Medicare Questions for American Expats 65 or Older......

[TerrenceLee]

I have a question for American senior expats that were residing in Thailand when you reached 65: Did you still sign up for the various Medicare plans (Part B,C,or D) when you reached 65? I'll assume you signed up for Part A upon reaching 65 (the only part that is usely free), but not signing for the other parts upon reaching 65 results in late signup penalties which is a pain in the ass. That said, signing up at 65 means paying premiums for services that are of no use if you live outside the US. Just wondering how some of you dealt with this all American quagmire. Thanks everyone, any feedback will be greatly appreciated.

[Seligne2]

I signed up for nothing.

[neilrob]

What is the point of signing up for more than part A, unless you intend to return and live in the US? If you do, then sign up. If you plan to live here, forget it.

[MrBrad]

Since I already had been receiving Social Security benefits since age 62, when I turned 65 I was automatically enrolled in both Part A and Part B. Not wanting to deal with the increased rates due to a later sign-up penalty, I'm OK with paying for Part B now.

As with all insurance, we seem to pay the monthly premiums (sometimes begrudgingly), and never take advantage of the coverage. In the long run, not needing the insurance is a good thing. I don't care to some day wish I had coverage for something serious, or be a burden on others because of my being a tightwad or a risk-taker.

[CaptHaddock]

You should consider signing up for Part B if there is any chance that you may ever return to the US. If you don't sign up at age 65 and then sign up later you will pay a 10% penalty for each year after age 65 that you failed to sign up. You will pay the penalty until you die. As for Parts C & D and Medicare Advantage you cannot sign up for them unless you reside in the US. Unlike Part B, if you were to repatriate you would have a two month window in which to start Parts C, D, and/or Medicare Advantage without ever having to pay a penalty. So, no incentive to sign up and pay now.

I do not intend at this time to repatriate in the future, but I can't rule it out. So, I signed up for Part B. I would recommend the same to any American expat since we cannot be sure that we will never want or have to return.

[DogNo1]

I signed up for Part B at the age of 70 when I retired from my job. There is no penalty if you live abroad and are covered by your employer's health care. After you lose the employer-based health care, you have six months (I think) to sign up. I self-insure (pay out of pocket) here in Thailand and am covered by Japanese National Health Insurance when I am back in Japan for six months of the year. I bought Part B as a precautionary measure. When I can no longer care for myself, I'll probably have to go into assisted living back in the USA and it will be handy to have Medicare at that time. I'll use the open enrollment period after I repatriate to buy into a Medicare Advantage plan that will cover drugs. BTW, the penalty for not signing up when you should do so is 10% per year. If you waited ten years until you repatriate, your cost would be double the premium - whatever it is at that time.. At today's prices, that would be $104.90 X 2 = $209.80. Still not a lot of money. During that time you would save $104.90 X 120 = $12,588 by not being enrolled. Since my age is advanced, I consider my enrollment in Part B as a kind of insurance. It could be that the monthly premiums will be wasted. On the other hand, if I should suddenly suffer serious health problems, I would be covered for most of my expense in the USA. Here's a government page for you to consult. Good luck.

http://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html

[Suradit69]

I signed up for nothing.

Likewise. I have no intention of living in the US and I have pension related health insurance that covers me in Thailand or the US. I seem to recall getting some notice that I was automatically enrolled for something, but maybe I'm imagining that.

Edited March 11, 2015 by Suradit69

[northernjohn]

I just asked my brother in law who is a CPA to look in to it for me. I have some major work coming up down the
line. I can get it free in Canada but the wait would not make it worth while. I already paid for one hip replacement here rather than go back there and wait a year.

I just barely qualified for SS so I asked him to check on it for me. I retired at 62 and opted to take nothing. Was interested in what Obamacare would do as it is still getting straightened out. Probably be a boon doogle for quite a while. My sister knows three people who have been hospitalized that would not have been able to if not for Obamacare.

Right now I would not expect much from it. I won't be needing any thing for 1 to 2 years that I know of so I am going to play the wait and see some thing else could come up.

[NancyL]

I think De Nile is a major river running thru Chiang Mai. You're major, major stupid to think you're not going to get old, frail and will somehow meet with the good good fortune of a sudden and happy death. Americans --- sign up for part B and what ever you do, don't opt out of part A. You'll probably live to regret it.

[jjczap]

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I just asked my brother in law who is a CPA to look in to it for me. I have some major work coming up down the
line. I can get it free in Canada but the wait would not make it worth while. I already paid for one hip replacement here rather than go back there and wait a year.

I just barely qualified for SS so I asked him to check on it for me. I retired at 62 and opted to take nothing. Was interested in what Obamacare would do as it is still getting straightened out. Probably be a boon doogle for quite a while. My sister knows three people who have been hospitalized that would not have been able to if not for Obamacare.

Right now I would not expect much from it. I won't be needing any thing for 1 to 2 years that I know of so I am going to play the wait and see some thing else could come up.

once you are 65 and Medicare eligible you do not qualify for Obamacare anymore

[Genericnic]

I opted to not sign up for it (Part B ) after doing a basic cost/benefit analysis. My thinking is that the $1200+ I save in premiums each year by not signing up will cover the penalty for roughly 10 to12 years if I ever have to go back and start and depending on how many years of penalty increase I have gotten.

David

Edited March 11, 2015 by Genericnic

[NancyL]

I opted to not sign up for it (Part B ) after doing a basic cost/benefit analysis. My thinking is that the $1200+ I save in premiums each year by not signing up will cover the penalty for roughly 10 to12 years if I ever have to go back and start and depending on how many years of penalty increase I have gotten.

David

I hope you're banking that $1200+ savings into a liquid bank account that you (or your loved ones) can draw upon in a time of crises when you're old and frail and need to be repatriated in a time of crisis for immediate medical treatment.

See, that's the problem with this line of thinking. Very few people actually set aside the money for the crises time.

This is why I say that the De Nile River is running deep and wide here in Chiang Mia.

[Genericnic]

I opted to not sign up for it (Part B ) after doing a basic cost/benefit analysis. My thinking is that the $1200+ I save in premiums each year by not signing up will cover the penalty for roughly 10 to12 years if I ever have to go back and start and depending on how many years of penalty increase I have gotten.

David

I hope you're banking that $1200+ savings into a liquid bank account that you (or your loved ones) can draw upon in a time of crises when you're old and frail and need to be repatriated in a time of crisis for immediate medical treatment.

See, that's the problem with this line of thinking. Very few people actually set aside the money for the crises time.

This is why I say that the De Nile River is running deep and wide here in Chiang Mia.

Actually I am investing the money (in the US) but I also have health care insurance through the State of Texas. I am covered here with that so I don't really anticipate heading back to the states.

David

[northernjohn]

I opted to not sign up for it (Part B ) after doing a basic cost/benefit analysis. My thinking is that the $1200+ I save in premiums each year by not signing up will cover the penalty for roughly 10 to12 years if I ever have to go back and start and depending on how many years of penalty increase I have gotten.

David

I hope you're banking that $1200+ savings into a liquid bank account that you (or your loved ones) can draw upon in a time of crises when you're old and frail and need to be repatriated in a time of crisis for immediate medical treatment.

See, that's the problem with this line of thinking. Very few people actually set aside the money for the crises time.

This is why I say that the De Nile River is running deep and wide here in Chiang Mia.

Nancy as you deal a lot with this kind of thing. Do you know what the guide lines are for allowing a sick person on an airplane back to North America?

[CMBob]

As I go back to the states for the summer every year, I definitely signed up for Part B as (in my view) it's critically important to have that coverage for any treatment while I'm in the US (plus you're required to have it to pick up any type of supplemental coverage). And I certainly don't know if I will ever return to reside permanently in the US (I think it's theoretically possible should I ever need long-term/serious medical treatment).

For anyone who knows for certain that he/she will never return to the US, then I suppose it's financially wise to opt out of Part B. Even if they end up returning anyway, they can still pick it up at a higher cost but (and this might be very important for somebody returning because of a immediate medical condition) you don't get coverage immediately (I'm not sure as to exactly how long it takes to get signed up for it).

[DogNo1]

David: If you're absolutely sure that you won't need to return to the USA for medical care and, even if you do, you will have saved enough money to pay your Medicare premiums and other medical expenses, then you don't need the extra insurance of Plan B coverage right now. NancyL can point you to many stories of Americans who were repatriated in dreadful shape went things suddenly went wrong for them. I hope that never happens to you.

[TerrenceLee]

Great feedback on my question everyone! Thank you all very much, you've given me some excellent information. Or should I say, my partner - he will be turning 65 in August, before we head over to Thailand in September. He was planning to sign up for the Part-B but wanted to get your opinions, and many of you have confined his decision!

[craigt3365]

If you are ex-military, part B is a requirement for Tri-Care Overseas. I didn't know that, canceled part B, and am now starting it up again. Luckily, no penalty. But a gap of no coverage for 9 months.

[Genericnic]

If you are ex-military, part B is a requirement for Tri-Care Overseas. I didn't know that, canceled part B, and am now starting it up again. Luckily, no penalty. But a gap of no coverage for 9 months.

A lot depends on how your insurance works. My coverage only requires Part B if I am in the US and then it only impacts the amount of reimbursement I would get not coverage as a whole. I asked if I needed Part B and was told that as long as I am outside the US, Part B is not required since Medicare does not cover you outside the US. If I went back and signed up for Pat B, it begins on the first day of the month after you sign up.

David

[craigt3365]

If you are ex-military, part B is a requirement for Tri-Care Overseas. I didn't know that, canceled part B, and am now starting it up again. Luckily, no penalty. But a gap of no coverage for 9 months.

A lot depends on how your insurance works. My coverage only requires Part B if I am in the US and then it only impacts the amount of reimbursement I would get not coverage as a whole. I asked if I needed Part B and was told that as long as I am outside the US, Part B is not required since Medicare does not cover you outside the US. If I went back and signed up for Pat B, it begins on the first day of the month after you sign up.

David

The insurance is Medicare and for military retirees living here, it's mandatory if you want coverage. Which is through Tri-Care Overseas if you are outside the US, or Medicare and Tricare For Life if you are in the US.

It was a bugger to cancel part B. I immediately restarted it when I found out the issues, but the open enrollment is something like January-March with coverage beginning July 1st...or something like that. If you don't have it, you can't sign up for part B and get it immediately. Believe me...I've spent hours on the phone with them. Ugh...love those 80 minute hold times at 0 dark 30.

[NancyL]

As to the question of medical repatriation. Those of us here wishing to go back to North America are very fortunate that Chiang Mai is served by Korean Air. Heck, we've even used them for repatriations to Europe, even though it would seem counter-intuitive to send someone west via Korea.

You see, Korean Air has a direct non-stop from CNX to Seoul, Korea, connecting with many non-stops to major cities in North America (and elsewhere). The staff does a great job of assisting people in wheelchairs. There are two nice day-hotels in the Seoul airport for resting during long layovers. The airport is easy to navigate (unlike Swampy) And if someone has visa problems, they clear immigration here in Chiang Mai and we know they're out of the country once they get on the Korean big bird. No way they can wander off and get in trouble at BKK.

Most of the people I've assisted are in a wheelchair. There is no charge for this service, an assistant is provided to push the wheelchair and there is priority at all lines for check-in, security, immigration. The airline staff always looks over the person and will ask if they can get handle transfers unaided -- walk down the aisle of the airplane, go to the toilet unaided etc. If they have doubts, they'll ask for a "Fit-to-fly" letter from a doctor. There is no standard form for this, but usually doctors will produce one on a hospital form detailing when the person was treated, diagnosis, any need for special accommodation. Sometimes they may specify that someone needs to travel with a "non-medical escort" if they think the person needs help remembering to take medications on schedule, help with toileting, eating, etc. Remember, flight attendants aren't personal attendants and they aren't going to provide this level of care for someone.

If someone is in worse shape, say they need oxygen or can't sit upright for take-off and landing, then they can still flight commercially, but with accommodation. Then a form called a MEDIF is submitted in advance (each airline has their own version, they can be downloaded) detailing the person's needs and the airline will supply a price. Someone can fly if they need to use oxygen, but the airline will supply the oxygen. The person can't just show up with their own oxygen bottle. If someone must remain prone, the airline can remove seats and bring a stretcher on-board, but obviously this must be arranged in advance. Amazingly, depending on what the doctor says in the MEDIF, it may not be necessary for someone in this condition to travel with a nurse or doctor. A family member may be adequate if that family member knows how to care for the person on the stretcher.

This route of flying commercially with seats removed can be much, much cheaper than a chartered air ambulance for someone who is stable, but just can't sit upright. When I read stories of families trying to raise money for repatriations, sometimes I wonder at the figures quoted. I think sometimes the private hospitals steer families into private air ambulances rather than organizing repatriation on commercial flights. Not everyone needs a medical team on stand-by with a full set of medical equipment. Sometimes they just need to be able to lay prone for the entire flight.

[streetlite]

If you have a separate pension it sometimes will cover the expense of Part B. The cost of Part B is automatically deducted from SS but that cost is added onto your pension. That's how mine works.

[DogNo1]

Craig: A friend of mine was able to sign himself and his wife up for Part B online without making any phone calls. Your case may have been complicated by cancelling and then signing up again so maybe those phone calls were inevitable. Glad you've got it cleared up now.

[neilrob]

I opted to not sign up for it (Part B ) after doing a basic cost/benefit analysis. My thinking is that the $1200+ I save in premiums each year by not signing up will cover the penalty for roughly 10 to12 years if I ever have to go back and start and depending on how many years of penalty increase I have gotten.

David

I hope you're banking that $1200+ savings into a liquid bank account that you (or your loved ones) can draw upon in a time of crises when you're old and frail and need to be repatriated in a time of crisis for immediate medical treatment.

See, that's the problem with this line of thinking. Very few people actually set aside the money for the crises time.

This is why I say that the De Nile River is running deep and wide here in Chiang Mia.

It all depends on individual circumstances, doesn't it? I'm certainly not in denial. I think your viewpoint, Nancy, is probably influenced by contact with those whom you have generously helped with getting repatriated and other problems. For me, my life is here in Thailand. Any chance of my returning to the US is vanishingly small (and if the vanishingly small happened, then I've no problem with paying more for Part B. So paying for Part B now makes no sense at all.

I wish that Medicare were like the French health insurance system. I just found out the system will pay for treatment at Ram for French citizens! But no chance of that happening with Medicare I'm sure.

Edited March 12, 2015 by neilrob

[Mapguy]

Assuming you found out from the French horse's mouth, Neilrob, then that coverage is quite impressive. Can anyone refer specifically to any other countries that cover expatriates through their national health systems?

[NancyL]

Neilrob, you're absolutely right my viewpoint about not opting out of Medicare is definitely colored by what I've seen with the people I've assisted. When I hear people say they worked the math and they found it's to their advantage to opt out and save the premiums, they're telling me the story from a hospital bed at Suan Dok where I've been called in to help them figure out how to pay the bill. Of course, they haven't been banking the premiums or even if they have, saving $1200 a year for a couple years doesn't go very far when you need something like cancer treatment or cardiac procedures that they could have received in the U.S. if they'd just kept their Medicare active.

People who worry about that extra $100 a month are usually living on the edge without adequate resources for coverage in case of a big emergency.

[chingmai331]

Yes, the French system may be ideal, until France defaults then Ram Slams U.

[neilrob]

I'm fortunate enough not to be living anywhere near the edge, but why throw away $100 per month for a system I'll never use? My life is here and I'll get medical attention here. Medicare part A is free and forms a backup if I should need hospitalisation on an occasional short visit to the US. The sort of repatriation I might need is more likely to be coming back to my home in Thailand, rather than the other way round! Obviously, others will be in different circumstances, but it does depend on individual circumstances.

[Langsuan Man]

The only thing that annoyed me about Part B was that when they changed the eligibility for full Social Security based upon your birth year from 65 to 66 (for me) , it was a PITA to have to pay for the coverage in three month increments until I started to receive Social Security so it could automatically be deducted from my monthly SS check

I learned early in life that money that comes directly out of your pay check is not missed because you don't change your life style if you don't have the money

My father retired at age 50 and my mother was shocked that he was able to retire at that age. When I asked him his secret, he smiled and said, everytime I got a pay increase I would not tell your mom, so that she wouldn't suddenly want new furniture or an expensive vacation

I did not make his enviable 50 year old retirement age but was able to retire at 57 with a huge nest egg because I always had money taken out of all my paychecks whether it be for private company 401 K plans or Government TSP. So the piddling $104.90 a month for part B hardly impacts me

The only absolute in this world is that there are no absolutes, and those who swear that they will never go back to their home countries are trying to make an absolute

Seriously people, we are living in an age of advances in medicine that our parents could not even dream of. If you get cancer and there is a treatment available in your home country, how absolute is your resolve not to go back going to be then ?

[CMBob]

The only thing that annoyed me about Part B was that when they changed the eligibility for full Social Security based upon your birth year from 65 to 66 (for me) , it was a PITA to have to pay for the coverage in three month increments until I started to receive Social Security so it could automatically be deducted from my monthly SS check

Interesting. I never thought of that and escaped knowing about it as I started taking Social Security at 62. So, since I was already receiving SS, they just took out the Part B expense monthly when I signed up for Medicare.

You're right about most people deciding to "permanently" stay here in Thailand. I've known people who made that decision but who later, due to either a medical condition or simply disillusionment, moved back to the states.....but it doesn't happen all that often. As noted, I always have reserved the right to go back (thinking it's possible due to medical concerns or, possibly, just because I theoretically might change my mind some day). I doubt if I will but I also know through experience that I like to leave all options open.

There is a fair number of westerners from the States and elsewhere that moved over here because they could afford to do so (or thought they could) and frankly have little or no economic ability to return to their home countries (i.e., they may have enough money to live an okay life here in Thailand but do not any longer have the money to live an okay life back "home"). I personally never have understood that mindset (which I suppose is why I felt it important to secure my economic future and options before making any transition here) but, I suppose, to each his own.