OK so I've been going round in circles on this for weeks and my head is spinning.

I turn 65 in a few months and the Medicare question is driving me mad.

Everyone back home assumes you just sign up and that's it sorted. Nobody tells you it's basically useless if you're living outside the US — Thailand included. Found that out the hard way after spending an afternoon on the phone with Social Security.

So now I'm stuck with the Part B decision. Pay the premiums every month for coverage I can't actually use here, or drop it and risk a permanent 10% penalty for every year I delay if I ever go back. Which at my age is a real possibility.

Part A I get — no premium so that's a no-brainer, sign up regardless. But Part B stings when you're paying for nothing.

For now I'm just using a private international plan which covers me fine here, but the thought of those Part B penalties stacking up is keeping me up at night.

Anyone else been through this? What did you actually decide and do you regret it? Would love to hear from people who've already wrestled with this rather than read another government FAQ that assumes way too much.

I got Part B.

I go back to the US annually for fam了ily reasons anyhow. Get all my routine preventive care then under Medicare. Most of it is covered under Part A with no copay but there are exceptions:

• Screening colonoscopy is free BUT if a polyp is found the entire thing gets reclassigied as a polypectomy and is subject to copay.

• Certain preventive services aren't covered under Part A e.g breast ultrasound, manual prostate exam, skin cancer screening. Allof these would come under Part B.

I've used Part B for the things listed above. I also recently used it for treatment of a thyroid mass as my internationsl policy has a thyroid exclusion.

I'm just paying the Part B.

It doesn't change my life whether I pay it or not.

I don't plan to repatriate and the more things change in the U.S. in a direction it's going, the less chance that I will. I don't even visit.

But it is possible.

If a time come where that money will make a real difference for me abroad, I'd probably drop it.

Remember at older age it's less about investing for the future, but more above defensive moves to keep the status quo OK.

3 minutes ago, Jingthing said:

I'm just paying the Part B.

It doesn't change my life whether I pay it or not.

I don't plan to repatriate and the more things change in the U.S. in a direction it's going, the less chance that I will. I don't even visit.

But it is possible.

If a time come where that money will make a real difference for me abroad, I'd probably drop it.

Remember at older age it's less about investing for the future, but more above defensive moves to keep the status quo OK.

100% not returning, especially with the fascist takeover.

1 hour ago, cjinchiangrai said:

100% not returning, especially with the fascist takeover.

You never know.

I keep Part B and think of it as insurance in the broadest sense.

I have international coverage here, but I still travel back to the U.S. a couple of times a year for a few weeks at a time. More importantly, none of us knows what life will throw our way. I don’t plan to live in the U.S., but if I ever had to return, whether due to a serious illness or a change in circumstances, I’m covered.

At around $200 a month, it’s not a financial burden for me, so I’m comfortable keeping that safety net in place.

Best case, I never need it. Worst case, it’s there when I do. I look at it like home insurance - you hope you never use it, but you’re glad you have it if you have a fire.

9 hours ago, cjinchiangrai said:

100% not returning, especially with the fascist takeover.

Never give up the ship!!Personally the medical insurance issue is just another reason why I don’t live here full time.I also have property’s to take care of and a nice shop to build whatever my little heart desires.perhaps I’m a bit more fortunate than some.Another reason is the wife has to spend at least half the year in the states to keep her green card.cheers and good health and blessings to all.

FWW, I stopped Part B when I came to Thailand about 10 years ago. The premium pays for my health care needs in Thailand. For now, I have no reason to return to the US. However, if I do, I can reenroll in Part B. Yes, my premium will be higher at that time, but at my age, that wouldn't be for very long.

As most of you know by now, There are many little gotchas that expats deal with that we never even thought about before coming to Thailand. But overall, coming was a good decision.

18 minutes ago, Tug said:

Never give up the ship!!Personally the medical insurance issue is just another reason why I don’t live here full time.I also have property’s to take care of and a nice shop to build whatever my little heart desires.perhaps I’m a bit more fortunate than some.Another reason is the wife has to spend at least half the year in the states to keep her green card.cheers and good health and blessings to all.

Healthcare is way cheaper in LOS and my wife does not have a visa. Happy here

I did not sign up for Part B. Hopefully if I ever need extensive care that my Thai private policy won't cover I will be able to join during the sign up period before returning. Maybe not a wise move as I age and insurance here becomes more and more expensive. Perhaps I will self insure here and start paying for Part B when I move into my late 70s.

You can use your part A in Guam, which is a American territory. The flight is not that expensive.

After a thorough review of personal and family medical history and lifestyle factors (to assess probability of a chronic illness materializing), and adding up the the travel expenses, premiums, co-pays, and deductible expenses which would need to be incurred to access stateside medical care, I decided to drop Part B after initially paying the premiums for 5 years.

While the probability of a medical problem arising obviously increases the older you get, I concluded that there was a high probability that the medical problems I would most likely encounter would most likely have to be addressed on an urgent or time-sensitive basis, thus effectively stripping away the option of returning home in order to access medical care anyway.

We moved to Thailand in 2013 From California and for 6 years we went to visit every year for 4-6 months but after Covid we never returned, We have both been Healthy so never used Part B Medicare so last year I dropped it. In Thailand we just pay as we go. Being Married to a Thai you don’t have to carry Medical Insurance. We are in our high 70’s and take a physical every year and blood test every 6 months. We use Private Hospitals and we never pay more than 600 dollars for the 2 of us. We eat healthy and exercise everyday. We have Banked more than 30,000 dollars for healthcare if we need it. We would never be able to afford to move or live in the US and we would never feel Safe there anymore anyway.

Part of you’re decision depends on your situation back in the U.S.

If you moved back to the U.S., do you have your own home to live in, or have family or friends that you could live with long term? If not, you need to take into consideration not only the cost of your flight back to the U.S., but all of you’re other expenses. Would you be able to find a place to rent that you could afford, including first and last months rent plus deposit. How about transportation? Bus, taxi? Buy a car, then pay insurance etc.

Lots to consider beyond just the cost of Medicare Part B.

Would the cost of Medicare Part B be a sever burden on you? If not, then that’s you’re answer. It’s insurance, something you pay for but hopefully never use.

FWIW, I personally would pay for part B. “Just in case”. That said, I’m in a different situation as my retirement package includes the cost of world-wide medical insurance, and in order to keep that insurance coverage I’m required to have Medicare Part B coverage, although my retirement package reimburses that cost to me.

I’m like DFPhuket. I pay for Part B. USA care and Medicare are my fallback if the wheels fall off my cart. A secondary insurance, if you will. You never know what problems might arise in the future. At least for now I can afford the cost of Part B coverage.

19 hours ago, MikeWill said:

OK so I've been going round in circles on this for weeks and my head is spinning.

I turn 65 in a few months and the Medicare question is driving me mad.

Everyone back home assumes you just sign up and that's it sorted. Nobody tells you it's basically useless if you're living outside the US — Thailand included. Found that out the hard way after spending an afternoon on the phone with Social Security.

So now I'm stuck with the Part B decision. Pay the premiums every month for coverage I can't actually use here, or drop it and risk a permanent 10% penalty for every year I delay if I ever go back. Which at my age is a real possibility.

Part A I get — no premium so that's a no-brainer, sign up regardless. But Part B stings when you're paying for nothing.

For now I'm just using a private international plan which covers me fine here, but the thought of those Part B penalties stacking up is keeping me up at night.

Anyone else been through this? What did you actually decide and do you regret it? Would love to hear from people who've already wrestled with this rather than read another government FAQ that assumes way too much.

Still dealing with this and have not had clear insight over the past 15 years. Medicare only good in USA territory (Guam closest?). BUT ... I was given a Medicare Advantage policy as part of earned retirement. Still have to pay the Part B monthly premium. Heart attack here in C. Mai 2015 ... policy paid $5000 usd bill out of $11,000 usd total. Now policy provider changed ... currently two months awaiting a clarifying answer on coverage. Between Part B and Advantage premiums, could I get a major medical only policy without pre-existing exclusions. Right ... the dilemma continues. good luck!

36 minutes ago, Front Row said:

I’m like DFPhuket. I pay for Part B. USA care and Medicare are my fallback if the wheels fall off my cart. A secondary insurance, if you will. You never know what problems might arise in the future. At least for now I can afford the cost of Part B coverage.

Agree but then, I also react on, if I needed the Part B fallback ... the co-pays, deductibles might be just as expensive as covering the bill in Thailand?

You cannot use Medicare here and also, you may not qualify for Medicare Advantage. Just Parts A & B.

6 minutes ago, wwest5829 said:

Still dealing with this and have not had clear insight over the past 15 years. Medicare only good in USA territory (Guam closest?). BUT ... I was given a Medicare Advantage policy as part of earned retirement. Still have to pay the Part B monthly premium. Heart attack here in C. Mai 2015 ... policy paid $5000 usd bill out of $11,000 usd total. Now policy provider changed ... currently two months awaiting a clarifying answer on coverage. Between Part B and Advantage premiums, could I get a major medical only policy without pre-existing exclusions. Right ... the dilemma continues. good luck!

Some Advantage policies cover emergency treatment abroad. BUT this assumes it is a temporary visit abroad. You normally need to be permanently living not just in US but in the specific plan area. Usually at least 6 months out of 12.

If actually living abroad and this comes out, it will invalidate the policy. They could even come after you for prior pay outs.

So this is usually a viable alternative only for part timers.

Possible there are some special emplyment related group policies which differ.

I just calculated my penalty, for sign up, think I'll give that a pass. For those thinking about it: https://medicaresmartguide.com/calculators?calculator=partb

For me, 5 years coverage, from now, without increases would be:

$31k+ = 1M THB ... no thanks, if I'm reading it correctly, and not

$362.78 + $527.68 monthly, which would really be nuts.

i keep both Part A and B current. its automatically deducted from my SS every month. comes in handy. flew back to the states last year for a hernia op. at UCLA superior compared to Thailand and the price gougers here.

1 hour ago, Taboo2 said:

You cannot use Medicare here and also, you may not qualify for Medicare Advantage. Just Parts A & B.

1 hour ago, Sheryl said:

Some Advantage policies cover emergency treatment abroad. BUT this assumes it is a temporary visit abroad. You normally need to be permanently living not just in US but in the specific plan area. Usually at least 6 months out of 12.

If actually living abroad and this comes out, it will invalidate the policy. They could even come after you for prior pay outs.

So this is usually a viable alternative only for part timers.

Possible there are some special emplyment related group policies which differ.

Yes, that is true. I have a US address that keeps me on Advantage and go back home to use Parts A & B for normal checkups and Meds.

I understand some expats have been overcharged for a variety of services, including medical. I go to Thammasat University Hospital and have never experienced overcharging, dual tier pricing, etc. My doctors are faculty members and the staff is excellent. We just need to be wise about choosing where we go for services. But this is true anywhere in the world.

13 hours ago, cjinchiangrai said:

100% not returning, especially with the fascist takeover.

Question you say fascist take over. I assume you don't like the Donald. Ok. What I wonder is if Kamala had won and the Biden policies were still in place with high taxes and high co pay med would you go back.

5 minutes ago, kingstonkid said:

Question you say fascist take over. I assume you don't like the Donald. Ok. What I wonder is if Kamala had won and the Biden policies were still in place with high taxes and high co pay med would you go back.

And we are off............

1 hour ago, malibukid said:

i keep both Part A and B current. its automatically deducted from my SS every month. comes in handy. flew back to the states last year for a hernia op. at UCLA superior compared to Thailand and the price gougers here.

Just out of curiosity, how much is a hernia op at UCLA?

I just had a laparoscopic hernia Op (bilateral inguinal + femoral) here at Chulalongkorn for ฿81,685 all inclusive. (Plus about 2k for all the pre-op appointments/checks). Could have gone to a smaller private hospital for ฿110,000. The big, well known hospitals were ฿240,000 and up.

Looking at online forum hernia discussions, it seems like most people who went the hospital route in the US paid about $4,000 - $6,000 out of pocket (10% copay) for surgeries that cost $40-60,000. Their copay was higher than my total cost. There are a few surgery centers scattered around the US which offer lower prices (but require hospital clearances/checks) and if there is any complication, off to the hospital you go anyways.

Last time I went to UCLA for healthcare (cash pay) to see a gastroenterologist, not only did I have to wait a long time for the appointment, but they hit me with an $850 (eight hundred fifty) bill for a 10 minute appointment. I tried to get them to give me a price quote beforehand, and was told $350-850 after pulling teeth. Trying to get a quote for a colonoscopy was even more difficult and after much pushing, I was told that it “starts at $7000”. This was in 2010 so I’m sure it’s all more expensive now.

All my fathers cancer care was at UCLA and even with full Medicare, they would still present us with huge additional/supplemental bills.

I’m not yet eligible for Medicare, but I think I’ll stick with the old “If they have to threaten us by force/penalty to buy something, I just might be better off without it.”

44 minutes ago, thayroopthai said:

I understand some expats have been overcharged for a variety of services, including medical. I go to Thammasat University Hospital and have never experienced overcharging, dual tier pricing, etc. My doctors are faculty members and the staff is excellent. We just need to be wise about choosing where we go for services. But this is true anywhere in the world.

You are most likely paying “dual tier” pricing. I use Chula and for all procedures, the bill has columns for reimbursable and non reimbursable costs. All very transparent. The Thais have to pay the “non reimbursable”. Foreigners have to pay both. I’d be surprised if any goverment hosptial was different.

28 minutes ago, Airalee said:

You are most likely paying “dual tier” pricing. I use Chula and for all procedures, the bill has columns for reimbursable and non reimbursable costs. All very transparent. The Thais have to pay the “non reimbursable”. Foreigners have to pay both. I’d be surprised if any goverment hosptial was different.

I pay 100 baht to see my doctors. An office visit and medication plus hospital fees are usual about 300 to 400 baht total. I was going to have blood tests at PatRangsit, the fee was 6000 baht. My doctor told me to go to Thammasat where they practice. The fee was 1400 baht. Like others, I am concerned about dual pricing, but at Thammasat, I haven't seen any signs of it. BTW, PatRangsit is a private hospital. Thammaset is a government hospital.

3 minutes ago, thayroopthai said:

I pay 100 baht to see my doctors. An office visit and medication plus hospital fees are usual about 300 to 400 baht total. I was going to have blood tests at PatRangsit, the fee was 6000 baht. My doctor told me to go to Thammasat where they practice. The fee was 1400 baht. Like others, I am concerned about dual pricing, but at Thammasat, I haven't seen any signs of it. BTW, PatRangsit is a private hospital. Thammaset is a government hospital.

Go for a procedure/surgery and you’ll see what I mean. The price list will look something like below. The foreigner prices were made “official” a number of years ago. Feel free to check with the ministry of health for further clarification.

Same same for both my colonoscopy and recent hernia operation.

6 minutes ago, thayroopthai said:

I pay 100 baht to see my doctors. An office visit and medication plus hospital fees are usual about 300 to 400 baht total. I was going to have blood tests at PatRangsit, the fee was 6000 baht. My doctor told me to go to Thammasat where they practice. The fee was 1400 baht. Like others, I am concerned about dual pricing, but at Thammasat, I haven't seen any signs of it. BTW, PatRangsit is a private hospital. Thammaset is a government hospital.

It's not 'dual' pricing, just the 'non' Thai price. As Thai get most things done for almost free. So expats or tourist aren't getting any Thai price.

Govt hosp. much cheaper than private. Private, you pay extra for AC & hand holding, and minimal Q vs half a day at govt hosp.