Medicare.

[BKKSnowBird]

I know a lot of our readers get social security, so I wanted to ask a few questions about Medicare. I know Medicare does not cover me in Thailand but $104 is pretty cheap as a backup if I ever got very sick and needed to return to the US, so plan to always keep part B.

I am in the US now but plan to return to Thailand in the future. I have to choose now about B, C or D. My understanding if I pick C (advantage) I cannot go back to traditional Medicare later.

1. Would I be better to just pick a part D for now?
2. I am assuming picking a C would be a bad idea for someone in my case?
3. If I pick D now, what will happen when I move? My understanding is you can’t have D outside the US even if you did want to keep it. I would not want to pay a penalty later for not having it.

Any help would be appreciated.

[Rooo]

Moved to home country.

[Langsuan Man]

Keep B, since that is what the $104 is for (doctors visits and hospital co-pays). Medicare part A is free, since you contributed to it during your entire working career that was subject to Social Security withholding

If you don't take B now (if age 65) , you will pay a penalty of 10% per year for every year you were eligible and did not take it, so say you wait 4 years to sign up for B it will cost you $145 per month

Most recipients in the US also purchase a "supplemental" or "secondary" policy to cover all the co-pays (usually 20%) for doctors visits, labs, etc. and extra charges that Part B does not cover

Unfortunately is all depends on how much time you will spend in Thailand every year on whether or not you need to purchase a supplemental or secondary plan. If you go back to the US every year, like I do, then it is worth it. If you are only planning to return to the US in the event of a major illness then a supplemental plan would not benefit you much since you would not be able to use it fully here in Thailand. In my case I am able to carry over my Blue Cross from my government service so to encourage me to use them for my "secondary" they will cover my medical expenses here in Thailand since Medicare A or B will not.

But you have to decide for yourself which one to get, unfortunately I am not familiar with part C or D but a quick search reveals this:

• Medicare Part C is the part that covers Medicare Advantage plans which are managed care provided by private companies. These are optional plans that Medicare patients may choose to pay for separately.
• Medicare Part D is drug coverage.

You can get more information from here, but try it during US Eastern time business hours

www.medicare.gov/

[BKKSnowBird]

Thanks Langsuan Man!

I have been doing lots of reading on this. You can not buy C or D if you live outside the US. I also believe you must cancel them if you have them and leave the US.

The supplement you talk about is called Medigap. You must have A and B to buy a medigap policy. I am not clear if I I can keep it once I move. I will be calling a few companies this week. Medigap does not cover meds but you can get part D back for meds when you move back.

I hope to never use Medicare but think it would be foolish not to keep at least part B.

[Langsuan Man]

You say potatoe, I say potato

What's Medicare supplement (Medigap) insurance?

A Medicare supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicaredoesn't cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

[BKKSnowBird]

LOL, but can that potatoe be kept outside the US? If I was an insurance company, I would love for someone to pay me a premium for something that would be hard to use.

[Langsuan Man]

Not hard to use, pay upfront and file a claim and wait for reimbursement. Just like all the retired military here that have to pay for part B and then claim reimbursement via Tri Care. You asked the question I'm sorry if you don't like the answer

[BKKSnowBird]

Thanks again Langsuan Man.

I expect to pay upfront if in Thailand. I do not think Medicare will even reimburse you?

I am just keeping part B in case of a very serious illness and decide to return to the US. I know I will need to pay out of pocket in Thailand or get some sort of expat insurance that looks way expensive.

[CaptHaddock]

You can't buy Medigap, Part C or Part D while living outside the US. When you re-establish residence in the US you will have two months in which to buy any of those three options without penalty and without restriction with respect to pre-existing conditions. So, I wouldn't see the benefit in paying for those programs while outside the country unless you thought it pretty likely that you would want to repatriate for immediate treatment at some point.

Part B is the only one that penalizes you for signing up later than age 65 whether you live in the US or not.

With only Parts A & B though, I find visiting the US to be financially dangerous.

[BKKSnowBird]

Capthaddock, that is exactly what I was looking for! One question. If I sign up for part D now since I still live in the US, what happens when I move?

I am guessing when I report my address to the SSA, they will kick me off? I would then keep B and just resign up for D later?

Why do you say dangerous? If you have A and B, you would only be liable for 20% until you were able to get C or a medigap back again.

[CaptHaddock]

Capthaddock, that is exactly what I was looking for! One question. If I sign up for part D now since I still live in the US, what happens when I move?

I am guessing when I report my address to the SSA, they will kick me off? I would then keep B and just resign up for D later?

Why do you say dangerous? If you have A and B, you would only be liable for 20% until you were able to get C or a medigap back again.

I did my signup for Parts A & B here in Thailand. So, I have no experience of expatting after signing up for insurance beyond A & B. I would guess the same as you, that when you report your foreign address to the SSA they will stop billing you for anything beyond B, but you may have to request a suspension of part D. I am sure they have a form for it. If I were you, I would call and put the question to the SSA. However the SSA gets the news, when you repatriate you would request to reinstate Part D and whatever else you want.

Without Part D you have no coverage for medication. Also, will doctors take you on as a new Medicare patient without any of the additional insurance plans? I have no idea. Seems dangerous.

[NeverSure]

Thanks Langsuan Man!

I have been doing lots of reading on this. You can not buy C or D if you live outside the US. I also believe you must cancel them if you have them and leave the US.

The supplement you talk about is called Medigap. You must have A and B to buy a medigap policy. I am not clear if I I can keep it once I move. I will be calling a few companies this week. Medigap does not cover meds but you can get part D back for meds when you move back.

I hope to never use Medicare but think it would be foolish not to keep at least part B.

Can we clarify some things?

A is free but doesn't give you much. Hospital stays which first require an ER visit...

B is $104 per month and covers doctors visits and routine things like x-rays with a deductible and co-pays.

C is Medicare Advantage. A bit broader coverage including prescription drugs. Still has co-pays. About $150 per month including the first $104 for B.

D Is prescription drug coverage with deductibles and co-pays. Co-pays on really expensive drugs can run to 50% but routine drugs are often 100% paid.

F is Medigap. It picks up the co-pays and deductibles for almost everything except RX. All in with B and RX it's about $260 per month.

Now, I have a medical issue that requires me to get an MRI and see some expensive doctors every 6 months. That's about $4K every time or 8K per year for those costs. They cost me nothing because I have F - Medigap, so the $260 per month seems like a bargain.

FOR WIW, S. Dakota is the only state in the union which actively encourages expats and snowbirds to assume residency there. You can legally be a resident of that state forever and only set foot in it once to register. There are companies which will give you a physical address (not a mailbox) and forward mail for you. Google and find America's Mailbox in Box Elder, SD. They are big and have an RV park. You get an address at that RV park. They will mail forward to you.

Now you are always legally a resident of S Dakota and can vote, have valid Medicare, a US driver's license, etc. They have different prices for different service levels. They have an RV park and a motel if you want to go there, even just to establish state residency. They will walk you through that.

Edited November 15, 2014 by NeverSure

[CaptHaddock]

Thanks Langsuan Man!

I have been doing lots of reading on this. You can not buy C or D if you live outside the US. I also believe you must cancel them if you have them and leave the US.

The supplement you talk about is called Medigap. You must have A and B to buy a medigap policy. I am not clear if I I can keep it once I move. I will be calling a few companies this week. Medigap does not cover meds but you can get part D back for meds when you move back.

I hope to never use Medicare but think it would be foolish not to keep at least part B.

Can we clarify some things?

A is free but doesn't give you much. Hospital stays which first require an ER visit...

B is $104 per month and covers doctors visits and routine things like x-rays with a deductible and co-pays.

C is Medicare Advantage. A bit broader coverage including prescription drugs. Still has co-pays. About $150 per month including the first $104 for B.

D Is prescription drug coverage with deductibles and co-pays. Co-pays on really expensive drugs can run to 50% but routine drugs are often 100% paid.

F is Medigap. It picks up the co-pays and deductibles for almost everything except RX. All in with B and RX it's about $260 per month.

Now, I have a medical issue that requires me to get an MRI and see some expensive doctors every 6 months. That's about $4K every time or 8K per year for those costs. They cost me nothing because I have F - Medigap, so the $260 per month seems like a bargain.

FOR WIW, S. Dakota is the only state in the union which actively encourages expats and snowbirds to assume residency there. You can legally be a resident of that state forever and only set foot in it once to register. There are companies which will give you a physical address (not a mailbox) and forward mail for you. Google and find America's Mailbox in Box Elder, SD. They are big and have an RV park. You get an address at that RV park. They will mail forward to you.

Now you are always legally a resident of S Dakota and can vote, have valid Medicare, a US driver's license, etc. They have different prices for different service levels. They have an RV park and a motel if you want to go there, even just to establish state residency. They will walk you through that.

So, I'm guessing your question is: can you legitimately keep your Medigap policy using the S. Dakota mailing address as your residential address? My guess is: no. The SSA does not care about S. Dakota's policy toward expats and won't use a different definition of residence because of S. Dakota. However, you might get away with continuing the Medigap policy while living in Thailand using the mailing address in S. Dakota. But this approach has the risk that should the company issuing your Medigap policy become aware that you actually live abroad, violating conditions of the policy, they may rescind the policy and refuse to make any payment based on it. It would be easy for the company to notice since all mail forwarders are agents of the USPS (and probably the private couriers as well) and your new address will show up on a list readily available to insurance companies and others.

But even if you could get away with the scheme, would it be worth it to you? The cost of the Medigap policy to you is $154/month or $1848/yr. What would the cost be for the MRI and specialist doctors here in Thailand per year? The scheme is worth it only to the extent that the cost of the service in Thailand exceeds $1848 per year. Perhaps you should add in the travel costs to return to the US for those treatments unless you would be visiting the US twice a year even without the medical necessity.