Some Background On The No Medicare For Americans Abroad Issue

[JLCrab]

Simple, Kuhn SurfRider:

Medicare.gov gives a guide to MediGap policies. I quoted the 'Estimated Annual Cost' for my zip code although they also say the monthly premium for the $6800 estimated cost is given as $192-499 per month.

The data on the Medicare Advantage comes from q1Medicare.com 2013 Medicare Advantage Plans Available to Residents (Your State).

Again, I have a few years to figure this all out as, if you do choose to enroll in Part B and some other plan, you are much better off doing so when you first become eligible. But for now I will continue BUPA even past age 65 as I intend to remain in Thailand permanently. Your friend as you mention was just visiting Bangkok when he had his accident.

[BEENTHEREDONETHAT]

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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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Thanks for the info Surfrider, unfortunately neither cover northern Idaho

[Balance]

Just wanted to clear up some things in the post:

You do not have to sign up with Medicare, Part B. But, if you opt out and then come back in later, there is a 10% add to current Part B coverage premium for each and every year you were out. I dropped out when I moved to Thailand, but then a burst of fear motivated me to opt back in about 7 months later. I do not know if there is a limit on how many time you can change your mind.

Medicare Advantage is a program set up for private insurers to bundle services like prescription drug coverage, eye care, etc under there private plan. Kaiser Permanente is one such private integrated health care firm who offers Advantage. I had this coverage for 3 years before moving to Thailand. There are two plans that differ on the co-pay percentages charged for hospital stays, office visits and other services. I have kept my Medicare Part B coverage even though I now have a high end plan from AIA that covers anything done during a hospital stay. Also, there are Advantage rules that state that you must be a resident of the area where you are getting your care, and that the provider (Kaiser or someone else) must be the exclusive provider of primary care.

Oh, Kaiser is nationwide, but is only active in about 6 states right now.

Cigna, Aetna and other carriers have offered people a choice of going overseas for years for big ticket procedures. And Tri-Care took care of the reimbursement issues a long time ago,there are a few hospitals in Thailand that are certified by main accreditation organization in the U.S. Why no Medicare coverage in Thailand? Lots of opinions, but the one that makes the most sense to me is that it saves the government money and expats are not a strong voting block.

The Medical Tourism Association is a well funded lobbying group that was formed a couple of years ago in Florida. It is funded by a group of healthcare providers throughout the U.S., Southeast Asia, India, and the Middle East. Reading between the lines it's purpose in to elevate the delivery of health care to a trade level issue. Along with that would be cross border recognition of insurance coverage. Given the climate in D.C. right now, who knows?

[mrjon]

We are still living in the States and my wife has Cigna as her Insurance carrier.

I happened across your post and more specifically your statement "Cigna, Aetna and other carriers have offered people a choice of going overseas for years for big ticket procedures"

My wife may or may not, I hope may not have a need to use them,(she needs more testing)

I just got off of the phone with Cigna, I asked the representative if my wife would be covered if she elected to have medical/surgical treatment out of country and the answer was a flat NO.

They will however cover anything of a medical emergency out of country.

Go figure.

Jb

[stevenl]

We are still living in the States and my wife has Cigna as her Insurance carrier.

I happened across your post and more specifically your statement "Cigna, Aetna and other carriers have offered people a choice of going overseas for years for big ticket procedures"

My wife may or may not, I hope may not have a need to use them,(she needs more testing)

I just got off of the phone with Cigna, I asked the representative if my wife would be covered if she elected to have medical/surgical treatment out of country and the answer was a flat NO.

They will however cover anything of a medical emergency out of country.

Go figure.

Jb

Of course medical emergencies out of country are covered.

I would not be surprised at all if the policy you have is different from the Cigna policy sold in Thailand.

[Nowhereman60]

When reading this I just thank God that I served my country for over 20 years and now have Tricare to pay 75% of my medical bills.

[Jingthing]

When reading this I just thank God that I served my country for over 20 years and now have Tricare to pay 75% of my medical bills.

That's great for you but American expats who paid into Medicare and are eligible for Medicare benefits DOMESTICALLY are being shafted en masse.

[JLCrab]

In addition to the penalties for late subscribing to Medicare Advantage TTBOMK, if you apply during your month age 65 eligibility window you are guaranteed acceptance. If you apply later you are subject medical underwriting and acceptance/rejection.

[Jingthing]

In addition to the penalties for late subscribing to Medicare Advantage TTBOMK, if you apply during your month age 65 eligibility window you are guaranteed acceptance. If you apply later you are subject medical underwriting and acceptance/rejection.

Interesting. First time I've heard of that. Can you linkify?

[NeverSure]

In addition to the penalties for late subscribing to Medicare Advantage TTBOMK, if you apply during your month age 65 eligibility window you are guaranteed acceptance. If you apply later you are subject medical underwriting and acceptance/rejection.

You are also subject to much higher rates due to pre-existing conditions which might not have existed at age 65. The time to buy into medicare is at age 65 when first offered especially if you are healthy.

Part A is free and covers only in-patient hospital stays. It's worth a thought because it's truly the "major medical" coverage and it's free.

Part B covers doctor's visits and procedures such as x-rays. No drugs. That might be worth risking the out of pocket self insured. Might.

Part C is Medicare Advantage. It covers A, B, and prescription drugs. It can also be upgraded to cover eyeglasses etc. at significant extra cost. Part C is always provided by a private insurer, who gets a monthly check from the government in exchange for taking the risk. I think that check is about $1,000. Now the private insurer collects a fee from you, plus the check from the government, and takes all risk.

As for the 10% penalty for late sign up, that's true only if you had no other full coverage. If for instance you or a spouse are still working, providing full insurance coverage, then that penalty is waived. However, you could still develop a new pre-existing condition which would drive your rates up.

My advice is to buy at least A and B at age 65. It costs only about $100 a month. Then if you are well enough to set foot on US soil, you have coverage, with deductibles, for all but drugs.

There is a way to maintain residency in the US without physically being there. Check for mail forwarding services in S. Dakota. There is no minimum number of days required to be a resident there, and the mail service is happy to walk you through establishing residency. Then all of your mail goes there, to be forwarded. That costs about $50 a month plus actual mail forwarding costs. A S. Dakota D/L is good for 4 years.