Signing up for US medicare as an expat

[CaptHaddock]

So, when the magic 65th birthday rolls around for Americans it's time to sign up for Medicare. I just did it myself and found it easier than I expected. I called the US Embassy in Manila where I had to leave my name, contact info, SS #, etc. After a few days they sent an email saying that they would call me eventually, but that in the meantime I could try to register on the SSA website even though previously expats were not eligible to do so. So, I went to the SSA website and went through the steps to sign up for Medicare (but not for Social Security benefits yet.) I was using a vpn and provided both my US mailing address and my physical address here in Thailand along with my US phone number provided by my voip service. I was able to complete the application without a hitch. Then I got an email saying they might require further information. This was followed a few days later by a letter received at my US mailing address saying that my enrollment was complete and that I would be receiving a Medicare card, but could use this letter in the meantime as proof of enrollment. The whole process took a little over two weeks. I had expected to have to present documents establishing my identity perhaps to the Bangkok embassy, but that was not necessary. I wonder if my US contact info enabled me to avoid that.

My motivation is for insurance to cover me while I visit the US annually and in case I decide to repatriate at some point in the future, although that is not my intention at this point. If I were not to enroll in Part B now, but did repatriate later I would then have to pay a penalty rate for the rest of my life. Of course. other than on visits to the US, I won't get any actual benefit from Medicare since it doesn't cover medical services outside of the US, but the considerations I mentioned are sufficient to justify the cost for me.

I will be enrolled in Part A (nursing and hospital services) and Part B (doctors.) Part A is free while part B will cost me about $104 per month, although I haven't got a bill from Medicare yet. I cannot enroll in additional Medicare Advantage or a Medigap insurance since those cover geographical areas in the US and I do not live there. However, if I do repatriate in the future I will then have a two-month window in which to enroll without penalty and without exclusion for pre-existing conditions. With that option I would not want to enroll now anyway. I could enroll in Part D that covers drugs, but I decided just to shoulder that risk for the two-weeks a year that I will be in the US.

The benefit of Medicare for us expats is limited, but I would encourage other US expats to make an informed decision before passing it up. The no-penalty signup window is the seven months beginning three months before your 65th birthday.

[Lefty]

I filed for medicare and Social security online while working in Middle East. Both went thru with no problems.I just returned from Houston where I

[Lefty]

I am currently living in Korat and have had a medicare supplemental policy for about 4 years. Use my daughters address in the U.S..I just returned from Houston where I had a leg bypass cost was well over $100,000, I paid zero dollars thanks to my medical supplemental policy type "F";You can get a policy for about $200/month-best money I ever spent. Two years ago , treatment for my prostrate cancer cost over $150,000, cost to me absolutely zero.

My advice-- don't be without a medigap policy.

Lefty

[NancyL]

I'd very much like to get a medigap policy for Hubby, but our only connection with the U.S. is our commercial mail forwarding service and I doubt 100% that we'd ever return to live in the state where the mail forwarding service is located. We no longer own property, don't have relatives, haven't set foot in the U.S. for over 6 years, but it would be nice to have the security of knowing he could go back for a major medical procedure. As it is, the best we could do is from here was to enroll him in Parts A & B -- at least from what we were told by Manila.

Any suggestions on how to enroll in a Medigap policy when you really don't have any tie to a specific geographic area of the U.S. and you don't want to return to the U.S. to initiate a policy?

Edited April 24, 2014 by NancyL

[CaptHaddock]

I'd very much like to get a medigap policy for Hubby, but our only connection with the U.S. is our commercial mail forwarding service and I doubt 100% that we'd ever return to live in the state where the mail forwarding service is located. We no longer own property, don't have relatives, haven't set foot in the U.S. for over 6 years, but it would be nice to have the security of knowing he could go back for a major medical procedure. As it is, the best we could do is from here was to enroll him in Parts A & B -- at least from what we were told by Manila.

Any suggestions on how to enroll in a Medigap policy when you really don't have any tie to a specific geographic area of the U.S. and you don't want to return to the U.S. to initiate a policy?

I don't know how you could enroll in a Medigap policy, but, if you do, you should avoid doing so in a state with an income tax. Some states look aggressively for ways to declare your tax domicile to be in the state, for instance, on the basis of an implied "intent to return." CA and VA are the worst in this regard, but there are others. The poster above enrolled in TX which has no income tax.

I don't think I would go back to the States for medical treatment as long as I am willing to live in Thailand. Apart from the cost, the quality of US healthcare, except at the very highest level, is not particularly good. The annual number of accidental hospital deaths in the US arising from treatment errors is now estimated to be more than 400,000. Estimates of diagnosis errors in the US rise to 40%. Of course, I don't have comparable numbers for Thailand.

Edited April 24, 2014 by CaptHaddock

[Suradit69]

I thought you automatically got Part A with no action on your part?

I recall getting a letter/notification from them when I became eligible (sent to me in Thailand), and (maybe??) an ID card, announcing the joyous occasion when I was covered by Part A as long as I was in the US. Since I have no intention of returning there and I have US based insurance that covers me in Thailand,I didn't file the notice in a safe place. Probably went into the circular file.

I am receiving Social Security and they have my address in Thailand and I file my 1040 using my Thai address, so I would hesitate to consider using a US address for Medicare, even if I thought I might use it in future ... which I don't.

[Lefty]

I'd very much like to get a medigap policy for Hubby, but our only connection with the U.S. is our commercial mail forwarding service and I doubt 100% that we'd ever return to live in the state where the mail forwarding service is located. We no longer own property, don't have relatives, haven't set foot in the U.S. for over 6 years, but it would be nice to have the security of knowing he could go back for a major medical procedure. As it is, the best we could do is from here was to enroll him in Parts A & B -- at least from what we were told by Manila.

Any suggestions on how to enroll in a Medigap policy when you really don't have any tie to a specific geographic area of the U.S. and you don't want to return to the U.S. to initiate a policy?

Nancy L,Google medigap insurance ,there are numerous brokers selling it and they will give you advice and answer your question-- that is how I got mine,all done over the internet with one EMS envelope containing signed application.Address and zip code mostly for pricing purposes by insr co. Check SSA.GOV for enrolling in Part a and b online using your mail forwarding address which you must get prior to getting medigap ..

Lefty

[smotherb]

I have been in Thailand since before I started taking SS at 62. The SSA simply mailed the sign-up form to me before my 65th B-day. Sorry it hasn't been so easy for you.

[CaptHaddock]

I thought you automatically got Part A with no action on your part?

I recall getting a letter/notification from them when I became eligible (sent to me in Thailand), and (maybe??) an ID card, announcing the joyous occasion when I was covered by Part A as long as I was in the US. Since I have no intention of returning there and I have US based insurance that covers me in Thailand,I didn't file the notice in a safe place. Probably went into the circular file.

I am receiving Social Security and they have my address in Thailand and I file my 1040 using my Thai address, so I would hesitate to consider using a US address for Medicare, even if I thought I might use it in future ... which I don't.

I think if you are already receiving SS benefits on your 65th birthday they will sign you up for

Medicare Part A automatically, but not otherwise.

[DogNo1]

I signed up for Medicare Part B when I retired at the age of seventy. I'm forced to pay a higher premium due to my income. The more you make, the higher your premium goes! Right now it's wasted money but if I should have to repatriate due to poor health, it will be money well spent. I didn't buy Medigap or Part D because I am from California and having to pay state tax would take a huge bite out of my income. I'm not sure that the OP's understanding of the two-month window to enroll for a Medicare Advantage program upon repatriation is correct. If you miss the window for enrollment when you first sign up for Part B, I think that you have to wait for the yearly open enrollment season after you go back.

[connda]

I signed up for Medicare Part B when I retired at the age of seventy. I'm forced to pay a higher premium due to my income. The more you make, the higher your premium goes! Right now it's wasted money but if I should have to repatriate due to poor health, it will be money well spent. I didn't buy Medigap or Part D because I am from California and having to pay state tax would take a huge bite out of my income. I'm not sure that the OP's understanding of the two-month window to enroll for a Medicare Advantage program upon repatriation is correct. If you miss the window for enrollment when you first sign up for Part B, I think that you have to wait for the yearly open enrollment season after you go back.

Just curious, but approximately how much are you paying for your Part B if you don't mind disclosing? Thanks.

[TallGuyJohninBKK]

Captain, thanks much for creating this thread and posting a very good account of your signing up process.

I'm a few years away from being eligible for all these things, but it's info I'm already looking at and thinking about. And your account helps.

I too am thinking about the issue Nancy raised above about how to sign up for the "medigap" policies when one doesn't have an actual physical presence/residence in the U.S.

[TheWizardofRnR]

Funny ,I was just thinking that an exemption to Medicare Services should be made for Veterans.

Reasoning , if your country can send you to fight or serve overseas , if you choose to remain living overseas

or move before you become eligible for medicare ,then Vets should be able to get their Medical assistance at

where they have chosen to live. I mentioned it to a VFW commander and he agreed that it made sense ,plus I said the services

in many of the overseas areas where Vets are living has cheaper prices for health care services then in the USA!

I guess if every Veteran wrote to their Congressmen and asked them to get behind or sponsor some kind of Bill ,giving Veterans some Medicare Coverage for serious life threatening medical situations ( just like many are subjected to during their time of Service to their Country)

I also always wanted to see a Law enacted guaranteeing any Member of the Armed Forces the right to have a drink at any establishment in the USA ,if they were on Active Duty ! I figured if your Country can send you to War at the Age of 17 , where you might die for your country , you damn well should not be refused having a drink before you reach the age of the lawful drinking age in whatever State and City you are at in America ! While your defending those people in the Military , no matter what your job is ...if you can die for your Country ,you should have the right to have a drink for it too!

[CaptHaddock]

I'm not sure that the OP's understanding of the two-month window to enroll for a Medicare Advantage program upon repatriation is correct. If you miss the window for enrollment when you first sign up for Part B, I think that you have to wait for the yearly open enrollment season after you go back.

I am quite sure that upon repatriation we will have a two-month window in which to sign up for insurance extensions to Medicare including: Part D, Medigap, and Medicare Advantage programs. That information comes from the book, "Medicare for Dummies" by Patricia Barry. The section that covers such enrollment for Part D is found in kindle location 3218. I don't have the reference handy for Medigap and Medicare Advantage, but I did pay close attention to it. You do not have to wait for the annual enrollment period window when you have repatriated. Indeed, you cannot wait without incurring penalties.

"Medicare for Dummies" is a good book and very thorough. It covers, for example, such situations as enrolling for Medicare while incarcerated.

[landslide]

There has been a proposal floated in Congress to allow the use of Medicare in select foriegn coountries, among them Thailand, Malaysia, The Philippines, Japan and India. The idea was that these countries had a sufficiently lower cost and high quality of care available that it would result in savings to the cost of Medicare. It was one way to reduce the rising cost of Medicare coverage in the USA. However, as usual, nothing much has happened, which is par for the course with our elected officials.

[CaptHaddock]

Captain, thanks much for creating this thread and posting a very good account of your signing up process.

I'm a few years away from being eligible for all these things, but it's info I'm already looking at and thinking about. And your account helps.

I too am thinking about the issue Nancy raised above about how to sign up for the "medigap" policies when one doesn't have an actual physical presence/residence in the U.S.

With regard to signing up for Medicare Advantage or Medigap policies while living abroad, we don't have quite the same incentive because there is no lifelong penalty rate for signing up after repatriating like there is with Part B. We have the two-month window in which to enroll without penalty and without exclusion of pre-existing conditions (possibly not including liver conditions, which have a special status for some reason.) Moreover, enrolling in such a program while living abroad appears to involve claiming falsely to reside in the States. I am loathe to commit fraud with the Social Security Administration because I expect to depend on them for a long time to come. Moreover, making such a misstatement on an application for insurance might subsequently enable the insurance company to rescind the insurance in the event that you have a claim. I realize from Lefty's story above that this is certainly not always the case, but a single success story cannot fully rebut the possibility of rescission, which we know has always been a favorite tactic of the health insurance industry.

In addition, for some of us using a (false) address in the States can only mean using a relative's address in a state with an income tax, possibly exposing us to liability for state income tax.

By not signing up now for Medigap or MedAdvantage we do have a gap in coverage that we would not have if we were residing in the States, since there may well be occasions when the need to use such insurance is too urgent to allow time to repatriate and apply. That looks to me like an unavoidable risk of living the expat life. The plus side is that I would probably prefer to get treatment here in Thailand and pay for it out of pocket.

[CaptHaddock]

There has been a proposal floated in Congress to allow the use of Medicare in select foriegn coountries, among them Thailand, Malaysia, The Philippines, Japan and India. The idea was that these countries had a sufficiently lower cost and high quality of care available that it would result in savings to the cost of Medicare. It was one way to reduce the rising cost of Medicare coverage in the USA. However, as usual, nothing much has happened, which is par for the course with our elected officials.

Will never happen. The health care industry has already been successful at preventing employer insurance plans from sending policlyholders abroad for lower cost treatment which represents competition. Even if the anti-competitive healthcare issue were not the deal-killer, the SSA would have to negotiate with and manage programs with a host of countries around the world with different care practices, languages, accounting systems, etc. It is hard to see how it would be workable. It's not like the EU where access to cross-border healthcare is available because of an EU-wide commitment to broad integration.

I would not lay any blame on negligence of elected officials however. I understand that there are only 5 million US expats, most of whom appear to be ex-military in Mexico. Even if all 5 million still vote, we would do so across the full range of congressional constituencies diluting our electoral clout to pretty much nothing. So, no one represents our interests in Congress. But we knew that before we decided to leave.

[DogNo1]

I concur. At a time when the congress is looking for ways to cut the outlay for the military including sharply reducing the size of the force and increasing the cost of Tricare to families, it is not likely that Medicare will be extended to Expat veterans.

Thanks for clarifying that Expats can enroll in Part D and/or Advantage plans within two months after repatriation. BTW, I must pay $146 monthly for my Part B.

[TallGuyJohninBKK]

Maybe I'm deluded, but I do think the day will come when Americans will be able to obtain Medicare services outside the U.S. I don't mean just expats, but also U.S. residents who wish to obtain treatment outside the U.S.

It would just be another step in the whole globalization of everything, and of course, ultimately, also a cost advantage to the U.S. government that's paying the bills. In the end, I think that will be the deciding factor.

There already are Joint Commission accredited hospitals here in Thailand, and at least some of the major U.S. private insurers already will pay for necessary treatment incurred by their policy holders when traveling outside the U.S., provided they use accredited hospitals. There's no reason Medicare can't follow in the same general path.

I'm not saying I think the change will come anytime soon. But I do believe it will come eventually, perhaps in a matter of years. Hopefully we'll all live long enough to see that day come.

[alfalfa19]

So, I would like to understand correctly: When I reach age 65 in 3 years, I will get medicare part a for free, which covers hospitals and nursing? Part B covers doctors? So, if I do not have part b, I will be unable to see a doctor for something like a broken arm, or simple things like that?

[CaptHaddock]

So, I would like to understand correctly: When I reach age 65 in 3 years, I will get medicare part a for free, which covers hospitals and nursing? Part B covers doctors? So, if I do not have part b, I will be unable to see a doctor for something like a broken arm, or simple things like that?

Yes, that is my understanding. That's to say that, when you see the doctor he will charge you full retail price. But note, you will get Part A for free, but you have to apply for it unless you are already receiving SS benefits at the time you turn 65.

Edited April 24, 2014 by CaptHaddock

[Langsuan Man]

I concur. At a time when the congress is looking for ways to cut the outlay for the military including sharply reducing the size of the force and increasing the cost of Tricare to families, it is not likely that Medicare will be extended to Expat veterans.

Thanks for clarifying that Expats can enroll in Part D and/or Advantage plans within two months after repatriation. BTW, I must pay $146 monthly for my Part B.

How much of that is the penalty for not signing up when you were first eligible at 65 ?

I know that there is a 10% penalty per year for not signing up for Par B , when first eligible, but I thought that if your were still working when you turned 65 (not retired) that penalty did not apply. But it appears that you are paying $41 more per month than those who signed up at 65

Please explain

[lopburi3]

Although there may indeed come the day that routine overseas medical care is allowed I do not expect to see it myself - at this time Tricare for military is available in the Philippines (where there are thousands eligible living - many US Military are actually nationals of that country) but even there it is under fire for fraud abuse and those using have found themselves without coverage as there hospitals were stricken from the approved list. To police a world wide system is likely beyond the beyond at this time - but as healthcare standards evolve and standards are set there may come a time - but just filling out paperwork in US is a huge process with everything having to be computer coded - which is not used anywhere else in the world. But there are insurance policies that do insure everywhere and there are limited number of firms that do translations and such so that time may come for some private insurance to open up to the lower cost options. The issue becomes is it cost effective to pay less if there is a lower success rate (maybe have to pay twice)? At this time it is hard to judge care (anywhere).

[NancyL]

Thank you for your research and explanations, CaptHaddock. I feel more comfortable with decision (actually the reality) that Hubby must forego Medigap since he hasn't been back to the U.S. for years and doesn't plan to return anytime soon. And since we no longer own property there. Good to someone has a two month window to enroll upon return and no penalty like there is when you forego Part B (which he did get).

Now the next hurdle will be to figure out how to obtain an exemption from the mandatory requirement for younger people (like Hubby's child bride -- me) to have health insurance under Obamacare. That requirement becomes law in a a year or two, doesn't it. Oh well -- guess we'll start a new Thaivisa thread on that subject......

[CaptHaddock]

Thank you for your research and explanations, CaptHaddock. I feel more comfortable with decision (actually the reality) that Hubby must forego Medigap since he hasn't been back to the U.S. for years and doesn't plan to return anytime soon. And since we no longer own property there. Good to someone has a two month window to enroll upon return and no penalty like there is when you forego Part B (which he did get).

Now the next hurdle will be to figure out how to obtain an exemption from the mandatory requirement for younger people (like Hubby's child bride -- me) to have health insurance under Obamacare. That requirement becomes law in a a year or two, doesn't it. Oh well -- guess we'll start a new Thaivisa thread on that subject......

I don't expect the Obamacare requirement to pose a problem for us expats as long as we report ourselves as such on Form 1040. We file as residing in Thailand, but with a US mailing address. The IRS does not request our Thai address. I expect that Turbo Tax will fill in the form appropriately that exempts us from the ACA insurance requirement as expats.

Glad to think that sharing information has been helpful to you, NancyL. We all need to pay close attention and continue to share this info because terms and conditions are likely to change in the coming years.

[joespnet]

The official Medicare website, medicare.gov, has an answer to the penalty issue for not getting Part B immediately upon turning 65:

"If you're a U.S. citizen, over 65, not eligible for Social Security benefits, and you lived in a foreign country when you turned 65, you must live in the U.S. to file for Part B. You're first eligible to enroll in Part B the month you return to the U.S. to establish your new residence. You won't have to pay a higher premium if you enroll in Part B when you first return to the U.S."

Source: http://www.medicare.gov/people-like-me/outside-us/signing-up-for-part-b-outside-us.html

[joespnet]

As far as penalties for not having insurance under the Affordable Care Act, US citizens who live in Thailand full-time are not eligible for coverage in the Health Insurance Marketplaces established by the ACA, so you would not be subject to any penalty.

The official ACA website, healthcare.gov, has the following details:

"Most people are eligible for health coverage through the Health Insurance Marketplace.

To be eligible for health coverage through the Marketplace, you:

• must live in the United States
• must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses.
• can't be currently incarcerated

If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan. Learn more about your options if you have Medicare.

U.S. citizens living outside the U.S.

U.S. citizens living in a foreign country for at least 330 days of a 12-month period are not required to get health insurance coverage under the Affordable Care Act for that 12-month period. If you're uninsured and living abroad under this definition, you don't have to pay the fee that other uninsured U.S. citizens may have to pay."

Source: https://www.healthcare.gov/am-i-eligible-for-coverage-in-the-marketplace/

[Stan7444]

I already signed up for Medicare Part A but not B since not living in the States with no intention to return there. However, if this changes due to some serious illness, can always sign up for Part B if needed. I have some retired US military friends in Thailand and they are receiving any needed medical treatment worldwide compliments of the US gov't. Don' t know the details on where and how they received treatment though. Also, I visited a Thai gov't hospital last year for some x-rays and other treatment on an injured foot and found that as a Thai resident, they told me I qualify for the same $1.00 per visit as Thai nationals, gave me a hospital card for return visits, but I had to pay extra for medicine at the hospital pharmacy, which was super cheap as well. In the future, I plan to return to this same hospital for any other treatments as needed. Quality of care I experienced was good, but certainly not a Bumrungrad level, and the waiting period was about 1 hour or so, but heard can be more than this sometimes. Biggest problem is that it was hard to find any medical or nursing person who could speak any English at all.

[lopburi3]

Actually only border foreign country workers are eligible for that hospital coverage but some did not know this and allowed others to obtain such cards but most now seem to be aware and have stopped allowing such cards or care from reports posted in this forum.

[Sheryl]

Some parts of the country, the hospitals are still issuing the card (though according to central MoPH should not). Communication between central and provincial levels of the Ministry is poor.

Note though that even in the absence of that scheme, foreigners can freely utilize government hospitals on a paying basis and for out-patient care and routine short admissions the costs are very affordable. But major surgery/catastrophic illness can cost quite a lot even in a government hospital.