U.s. To Raise Medicare Advantage Payment Rate

[NeverSure]

In a reversal that followed intense lobbying from the health insurance industry and members of Congress, the U.S. government said it will increase the payment rate for health insurers that offer coverage through the popular Medicare Advantage program.

The Centers for Medicare & Medicaid Services said on Monday it will increase the rate by 3.3 percent in 2014, reversing a 2.3 percent cut announced in February.

The turnaround boosted shares of major health insurance companies such as Humana in after-hours trading.

Medicare Advantage provides care for seniors who select to receive their Medicare benefits through private insurance plans. About 14 million Americans are enrolled in the program.

The program has long ensured industry participation by paying more than the cost of the traditional Medicare program for the elderly and disabled. The proposed reduction had followed efforts by the Obama administration to reduce how much money it pays private insurers as an incentive to participate.

In announcing its final rates for 2014 on Monday, CMS said the changes came "after careful consideration of public comments."

Reuters

Published: Tuesday, 2 Apr 2013 | 6:07 AM ET

http://www.cnbc.com/id/100608355

[Jingthing]

Medicare is not usable for American expats in Thailand.

[NeverSure]

It is for those of us who are part timers. I will always maintain residency in the US so I can keep the MA, and my state driver's license, other licenses, voting rights etc.

I have to be a resident of any particular state in order to have its driver's license etc. I use a mail forwarding service which is cheap and efficient.

If I can get on a plane and make it back to US soil, I have full medical insurance that costs me about US$100 per month.

I can think of several guys on ThaiVisa who maintain residence in their home countries, and who travel back and forth, and that's only the ones who make it obvious.

[Jingthing]

Yes many of us have at least faux residences in the U.S. That is true. But realistically if you need urgent care and you're in Thailand, you're going to have to go to a hospital in Thailand. On voting rights, no, that is for ALL American citizens. You most certainly DO NOT need to be a current resident of any state to have the right to vote. Any expat can register based on their last U.S. state residence even if DECADES ago.

Edited April 2, 2013 by Jingthing

[NeverSure]

Yes many of us have at least faux residences in the U.S. That is true. But realistically if you need urgent care and you're in Thailand, you're going to have to go to a hospital in Thailand. On voting rights, no, that is for ALL American citizens. You most certainly DO NOT need to be a current resident of any state to have the right to vote. Any expat can register based on their last U.S. state residence even if DECADES ago.

You're right, but not every medical issue is an emergency even if care is vital. Even so, I might get stabilized in Thailand and then head for home too.

You're forgetting about state, county, and city elections. I still care about that. I'm high on a hill, looking down on the grade school I attended, and the high school I graduated from. I've been in this area "forever." I have to be a current resident of any state, county and city to vote those elections.

There are just too many benefits that arise from maintaining residence, just for me and in my opinion only.

Edited April 3, 2013 by Sheryl

[USNret]

On a related note, I have military health care (Tricare) due to my status as a Navy retiree. I have to pay a (very small) monthly premium because I live in the States, but when I reside in Thailand there is no monthly premium. When in Thailand, I can go to any health care provider, pay out of pocket, then submit the receipt for something like 80% reimbursement. it's a pretty good deal & I used it for my wife & I when we lived here a couple of years ago.

When I turn 65, I'll have to subscribe to Medicare Part B. I can't use medicare in Thailand as has been pointed out but purchasing Part B is required to stay eligible for Tricare past age 65. Although it all seems like a great deal, there is some harbored resentment since vets of my generation were promised free health care for life when we first joined, until good ol Congress decided to unilaterally rewrite that agreement some time ago (in the Bush 2 era).

Edited April 3, 2013 by USNret

[NeverSure]

On a related note, I have military health care (Tricare) due to my status as a Navy retiree. I have to pay a (very small) monthly premium because I live in the States, but when I reside in Thailand there is no monthly premium. When in Thailand, I can go to any health care provider, pay out of pocket, then submit the receipt for something like 80% reimbursement. it's a pretty good deal & I used it for my wife & I when we lived here a couple of years ago.

When I turn 65, I'll have to subscribe to Medicare Part B. I can't use medicare in Thailand as has been pointed out but purchasing Part B is required to stay eligible for Tricare past age 65. Although it all seems like a great deal, there is some harbored resentment since vets of my generation were promised free health care for life when we first joined, until good ol Congress decided to unilaterally rewrite that agreement some time ago (in the Bush 2 era).

First, Thank you for your service.

Yes, it sucks. You guys paid your dues, worked for low pay, and wrote a blank check for your lives. There were promises made in exchange which never should have, and I don't know legally how they could have, been broken.

If it helps, there is a lot of noise and a lot of protest and congress is hearing it. I think this Medicare Advantage payment is just the beginning.

I think we'll see an increase in payroll taxes in the next couple of years to cover some of these things. Dang, you have 47% of the country not paying any taxes, but everyone who works or is self employed pays into this fund.

[Sheryl]

Flamefest has been deleted. Cease and desist.

[JLCrab]

So Kuhn NS, in addition to maintaining the Medicare Advantage do you have health insurance while you are here on the Kingdom of Thailand's soil?

I am asking because I will soon be in a similar situation. There are distinct advantages to signing for Advantage when first eligible at age 65. The thing that concerns me the most is not the finances but reports that it is very difficult to find doctors to take on new Medicare patients.

[NeverSure]

If I knew who Kuhn NS was, I'd stand aside. If that's me, haha...

I have no health insurance while in Thailand. I have challenged people here to tell me where I can get any real health insurance at age 67 and no takers. What I did hear is that I might get "something" but it would be very expensive, and not cover pre-existing conditions. While I don't have any of those, they also said that insurance companies in LOS are very good at calling something a pre-existing condition even if no one knew about it, and deny the claim.

As for doctors taking new patients, I haven't seen that. There's a phenomena happening in the US right now, where more and more doctors are going to work for hospitals, and more and more clinics are being bought by hospitals. Many hospitals and clinics are installing "urgent care" departments which isn't like an emergency room. It is a no appointment needed, don't get your choice of doctor section where you just walk in. I've done that on a Saturday or Sunday and never had to wait more than 1/2 hour.

The reason so many doctors are hospital employees is due to the skyrocketing cost of malpractice insurance, which is often more money out of a doctor's pocket than his net income. If he goes to work for the hospital, even by the hospital buying the clinic, then the hospital can use it's might, economy of scale, and cover the doctor. The one hospital I can vouch for has an annual deductible of US$1 million. That covers about any claims, and keeps the premiums low. The hospital is self-insuring the first mil.

As you know, any entity that receives government support can't turn away a patient. I know of no hospital that could survive without government grants. Also, they couldn't survive without medicaid and medicare patients. It's just too big a percentage of their patient population. So if they own a clinic, the clinic is under that rule.

Our local largest (450 bed) hospital just bought a 28 or 27 doctor clinic. The doctors save a ton of money not only on insurance, but the economy of scale follows into the fact that they no longer need to worry about HR rules and documentation because the Hospital has that steam engine running too. The hospital has building maintenance experts, and on it goes. Everyone is now an employee of the hospital, under the hospital's expertise and umbrella.

The hospital now has all of these doctors including specialists who are employees and can be scheduled on call. This is the biggest reason for the hospital.

Only in big inner cities do I know of problems, but they have a lot more problems than that as you know. I think a wise man stays away from them. Like the man said. "You're from Detroit? Wow, I'd like to be from Detroit. Farrrrr from Detroit."

As to MA at age 65, definitely. Do you know that your premiums are based on pre-existing conditions? If you are now suffering from something that costs, say, $500 a month in visits and medications, you premiums will be more like $500 than $100 and you never know when that condition might surface. So the $100 a month you save for five years could be eaten up in one year, with many years to go at the higher premium.

My father is 96 and well. His MA costs $96 a month, but the conditions he has now he didn't have when he signed up. He also a wounded vet of Normandy and Belgium, (wounded just before the Battle of The Bulge) so he's also got the European Theater #2 on the list VA coverage. They do his eyeglasses and hearing aids free anyway, and anything else he needs.

Too long to proof read, sorry.

Edited April 3, 2013 by NeverSure

[JLCrab]

Thanks for the report. I tend to use initials but maybe next time I'll just use 'Dino'.

Insurance in Thailand is available if taken before age 60. After that as you say. If you apply for Advantage in the 6 month window at age 65 you cannot be refused. Even if you CAN get it later, the premiums are increased for each year following age 65. So at age 65 even though I might never use it, I will most likely sign up anyway. As you say, your father is 96; my Mother is 88 and in good health except for some mobility issues so one never knows.

As for the 'new patient' doctor thing, I guess that is mainly for Part 'B' type issues. If you need to be admitted under 'A' as you say it is the hospital staff or the doctor / surgeon on call.

(That's 3 as-you-says now that I look)

Edited April 3, 2013 by JLCrab

[NeverSure]

Thanks for the report. I tend to use initials but maybe next time I'll just use 'Dino'.

Insurance in Thailand is available if taken before age 60. After that as you say. If you apply for Advantage in the 6 month window at age 65 you cannot be refused. Even if you CAN get it later, the premiums are increased for each year following age 65. So at age 65 even though I might never use it, I will most likely sign up anyway. As you say, your father is 96; my Mother is 88 and in good health except for some mobility issues so one never knows.

As for the 'new patient' doctor thing, I guess that is mainly for Part 'B' type issues. If you need to be admitted under 'A' as you say it is the hospital staff or the doctor / surgeon on call.

(That's 3 as-you-says now that I look)

You're right about the age and premium increase, which I neglected to mention. The MA insurer doesn't want people who only sign up at age 88. They'd take a bath. They want the "younger" and healthier people from age 65.

There's always the option of part B and even C. Everyone doesn't go for MA. Each person has to weigh what he wants. I'm right at $100 a month for MA which doesn't cover hearing tests or hearing aids if I ever need them, or eyeglasses which I don't need. (Lasik surgery.) I could get that if I wanted to pay the premium but it's high.

[JLCrab]

BTW Dino when I moved to Thailand 10 years ago, I was covered by a COBRA plan that was costing about $6000 per year and there was no way for me to get an individual policy otherwise. So I then came to Thailand as a health insurance refugee.

[NeverSure]

How long can you ride on cobra? Isn't it limited - sort of meant to be stop-gap?

[Jingthing]

I think generally 18 months. I used it a number of times. One time it ended and there was a number to call to convert it to private and the conversation was very funny. The cost was many multiples as much as the Cobra premium.

[JLCrab]

I don't remember that there was any time limit on the COBRA; it was just that the rates keep going up -- and they are allowed by the state to raise the rates -- as the insurer (United Healthcare in my case) knows that the only person who stays long-term on a COBRA is someone who cannot otherwise be insured.

AS per JT I don't remember but I think it was longer than 18 months in my case.

Edited April 3, 2013 by JLCrab

[Jingthing]

Cobra is regulated by the feds. I think they add time to the standard 18 months sometimes during hard times. No, it is not permanent; it always has a time limit.

Edited April 3, 2013 by Jingthing

[JLCrab]

OK it is 18 months so I guess I was not on for that long as mine was not cancelled; I cancelled it when I bought insurance in Thailand. COBRA is federal as is Medicare but the rates are set within each state.

[NeverSure]

The only time I ever had cobra was so long ago, probably the rules have changed. I quit a job with a bank where I had coverage, and became forever self employed. I converted to cobra then as an interim until I could figure out what to do.

What I did was to find a good plan with a good company, with I think, a $10,000 per year deductible. After that they paid 90%. I was young and healthy and never needed much and the premiums were quite low for the time. Then I went off cobra and never looked back.

[NeverSure]

Back to topic, In my mind I do have some coverage in Thailand and it's all I know to get. It's my Medicare Advantage. If there's any way I can set foot back on US soil, I'm covered including an ambulance. There could be an ambulance waiting at the airport, and allowed to come right out onto the tarmac to the plane.

That's one of the reasons I keep thinking of Ecuador. It's a 7 hour flight to San Diego. It takes me 30+ hours to get from my house to BKK. I have to fly out of here to an airport that has flights to Thailand, and that's SEA, SFO, LAX or PDX. Additionally, I might have to fly first out of Udon or Chiang Mai or something to BKK to get home. Coming back in an emergency, it's about 20 hours BKK to LAX, SFO or any West Coast destination.

[Jingthing]

Airlines don't have to board people with serious medical conditions so if they don't the only option is a private ambulance flight, only for the very wealthy unless you have coverage for it.

[Jingthing]

That's one of the reasons I keep thinking of Ecuador.

I am also very interested in Ecuador but I think there is a special problem with getting residency there for current expats in Thailand. PM me if you want to discuss that.

Edited April 3, 2013 by Jingthing

[NeverSure]

That's one of the reasons I keep thinking of Ecuador.

I am also very interested in Ecuador but I think there is a special problem with getting residency there for current expats in Thailand. PM me if you want to discuss that.

I'm a resident of the US, and a retirement visa in Ecuador is much easier and cheaper than LOS. I'd rather be in LOS, but Ecuador is a good option.

Ecuador doesn't require you to be over 50. It's financial requirements are less. You can own land. I don't yet know about work permits because I wouldn't work. Medical care is excellent.

[NeverSure]

Airlines don't have to board people with serious medical conditions so if they don't the only option is a private ambulance flight, only for the very wealthy unless you have coverage for it.

Yep. You'd have to be healthy enough to fly. But say you were told you had cancer or needed bypass surgery or something really serious, but it didn't have to be done "today." Those are the types of things I'm thinking of. I can think of lots of scenarios.

But you're right. If you were too sick to be a passenger and fend for yourself, you'd be stuck paying for Thailand.

[Pacificperson]

Never sure, If you have Medicare Advantage and can make it to Guam (6.5 hours from Bangkok) you will be covered. If they cannot take care of your problems locally, you can request to be sent to the large hospitals in Manila, and Medicare will cover your care there. The better hospitals in Manila are just as good as those in Bangkok.

[NeverSure]

Never sure, If you have Medicare Advantage and can make it to Guam (6.5 hours from Bangkok) you will be covered. If they cannot take care of your problems locally, you can request to be sent to the large hospitals in Manila, and Medicare will cover your care there. The better hospitals in Manila are just as good as those in Bangkok.

Awesome. I'll ask. I thought that was only for vets with VA coverage from the military - get onto any US military base or ship.

Is it only on a military base, or is it any Philippine hospital in Manilla?

If it's good in Manilla, it would attract a lot of senior expats. Geez, I'm covered in Manilla as a non-vet?

[jmac]

The way I read that agreement it was for residents of Guam only to get care in the Philippines.

[Pacificperson]

The Medicare regulations have a clause that allows referals to the closest hospital that is capable of handling the problem, if the local facilities cannot do it. This was put in place mainly for people living on the Canadian border. However, it also applies to Guam. Manila is about 1,500 miles, while Honolulu is 3,700 miles. I don't think there is a local residency requirement. Medicare is a Federal program, so I would doubt it. You have to be on Guam with Medicare coverage to be refered to Manila with Medicare coverage. You cannot just show up in Manila and claim it. I don't don't think that there is a minimum time of residence. You are probably covered once you set foot on US soil.

If you are a vet, there is a Naval Hopital on Guam which is undergoing significant expansion. I think that they do some charity care of vets without resources, but I would not count on it as they are at the very bottom of the Navy's priorities. There are plenty of poor vets already here and plenty of retired vets who are above you on the prority list.

Edited April 4, 2013 by Pacificperson