Questions About Medicare

[chiang mai]

I have recently found out that I am eligible for a US SSc pension following the fifteen years that I lived and worked in America - it has come as a pleasant surprise because I hadn't factored that income into my retirement planning. This also means that I am eligible for Medicare and this would also seem to be a useful thing to have.

Whilst I do not live in the US any longer and nor do I plan to do so in the future, the fact that I will be enrolled in Medicare seems useful in principle, if/when I develop medical problems requiring treatment in the future. For example, I had non-emergency angioplasty last year and I wonder if that is something that could have been provided under Medicare. My other questions are: how useful and beneficial is Medicare, does the system provide good quality health care or is it viewed as a second tier behind private insurance, and, is it worth being enrolled?

Thanks in advance for any pointers on this, a subject about which I know very little.

[Jingthing]

It is not second class care (same docs and hospitals that everyone uses) but it is often hard to find a doc to accept new medicare patients as they are paid less. However, medicare does not cover nearly everything, so people buy supplement medicare insurance. Also, you cannot use penny one of the care outside US borders (I guess you know that, but just in case). I would think its use for an expat would be limited.

Edited April 4, 2009 by Jingthing

[chiang mai]

It is not second class care (same docs and hospitals that everyone uses) but it is often hard to find a doc to accept new medicare patients as they are paid less. However, medicare does not cover nearly everything, so people buy supplement medicare insurance. Also, you cannot use penny one of the care outside US borders (I guess you know that, but just in case). I would think its use for an expat would be limited.

Thanks for that, I suppose it will be a case of weighing the cost alternatives at the time the care is needed. Before having angioplasty last year I looked at the cost/quality issues of the available options. To have it done for free under the UK's National Health system was the least attractive route simply because of the apparently poor condition of UK hospitals and the high rate of C-Diff infections there. Private care in the UK at Bupa/Spire would have cost £15,000 plus plus whilst Bumrungrad eventually charged me THB 140,000 (circa £2,200 at the time). It would be interesting to know what the costs might have been under Medicare in the US.

[maxjay]

I have recently found out that I am eligible for a US SSc pension following the fifteen years that I lived and worked in America - it has come as a pleasant surprise because I hadn't factored that income into my retirement planning. This also means that I am eligible for Medicare and this would also seem to be a useful thing to have.

Since the whole SS thing came as a "pleasant surprise", I'd go for the Medicare. You never know. As you said you "handn't factored" it in, so if you sign up for it, you're only paying money that came as a "pleasant surprise".

[lopburi3]

http://www.cordis.com/active/crdus/en_US/h...imbursement.pdf

About $6,000 is what MediCare paid doctors in 2007 according to above.

[PeaceBlondie]

Americans can draw non-disability early retirement pensions from the SSA at age 62, reduced. They can start drawing Medicare health benefits at age 65, by paying $100 premiums monthly, for care that is not available overseas. Most of us do not enroll in Medicare because we do not live in the States. You can later enroll at a penalty of 10% for each year you delayed, but only during an enrollment period, not the day you have a heart attack, etc.

[Thanyaburi Mac]

Americans can draw non-disability early retirement pensions from the SSA at age 62, reduced. They can start drawing Medicare health benefits at age 65, by paying $100 premiums monthly, for care that is not available overseas. Most of us do not enroll in Medicare because we do not live in the States. You can later enroll at a penalty of 10% for each year you delayed, but only during an enrollment period, not the day you have a heart attack, etc.

Need to do some browsing around this www site: http://www.medicare.gov/

I'm in MediCare A, which is free, and as mentioned already, is useless overseas.

I have not signed up for MediCare B, which provides additional coverage, cost something like that $100, or a bit less a month, and is also useless overseas.

There's another MediCare option, CRS on which letter it is, perhaps "D" (?), which costs more and is also useless overseas.

So, I'd say yes, sign up for MediCare A, why not, got an extra ID card to carry in your wallet so show around the Singha table, and who knows, might just be handy one day if you happed to be in the U.S. when you get a hangnail.

Mac

[chiang mai]

Lots of good pointers here, thanks to all for the information you've provided.

[Sheryl]

There has been talk on and off about Medicare starting to reimburse for care outside the US. Hasn't happened yet but it well may, although would of course be limited to hospitals that Medicare has approved and which have a negotiated agreement with Medicare.

So both against that eventuality and in case soemthing happens during a visit to the US, yes, enriol in medicare A, but for now Medicare B (whioch requires pyament) does not seem worthwhile.

[Jingthing]

There has been talk on and off about Medicare starting to reimburse for care outside the US.

I know of some talk about covering some hospitals in MEXICO only as Mexico has the most retired expat Americans by far. However, it is just talk and given that the US is now in a severe economic crisis, I would bet you this is NOT going to happen. If it does, it will likely be Mexico only. The reason Mexico is important is because it is a border country so sick Americans often repatriate for medical care. It is also very common for retired Americans in Mexico to simply commute to US border areas for periodic medicare care. It would save the government to pay for the care at the cheaper Mexican levels. Most sick Americans who are really far seek treatment where they are, which costs the government nothing.

Edited April 4, 2009 by Jingthing

[chiang mai]

I read many months ago that Blue Cross/Blue Shield had subcontracted with Bumrungrad for some levels of care, presumably on the basis of cost - the NHS in the UK apparently does similar things with European hospitals. It would therefore make sense for hospitals outside the US to be used by Medicare on the same basis - apologies that I have no pointers to the article I refer to here but references can surely be found if anyone is interested.

[PeaceBlondie]

I agree with Jingthing that an expansion of Medicare coverage overseas is extremely unlikely, especially now, and since Medicare is already expected to run out of funds in another several years.

[lopburi3]

The only relationship between US Blue Shield/Blue Cross to any Thai hospital that I am aware of is that they 'may' be able to arrange post billing for customers at about a half dozen hospitals here - but only for inpatient care. Many international insurance companies have such an arrangement. As it delays payment to hospital they seem to prefer you do not use it.

[chiang mai]

The only relationship between US Blue Shield/Blue Cross to any Thai hospital that I am aware of is that they 'may' be able to arrange post billing for customers at about a half dozen hospitals here - but only for inpatient care. Many international insurance companies have such an arrangement. As it delays payment to hospital they seem to prefer you do not use it.

http://www.bumrungrad.com/overseas-medical...arch_2008).aspx

[Spaniel]

I will be turning 65 in July and recently I received the booklet, "Medicare & You, from Dept of Health & Human services. I would think that they would be sending you a copy of this book too or you can probably request a copy from the following:

US Dept. of Health & Human Services

Centers for Medicare & Medicaid Services

7500 Security Blvd.

Baltimore, MD 21244-1850

U.S.A.

As others have posted it isn't of any value if you're not in the US. The current minimum monthly charge is $96.40 and if you do not take it when you turn 65 then you must wait for the enrollment period which is in Jan/Feb/March, then the coverage starts in July. As another poster mentioned their is also a 10% penalty.

[lopburi3]

The only relationship between US Blue Shield/Blue Cross to any Thai hospital that I am aware of is that they 'may' be able to arrange post billing for customers at about a half dozen hospitals here - but only for inpatient care. Many international insurance companies have such an arrangement. As it delays payment to hospital they seem to prefer you do not use it.

http://www.bumrungrad.com/overseas-medical...arch_2008).aspx

Very long on words and short on facts. Mentions "Blue Cross & Blue Shield of South Carolina" which is but one of many (each state has independent office). Federal Blue Cross & Blue Shield offers coverage in any hospital in the world. In selected hospitals they will pay up front - but for most you must pay and then obtain re-reimbursement. As mentioned in the article that specific hospital does not have an office in the US; to avoid legal redress.

[cathyy]

Whilst I do not live in the US any longer and nor do I plan to do so in the future, the fact that I will be enrolled in Medicare seems useful in principle, if/when I develop medical problems requiring treatment in the future. For example, I had non-emergency angioplasty last year and I wonder if that is something that could have been provided under Medicare. My other questions are: how useful and beneficial is Medicare, does the system provide good quality health care or is it viewed as a second tier behind private insurance, and, is it worth being enrolled?

No, it's not worth being enrolled in Medicare if you are never returning to the US. They will not cover any treatment not performed inside the US. The care is only fair. For example, my mother had mild cataracts. She saw the doc and he suggested she schedule her surgeries, one on each eye, only two months apart and almost immediately for the first surgery. The reason was that she was turning 65 in about 4 months, and once that happened Medicare would not pay for cataract surgery until the cataract caused her to be legally blind in that eye. Medicare sets a high bar for how serious a malady must be to be covered.

[Alwaysright]

I read many months ago that Blue Cross/Blue Shield had subcontracted with Bumrungrad for some levels of care, presumably on the basis of cost - the NHS in the UK apparently does similar things with European hospitals. It would therefore make sense for hospitals outside the US to be used by Medicare on the same basis - apologies that I have no pointers to the article I refer to here but references can surely be found if anyone is interested.

Blue cross/Shield is subcontracted to most major hospitals in Bangkok..

[Thanyaburi Mac]

I will be turning 65 in July and recently I received the booklet, "Medicare & You, from Dept of Health & Human services. I would think that they would be sending you a copy of this book too or you can probably request a copy from the following:

US Dept. of Health & Human Services

Centers for Medicare & Medicaid Services

7500 Security Blvd.

Baltimore, MD 21244-1850

U.S.A.

As others have posted it isn't of any value if you're not in the US. The current minimum monthly charge is $96.40 and if you do not take it when you turn 65 then you must wait for the enrollment period which is in Jan/Feb/March, then the coverage starts in July. As another poster mentioned their is also a 10% penalty.

Spaniel

Believe that $96 charge is ONLY for MediCare Part B. Part A is FREE and I have a card to carry around if I want to, which I don't here. However, headed to PDX area for 50th high school reunion and will take it along. However II, if something comes up while there reckon I'll just put it on my commercial med insurance as services is way faster.

Speaking of the commercial med insurance, it does refer to MediCare and assumes that at 65 you're/me are covered, therefore only pays to MediCare maximums. So far not a problem with any med service I've had here in the LoS, given that costs here are way lower than in the U.S.

Mac

[Jingthing]

From the US government:

Part A, the free one for most people, sounds REALLY LIMITED.

Medicare Premiums for 2009:

Part A: (Hospital Insurance) Premium

*

Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

*

The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment.

*

The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

Medicare Deductible and Coinsurance Amounts for 2009:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2009 = $1,068) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

*

A total of $1,068 for a hospital stay of 1-60 days.

*

$267 per day for days 61-90 of a hospital stay.

*

$534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).

*

All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

*

$133.50 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

*

$135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)

Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2009 is available in the September 19, 2008 Fact Sheet titled, "CMS Announces Medicare Premiums, Deductibles for 2009" on the www.cms.gov website.

*Note: If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $96.40 per month. For additional details, see our FAQ titled: " Medicare Part B Monthly Premiums in 2009"

$96.40 per month*

Edited April 5, 2009 by Jingthing

[elektrified]

When my mother was alive she was extremely ill the last 3 years of her life. She had medicare thank God and we were able to take her to some of the best specialists and hospitals in Los Angeles. (Cedars Sinai, UCLA etc.) She also had Medicare part B which I think was about $80 USD per month through Blue Shield. But many of the doctors told us that even if she didn't have part B that they still would have treated her because they can bill the government for a bundle under part A.

[JimGant]

No, it's not worth being enrolled in Medicare if you are never returning to the US

Unless you're retired military, eligible for Tricare for Life, which will pay for overseas medical care -- but only if you're enrolled in Medicare B.

[noahvail]

No, it's not worth being enrolled in Medicare if you are never returning to the US

Unless you're retired military, eligible for Tricare for Life, which will pay for overseas medical care -- but only if you're enrolled in Medicare B.

I've been on SSDI for 15 years now, 9 of those away from the US. 10 years ago, with Medicare A & B plus private insurance, I had a triple bypass; contracted a staph infection, and they had to debrade 90% of my sternum. After that, there was an open wound in my chest the size of my fist. I was in hospital private room for 31 days, getting 6 bags of some wonder IV anti-biotic through a catheter (?) directly to the heart, at US$900 each. Then home to a hospital bed, same IV bags X4/day for another month, visiting the plastic surgeon every week to debrade the dead skin around the wound. Took just over 10 months to heal. Total cost something over US$330,000. With Medicare A&B and private insurance, all it cost was the deductible, which was next to nothing. 11.5 million Baht, at today's prices. So yeah, I pay the $96 a month - it comes out before the balance is deposited to my account, so I don't miss it. But if there's some weird thing that they can't fix in LoS, it's nice to know I can hop on a plane to Hawaii and get it taken care of.

[NamSod]

The only relationship between US Blue Shield/Blue Cross to any Thai hospital that I am aware of is that they 'may' be able to arrange post billing for customers at about a half dozen hospitals here - but only for inpatient care. Many international insurance companies have such an arrangement. As it delays payment to hospital they seem to prefer you do not use it.

I wrote the director of BKK General Hospital back in 2005 about insurance. I hope this helps. Here is his reply:

"Today I am writing in response to your email queries regarding the

international insurance companies

we currently have most business with. If you mean American companies,

below are accepted ones

we have direct billing contract with:

1. BLUECROSS BLUESHIED (in-patient and out-patient) : members of the

following 2 programs

are accepted

1.1 Federal Employee Program : mostly for US diplomats

1.2 BlueCard Worldwide

2. TIECARE (in-patient and out-patient): mostly for educational

institutions' members

3. TRICARE (out-patient only): for US military officers and retirees

Also, there are some more insurance companies currently we do not have

direct billing contract with,

but cashless services are accepted depending on the members' policies and

benefit verification.

They consist of :

- SRI ADMINISTRATORS

- CIGNA INTERNATIONAL EXPATRIATE BENEFITS

- AETNA GLOBAL BENEFITS

- IMG

Should you have any queries, please feel free to contact me. I will be

pleased to be of further service to you.

Sincerely yours,

Sunee Tumcharoen

Head of Intercredit Department

Bangkok Hospital

Tel: +662-7551163; Fax: +662-3103252

Email: [email protected]"

[lopburi3]

That was four years ago. The current policy is on there web site and requires pre approved payment before discharge or you must pay up front.

http://www.bangkokhospital.com/eng/claiming.aspx

If you have information that the above web site information is not correct please advise as I would be interested in it as have the coverage you listed. But AFAIK they do not accept out patient coverage and require pre approval for in patient payment.

[CaptHaddock]

The reason for a retired, American expat to sign up for Medicare is to reserve the option to return to the US at some time in the future. Without Medicare it would basically be impossible to return because the eventual costs of health care during old age without insurance would be prohibitive for most people. The OP is not in this category since he has access to NHS. However, when I retire to Thailand I plan to sign up for Medicare just so that I can go back at some point if I have to.

[Lopburi99]

The reason for a retired, American expat to sign up for Medicare is to reserve the option to return to the US at some time in the future. Without Medicare it would basically be impossible to return because the eventual costs of health care during old age without insurance would be prohibitive for most people. The OP is not in this category since he has access to NHS. However, when I retire to Thailand I plan to sign up for Medicare just so that I can go back at some point if I have to.

I plan on doing exactly the same Capt. My Medicare starts August 1 but I am delaying signing up for Part B. I can enroll next Jan/Feb/Mar then my Part B will start ($96.40/month) on July 1. Although my plans are to live in Thailand indefinitely, I want to visit the States once per year for a month to see my daughter. I figure maybe I could arrange my treatment for something which may come up while I am in the states. Also, as Capt said, if something nasty comes along for which I could not afford treatment in Thailand then at least I could go to the States for treatment. Part B is a necessity I believe because it includes outpatient hospital and much more which Part A does not. The way I look at it, about $100/month is worth paying for contingency purposes, or worst case scenario.

Also, when one signs up for Part B they can get a complete preventative physical for only a 20% copay within the first year. I am timing my trip next summer to be there in July, after my Part B starts up. At that time I will get my complete physical. That should help me be aware of meds or treatment which I may need upon returning to Thailand. I intend to get another angiogram, colonoscopy, and GI tract xrays.

But I will add if I come down with something which would involve a prolonged painful hospitalization/treatment prior to my death, to hel_l with it, I'll just come back to Thailand and go naturally. I saw my poor mother live for years in a nursing home before she finally passed at 94. Not for me. Maybe I'll arrange instead to "accidently" step on a KC in the Land of Snakes.

Edited July 9, 2009 by Lopburi99

[PeaceBlondie]

The odd thing about the e-mail quoted by lopburi99 is

1.1 Federal Employee Program : mostly for US diplomats

I've been in FEHBP since 1976.

[wpcoe]

I agree with Jingthing that an expansion of Medicare coverage overseas is extremely unlikely, especially now, and since Medicare is already expected to run out of funds in another several years.

I wish I could remember where I read this, but online someplace (i.e. speculation and rumor) was the hope that Medicare would approve a limited number of overseas hospitals including in Thailand, Malaysia and Singapore to parallel what some HMO's in America were doing: sending their patients for some treatments over here (I believe it was Bumrungrad) because (a) the overall cost, including transportation and lodging during recovery, was lower and ( the treatment itself was better with fewer relapses/associated traumas (like infections) requiring extended (i.e. expensive) follow-ups.

I don't recall the details, but the overall impression I was left with was: consistent with the goal of cost-reduction, flying patients over here saved money. In that light, I would hope Medicare would pursue the same option.