or Advantage policies. I pay Part B and an additional $64/month for the gold plated Advantage. Gives me medical, dental, vision, medication(Part D) and hearing. The dental and vision coverage is actually better than I had at work

My maximum out of pocket is $3800

 

So here are main points of my plan, make of it what you will.

 

But those of you who make annual trips home something to thing about.

 

I do the enhanced PPO for $64

[GinBoy2]

On 9/8/2024 at 9:49 AM, TallGuyJohninBKK said:

 

But from what I've read (I think), you can't actually sign up for a Medicare Advantage plan until AFTER you're already enrolled in basic Medicare?

 

I didn't get the impression, a newbe could do A, B and Advantage all in one sign-up at the same time.

 

Yes and No.

 

What I did was I signed up for B in the three months ahead of my birthday., A happens automatically you don't have to do anything

 

I'd been researching all the options for additional coverage so I knew who I was going with.

 

I contacted Wellmark (or whoever you choose) to tell them I was enrolled in B, they do some online check with Medicare and within 10 mins I was signed up.

 

I filed away my Medicare card and just carry the Wellmark card.

 

After my initial confusion of the baffling array of options, the actual sign up was curiously rather easy.

 

If you then go back to the Medicare website and look at your account it shows you are signed up with an outside provider