What USA city for Medicare?

[ricklev]

I recently turned 65 and enrolled in Medicare although although not in part B yet.  

 

I figure with part B it may be useful for catastrophic coverage, if I can get back there.  I do have Thai insurance but it is only 5 million baht and not that great.  

 

I wonder if other people have researched the best/cheapest city to go to if need be?  I no longer have family ties in the USA.  

 

Thanks.  

 

 

[jas007]

17 minutes ago, ricklev said:

I recently turned 65 and enrolled in Medicare although although not in part B yet.  

 

I figure with part B it may be useful for catastrophic coverage, if I can get back there.  I do have Thai insurance but it is only 5 million baht and not that great.  

 

I wonder if other people have researched the best/cheapest city to go to if need be?  I no longer have family ties in the USA.  

 

Thanks.  

 

 

One thing you should consider is whether doctors in the area are likely to accept Medicare patients.  In some parts of the country, it may be more difficult to find doctors who will "accept assignment" of Medicare benefits, or to even find a doctor who will accept Medicare patients in the first place.  For example,, if you're on Medicare, the Mayo Clinic won't even accept you as a patient (as of the last time I looked). "

 

Accepting assignment" of benefits is common, and just means that you assign your Part B benefits payment to the doctor before treatment, and, in return, the doctor accepts  whatever Medicare benefit is allowed as payment in full.  Doctors do this because payment is made to them very quickly, and they're assured of payment.  

 

As for what city?  I'd look for a low cost city in the Midwest, perhaps, with good medical facilities. Louisville, Indianapolis, Columbus, Cincinnati.  Something like that.  If you have to stay there for an expended period for whatever reason, it won't break the bank. 

[Sheryl]

Costs of care under Medicare will be the same anyplace since Medicare sets the rate. The only locality specific issue in mecical costs is the availability of doctors who will accept Medicare. Avoid NYC for sure. And of course, living costs vary greatly by locality but for that you might prefer to look at places you have friends you might stay with. If you do nto have any friends anywhere, then the combination of inexpensive lodging plus good availability of doctors/hospitals would be key, and as you'd likely also nto have a car, that means a comparatively inexpensive city.

 

Note that there is a penalty for late enrollment in Part B,

 

Part B is not so much for catastrophic coverage as all outpatient care. In the US that is a lot as hospitalizations are kept very short, with much care done as outpatient.

[srowndedbyh2o]

If there is a chance you will need medical care in the U.S., you may want to reconsider getting Medicare part B. As Sheryl mentioned there is a (10% per year) penalty for signing up late.

From the medicare.gov website:

“Late enrollment penalties:

• Are added to your monthly premium.
• Are not a one-time late fee.
• Are usually charged for as long as you have that type of coverage (for most people, that’s a lifetime penalty). The Part A penalty is different.
• Go up the longer you wait to sign up – they’re based on how long you go without coverage similar to Medicare. Find out when you should sign up to avoid penalties."

 

The out-of-pocket costs for not having Part b will quickly surpass what you would have paid for the base premium.

[GypsyT]

I's recommend joining this; https://www.aarp.org/

 

They have lot of political power and are experts to help.

[jas007]

On 1/16/2025 at 12:22 PM, Sheryl said:

Costs of care under Medicare will be the same anyplace since Medicare sets the rate. The only locality specific issue in mecical costs is the availability of doctors who will accept Medicare. Avoid NYC for sure. And of course, living costs vary greatly by locality but for that you might prefer to look at places you have friends you might stay with. If you do nto have any friends anywhere, then the combination of inexpensive lodging plus good availability of doctors/hospitals would be key, and as you'd likely also nto have a car, that means a comparatively inexpensive city.

 

Note that there is a penalty for late enrollment in Part B,

 

Part B is not so much for catastrophic coverage as all outpatient care. In the US that is a lot as hospitalizations are kept very short, with much care done as outpatient.

Not necessarily so, unless things have changed recently.  Medicare sets the reimbursement rate for some items and services based on an evaluation process that considers market conditions in the metropolitan area and existing provider agreements. No big deal for the patient if the doctor or hospital or provider "accepts assignment." The provider accepts whatever Medicare pays.  Otherwise, the patient may be stuck with a very expensive bill, even after Medicare has paid according to its schedule. 

 

For example, I once saw a case where a Medicare patient was charged thousands of dollars for an air ambulance trip in Hawaii. Medicare paid its part, but, over the years, the air ambulance charges in the Honolulu area had been increased to a level far in excess of where they were when the rate schedule was originally set.  The patient thought he was covered.  He was, but was still on the hook for thousands. 

[GinBoy2]

To be honest Part A albeit free, doesn't really mean coverage. It'll keep you alive but not much else,

 

You need to sign up for Part B to make any of medicare worth while, and do it before you incur a penalty.

 

I don't think any location makes things better or worse, although @Sheryl may know better than any of us.

 

The fact that you are asking this question, if you worry about a health issue, do Part B and do a Part D supplement

[ricklev]

Thanks for your comments.  

 

The way I see it Part B is $2220 ($185X12) per year in 2025 which means the first year penalty is about $220 and the savings is about $2000 by not enrolling.  My understanding is that if you live abroad you can sign up for Part B at any time and immediately receive the benefits, so it seems reasonable to wait until it is needed, even with the compounded monthly increase.  (Am I wrong?)

 

I am less concerned with the cost of coverage if I have to go back than with the cost of living and livability of the city.  That is why I was curious if anyone had thought about it.  I will have to immediately find housing.  

 

I am just musing.  Hopefully my health will remain excellent and my biggest issue will be the rising cost of my Thai insurance policy.  

 

 

[ricklev]

On 1/18/2025 at 10:10 AM, GypsyT said:

I's recommend joining this; https://www.aarp.org/

 

They have lot of political power and are experts to help.

I used to have a high opinion of AARP, although I am not sure why.  After the murder of the United CEO I started reading articles about the relationship between AARP and United and it sure made me change my opinion of AARP.  https://prospect.org/blogs-and-newsletters/tap/2024-12-11-how-aarp-shills-for-unitedhealthcare/