Some Background On The No Medicare For Americans Abroad Issue

[Jingthing]

Don't have anything new to share here.

But this historical tidbit is new to me and perhaps you. Some information on a time when this injustice was challenged before:

The argument the government continually regurgitates when challenged on this issue is one they first came up with in 1979, namely: “There are two primary difficulties in extending Medicare services abroad: (1) determining reimbursement rates for foreign services; and (2) ensuring compliance with Medicare standards by foreign medical personnel and facilities.”

However, this argument didn’t hold much water back then, and it certainly doesn’t today because there is already a working model in place to deliver the insurance benefits to those who are eligible and who are living abroad, namely TriCare, the model used to support and reimburse U.S. military personnel and their dependents who are resident overseas.

I see very little hope Medicare will be extended to expats who would otherwise be eligible if they lived in the U.S. though. The article explains the sad reality of the status quo and what it means to American expats, to those who may not know:

http://www.cuencahighlife.com/post/2013/01/02/Medicare-is-still-unavailable-to-US-citizens-living-overseas-although-efforts-continue-to-change-the-law.aspx

[JLCrab]

Hello JT - As I am pushing that age and weighing the options, I am mostly of the opinion that my continued full In-Patient coverage with BUPA would be less than taking out and paying annually for the Parts B & D coverage which I would never use. If I develop any serious maladies that are not emergencies, I can always return to the USA where In-Patient Part A is available no-questions-asked.

BTW The article does not mention any private Medigap insurance for any Part A co-pay which is also an annual expense that can be saved if living abroad -- that assumes you have the cash if the unforeseen occurs. It seems most if not all Medigap plans require that you be enrolled in both Parts A & B.

Edited January 11, 2013 by JLCrab

[IMA_FARANG]

Yes, I'm aware that medicare/Medicaaid is not available to U.S. citizens living (residing) outside the U.S. (Thailand as an example).

This is mainly do to the fact that no Thai hospitals/doctors will accept any medicare/medicaid claims anyhow simply because the U.S. government won't pay those claims.

But that's not my real question.

Somewhere in that article there is the statement that when living overseas you do NOT have to pay the premiums for Part B coverage,

I, personally, have gone around with Social Security about this very issue.

Why am I being forced to pay the premium for Part B coverage that I can not use unless I return to the U.S.?

But I am STILL having $115 a month deducted from my Social Security pension each month .... and so far I haven;t had a clear answer to that question .... if I can decline part B and NOT pay that monthly premium.

Anyone who has valid information about that question ....please pass it to me.

All, I seem to get from Social Security is how great the Medicare/Medicaid system is ... nd the advantages of me paying the "minamal cost" of that monthly premium for the health care service it gives me.

When I retired in 2010, at the age of 64, I deliberately declined applying for Medicare/Medicaid as I was aware that living in Thailand i almost certainly I would not be able to use it.

On my 65th birthday, without my consent, the Social Security registered me for Medicare/Medicaid ... including Part B and a then $95 premium which rhey began deducting from my monthly Social Security deposit.

Apparently they assumed that at my "advanced age" I was becoming senile, and therefore they assumed control of my financial affairs for themelves (that's a joke).

In January 2013 they increased that Part b premium to $115 each month.

I still have not had any answer from them as how i can opt out of that so-called "benefit" and stop paying that $115 monthly for Part B coverage I can't use.

[JLCrab]

IMA_F -- Thanks for the heads up on the Part B SSA deduction I still have a few years to go but will keep a diligent eye on that one.

[SurfRider]

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"how i can opt out of that so-called "benefit" and stop paying that $115 monthly for Part B coverage"

When you turn 65 Medicare automatically enrolls you in Part-A for which there is no charge. They give you an option to decline Part-B, otherwise they enroll you in that also. Practically speaking, it's VERY CHEAP insurance for what it offers, but you can only use it if you go back to the US in the event of a serious medical situation.

If you're absolutely sure that you really want to drop Part-B, contact the SS/Medicare unit at the Manila Embassy. They will take care of that.

eMail: [email protected]

Social Security Administration

US Embassy Manila

1201 Roxas Boulevard

Ermita, 0930 Manila, Philippines

Tel No. (63) (2) 301-2565

Fax No.(63) (2) 708-9714

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[Langsuan Man]

I was told that if you decline Part B, when first eligible, that it is extremely expensive to enroll in Part B later on

Is this true ?

[MilesCh]

And I read more than a year ago that if you cancel Medicare (A or B?) it takes quite some time to have it re-instated.

What is the cost of A and B individually? I simply see one deduction on the annual Social security statement. And has anyone been able to cancel one or the other without cancelling both?

[lanny]

I was told that if you decline Part B, when first eligible, that it is extremely expensive to enroll in Part B later on

Is this true ?

Yes. If you opt out of part B and later change your mind, the premium is much higher. I don't know how they determine the higher premium but it is significantly more. Cumulatively, it could be cheaper to opt out for a few years and then apply for the coverage again.

Part A, which is no cost, covers hospitalization but does not pay the full bill. Part B covers out-patient services but, again, does not pay the full bill.

Unless you don't have confidence in Thai hospitals, medical bills here are much lower than in the US. My own experience with Thai doctors is that they are competent and I don't think I could have a problem that couldn't be treated here. So, I have opted out of part B and I estimate that the hospital bills I have incurred here are about equal to the co-pay that would have been required in the US after medicare paid its share.

[JeffreyMcCollum]

Oh Good grief !

Pay your Thai medical. It is only a fraction of what your co pay would be. And I do live here and get covered under the government plan. Good care and OMG $1 a vist

[SurfRider]

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If you decline Part-B and later decide to enroll in it, the penalty is 10% for every year when you were NOT enrolled - added to the monthly payment and deducted from your Social Security benefit payment.

Medicare has 4 parts.

Medicare Part A is for inpatient care in hospital and nursing facilities

Medicare Part B is for doctors fee and outpatient services

Medicate Part C is for other services not covered by Part B.

Medicare Part D is for prescription drugs.

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[Jingthing]

Oh Good grief !

Pay your Thai medical. It is only a fraction of what your co pay would be. And I do live here and get covered under the government plan. Good care and OMG $1 a vist

Congrats. People coming here on retirement status here can't buy into that.

[Lancelot]

No Medicare coverage abroad is another example of government complicating an issue that should be uncomplicated

Oh well, maybe the savings from not reimbursing US citizens abroad could be "invested" in another aircraft carrier group. According to Wiki, the US presently has 10 in service, two in reserve and three planned

[Jingthing]

No Medicare coverage abroad is another example of government complicating an issue that should be uncomplicated

Oh well, maybe the savings from not reimbursing US citizens abroad could be "invested" in another aircraft carrier group. According to Wiki, the US presently has 10 in service, two in reserve and three planned

I think it's more like expats haven't bothered to LOBBBY hard enough. Also, sadly, out of sight, out of mind.

[SurfRider]

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Here's an example of one good reason why Part-B is worth having.

A retired American friend fell and broke his hip while visiting in Bangkok. He was immobile and taken to Bangkok Hospital. The doctors put three screws in his hip so the bones would start to fuse together and heal. The cost of the initial surgery was the equivalent of US$5000. It was covered by his state-side insurance (Medicare Advantage) because it covers a person who is traveling. Medicare reimburses his private insurance company.

Three months later it was discovered that one of the screws had migrated and was about to enter the hip joint, which would cause severe pain. The surgery would cost US$15,000 in Thailand, which he would need to pay up-front out of his own pocket. The state-side insurance was only good for the initial operation and would not cover the second surgery.

He went back to the states where doctors discovered that no healing had taken place and recommended a complete hip replacement, which he decided to do. The entire cost was covered by Part-A and Part-B, with the exception of medication.

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[JLCrab]

Well I'll go out on a limb here because I'm still not sure exactly how Medicare works in its entirety.

Your friend does not live permanently in Thailand. I believe there is a limit to how many months outside the USA one can stay each year and still be covered by the Medicare traveler provisions. He obviously does not have any Thai insurance such as BUPA which would have covered the operation and any inpatient followup (including a second operation) in full up to the several million baht limit per incident chosen.

You can stay for a week or more in Thailand for in-patient surgery whereas in USA they may send you home in short order so there are more out-patient costs involved that need to be covered by Part B.

Secondly, TTBOMK Medicare Part A does not pay IN FULL for anything but only 80%. Your friend maybe also had a Medigap coverage plan. I recently looked at such plans in my state and they run $6800-7400 per year. My no-deductible BUPA coverage at 2 Million baht per incident is around $2500 age 60+.

And I have no immediate plans to relocate permanently to USA any time soon if ever.

Edited January 13, 2013 by JLCrab

[JeffreyMcCollum]

Oh Good grief !

Pay your Thai medical. It is only a fraction of what your co pay would be. And I do live here and get covered under the government plan. Good care and OMG $1 a vist

Congrats. People coming here on retirement status here can't buy into that.

I didn't buy into it. Government gives it to me free as they do many expats

[Jingthing]

Oh Good grief !

Pay your Thai medical. It is only a fraction of what your co pay would be. And I do live here and get covered under the government plan. Good care and OMG $1 a vist

Congrats. People coming here on retirement status here can't buy into that.

I didn't buy into it. Government gives it to me free as they do many expats

Based on what? Anyway, I am sure an expat moving to Thailand starting on a retirement extension is not getting into the Thai government system, buy in or not. I realize that some foreigners are on that system. This thread isn't about that. It is about American MEDICARE. Cheers. Edited January 13, 2013 by Jingthing

[JeffreyMcCollum]

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Here's an example of one good reason why Part-B is worth having.

A retired American friend fell and broke his hip while visiting in Bangkok. He was immobile and taken to Bangkok Hospital. The doctors put three screws in his hip so the bones would start to fuse together and heal. The cost of the initial surgery was the equivalent of US$5000. It was covered by his state-side insurance (Medicare Advantage) because it covers a person who is traveling. Medicare reimburses his private insurance company.

Three months later it was discovered that one of the screws had migrated and was about to enter the hip joint, which would cause severe pain. The surgery would cost US$15,000 in Thailand, which he would need to pay up-front out of his own pocket. The state-side insurance was only good for the initial operation and would not cover the second surgery.

He went back to the states where doctors discovered that no healing had taken place and recommended a complete hip replacement, which he decided to do. The entire cost was covered by Part-A and Part-B, with the exception of medication.

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Rubbish Is this story make believe ? First he started going to the wrong Hospital. Mistake 1

[JeffreyMcCollum]

Purchased a house, was given the card, so was my wife. Bet you still think expats can not buy a home in Thailand too.

If you want the restricted Medicare plan please do us all a favor, Don't worry so much about it and stay there

[JeffreyMcCollum]

Oh Good grief !

Pay your Thai medical. It is only a fraction of what your co pay would be. And I do live here and get covered under the government plan. Good care and OMG $1 a vist

Congrats. People coming here on retirement status here can't buy into that.

I didn't buy into it. Government gives it to me free as they do many expats

Based on what? Anyway, I am sure an expat moving to Thailand starting on a retirement extension is not getting into the Thai government system, buy in or not. I realize that some foreigners are on that system. This thread isn't about that. It is about American MEDICARE. Cheers.

Based on what ? Are you a Thai Medical insurance expert ? DO you even Speak Thai ? Have a home here ?

Where I won't say all Expats, in all areas, I don't know for sure, but many of my friends have it too or are waiting to soon get on it

[Jingthing]

Based on what ? Are you a Thai Medical insurance expert ? DO you even Speak Thai ? Have a home here ?

Where I won't say all Expats, in all areas, I don't know for sure, but many of my friends have it too or are waiting to soon get on it

Please start a new thread and explain to us how to get Thai national medical insurance. I am sure it would be useful for those expats who can manage that. I reckon through employment in Thailand is standard, correct? Again, this thread is about American MEDICARE. I am not expert but I do think I know enough that an American expat who comes to Thailand and starts to use retirement extensions is not typically going to find a way into the Thai government plan. Edited January 13, 2013 by Jingthing

[SurfRider]

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"there is a limit to how many months outside the USA one can stay each year and still be covered by the Medicare traveler provisions"

"Medicare Part A does not pay IN FULL for anything but only 80%"

He has Medicare-Advantage coverage, which is private insurance that costs US$34 per month. It's an extension of Medicare coverage that covers most of what Medicare does not. The cost of the hip replacement was paid in full by the private insurance and they are reimbursed by Medicare.

"he started going to the wrong Hospital. Mistake 1"

He had few options. He was in severe pain, immobile, and requested Bumrungrad. They couldn't take him for some reason, so the ambulance took him to Bangkok Hospital.

Why don't you consider staying on-topic and keep your irrelevant opinions out of the discussion?

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[BEENTHEREDONETHAT]

I was told that if you decline Part B, when first eligible, that it is extremely expensive to enroll in Part B later on

Is this true ?

I declined it at age 65 as I was living in Australia at the time. Joined 12 years later at age 77 and I was charged 10% per year for each year I wasn't signed up' So I pay 120% more than someone who joined at age 65.

It is very difficult to find a Dr. who will accept a patient on Medicare. I presently need to have a back operation as I have 3 bulging disk. But very doubtful I can find a well Qualified Dr. in the US to accept me as a patient. So I will most likely have the operation done in BKK at a cost of somewhere between $10,000-40,000. So the $9,000 we spend a year for Medicare and supplemental is of very questionable value. We carry it because we typically spend the summer in Idaho. But with my buggered back I don't think we can do the trip this year.

[Jingthing]

I was told that if you decline Part B, when first eligible, that it is extremely expensive to enroll in Part B later on

Is this true ?

I declined it at age 65 as I was living in Australia at the time. Joined 12 years later at age 77 and I was charged 10% per year for each year I wasn't signed up' So I pay 120% more than someone who joined at age 65.

It is very difficult to find a Dr. who will accept a patient on Medicare. I presently need to have a back operation as I have 3 bulging disk. But very doubtful I can find a well Qualified Dr. in the US to accept me as a patient. So I will most likely have the operation done in BKK at a cost of somewhere between $10,000-40,000. So the $9,000 we spend a year for Medicare and supplemental is of very questionable value. We carry it because we typically spend the summer in Idaho. But with my buggered back I don't think we can do the trip this year.

That's a good point! I have read its going to get harder and harder to find Medicare docs at all to accept NEW patients. That's the issue, getting accepted as a NEW patient. People in the US are advised to line up a doctor as early as possible and to show preference to YOUNG doctors who won't retire on you. For people who move back to the US or even people who MOVE within the US, this could be a real crisis.

It just occurred to me that this worsening access crisis even for those with use of Medicare may be a policy opening to reform use of Medicare ABROAD. Consider this with millions of baby boomers finding it harder to find doctors who will take Medicare, wouldn't it make sense for the government to PROMOTE medical medicare tourism? Potential lower costs even with airfare and lodging and the people can get the care they need, at least for certain major procedures. That could be the impetus, OTHER first world countries are doing similar, but once the precedent is set of Medicare paying foreign hospitals, it could be an opening to cover full time retired expats as well. Wishful/hopeful thinking? Sure.

Edited January 13, 2013 by Jingthing

[SurfRider]

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"It is very difficult to find a Dr. who will accept a patient on Medicare"

It might be worth checking with Kaiser Permanente. They're a large nation wide operation and they accept Medicare patients. Some of the Mayo Clinic satellite clinics also accept Medicare.

https://medicare.kai...ortal/medicare/

http://www.mayoclini...t/medicare.html

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[JLCrab]

The $6800 to 7400 cost for Medigap which includes Part 'B' I mentioned above comes straight from the medicare.gov website.

Looks like I found the $34 per month Medicare Advantage Policy which is in addition to the Part B premium. In-patient co-pay is $322 per day for days 1-5. $6700 (annual) out-of-pocket limit for Medicare-covered services.

Worth considering even if one lives in Thailand I guess.

[JeffreyMcCollum]

Why don't you consider staying on-topic and keep your irrelevant opinions out of the discussion?

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I thought the discussion or reason for it was about medical care for an American Living here.

Thought I would try to help. Lived here a while now, from America, and not working. So it sounds like I fit the question very well and use the Thai Health care system, and remember there are 3 of them in Thailand,

And Ambulances take you to the nearest "Government Hospital" Not private. Only a direct call to that hospital to take you in their Ambulance will get you to their.

But clearly you don't seem open to learning anything new and wanting to misguide others.

[PC800]

I recently found out that the USA Embassy in Bangkok can cancel your Medicare Part B if you choose. BUT....you also need to fill out an SSA-address form listing Thailand as your primary address. That's not all bad in of itself, but they sometimes require you to show your face once a year to prove you are among the living. It can be all handled through the mail, along with a copy of your passport. I have the two forms if anyone needs them. SSA-21 is the change of address to Thailand, and the other form to cancel is Form CMS-1763.

[SurfRider]

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"wanting to misguide others"

You're the one misleading people. You've got your head stuck in Thai Govt. insurance and government hospitals. I don't know what type of ambulance was called after he had the accident, but I'm reporting what ACTUALLY HAPPENED - that's obviously at odds with what you think SHOULD have happened. Everything I've reported is 100% accurate.

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[SurfRider]

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"Looks like I found the $34 per month Medicare Advantage Policy which is in addition to the Part B premium"

I don't know what you're referring to on the Medicare website, but his Medicare-Advantage policy is from a private company, not Medicare. He's not paying any of those high premiums that you mentioned. Yes, you need to be enrolled in Part-B to be able to purchase the private Advantage add-on. I assume that's because the private company needs to be reimbursed from both Parts A and B.

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