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

[cardinalblue]

Penny-wise pound foolish comes into play for those who don't sign up for part B....

ill-health can change one's best laid plans...

CB

[BKKSnowBird]

$104 is pretty cheap insurance. I think best to keep it.

[CaptHaddock]

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.

Part A only covers hospital charges and maybe not all of those. I doubt if any US hospital would admit you without insurance to pay the doctors, medicine, etc. My guess is that Part A is probably completely useless by itself.

[craigt3365]

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.

Part A only covers hospital charges and maybe not all of those. I doubt if any US hospital would admit you without insurance to pay the doctors, medicine, etc. My guess is that Part A is probably completely useless by itself.

My friend is going back for some tricky back surgery soon. Part A covers everything he'll need, but he needs to pay the deductible and I believe it only covers 80% of the total bill as the costs are above what Medicare allows. He's already got it setup with Medicare and with the hospital. He also has part B, so meds are covered also.

[BKKSnowBird]

Part B does not cover meds. You need a part D and can't sign up for that right away. His meds when in the hospital may be covered but any RX will be out of pocket.

[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.

Part A only covers hospital charges and maybe not all of those. I doubt if any US hospital would admit you without insurance to pay the doctors, medicine, etc. My guess is that Part A is probably completely useless by itself.

Medicare Part A IS hospital insurance. Part A coverage includes "inpatient care at a hospital, skilled nursing facility (SNF), and hospice. Part A also covers services like lab tests, surgery, doctor visits, and home health care". This is a direct quote from the official Medicare web site. Sounds worthwhile to me. Most hospitals accept Medicare as you can see by looking up coverage. Indeed, hospitals which at any time in the past have accepted certain types of Federal funds are legally required to accept Medicare patients and Medicare payment for their services---they don't have a choice. It is more of a problem to find a doctor who will accept Medicare patients, since quite a number do not, but this of course is a problem with Part B, which covers outpatient services, not Part A. Is your "doubt" and "guess" actually based on anything?

[craigt3365]

Part B does not cover meds. You need a part D and can't sign up for that right away. His meds when in the hospital may be covered but any RX will be out of pocket.

Ah...got it now:

http://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html

I cancelled because my mother is 90 and will never be able to go back to the US. She's covered here via her military insurance, but my mistake was thinking part B was only for US residents. My BIG mistake.

[CaptHaddock]

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.

Part A only covers hospital charges and maybe not all of those. I doubt if any US hospital would admit you without insurance to pay the doctors, medicine, etc. My guess is that Part A is probably completely useless by itself.

Medicare Part A IS hospital insurance. Part A coverage includes "inpatient care at a hospital, skilled nursing facility (SNF), and hospice. Part A also covers services like lab tests, surgery, doctor visits, and home health care". This is a direct quote from the official Medicare web site. Sounds worthwhile to me. Most hospitals accept Medicare as you can see by looking up coverage. Indeed, hospitals which at any time in the past have accepted certain types of Federal funds are legally required to accept Medicare patients and Medicare payment for their services---they don't have a choice. It is more of a problem to find a doctor who will accept Medicare patients, since quite a number do not, but this of course is a problem with Part B, which covers outpatient services, not Part A. Is your "doubt" and "guess" actually based on anything?

I do not claim to understand Medicare and it's quite possible I never will. However, I note that a common sense understanding of "hospital" costs and doctor costs is hardly adequate.

Medicare Part B (Medical Insurance) covers most of your doctor services when you’re an inpatient. You pay 20% of the Medicare-approved amount for doctor services after paying the Part B deductible.

Also, you are an inpatient only when a doctor has ordered your admission to a hospital and the hospital has formally admitted you. Otherwise you are an outpatient even if you are staying overnight in the hospital, for instance, for observation or emergency room treatment, all of which is outpatient and not covered by Part A. Of course, doctor's services in those cases would only be covered by Part B, not Part A.

That being the case, why would a hospital admit you without Part B or some other insurance that would pay for doctor's care?

My expectation is that if you or I are getting treatment in a US hospital, unless we have the full complement of insurance including Medicare Parts A, B & D, or better yet, Medicare Advantage, we are going to be screwed financially. The most we can sign up for as expats is Part A & B. So, that's what I do and that's what I recommend. I do not do so in the belief that it will actually be adequate.

From cms.gov:

https://duckduckgo.com/l/?kh=-1&uddg=http%3A%2F%2Fwww.medicare.gov%2FPubs%2Fpdf%2F11435.pdf

[TerrenceLee]

To all of you who took the time to post responses to my original post.......thank you so much!! This was my first post on this forum and I didn't know what sort of response I'd get. Suffice to say, I'm satisfied to the point of being blown away! You're realtime experience is invaluable, and you're willingness to share it is truly appreciated.

[neilrob]

Part A covers, among many other items, doctor visits when you are an inpatient. If the hospital admits you (for good medical reason) you are covered and the hospital gets paid. Of course it does not cover outpatient treatment---no one is suggesting it does. If you don't have Part B, then yes, you are going to have to pay for outpatient care. It is hospital insurance. I don't know how much clearer it could be. Part A is hospital treatment, with all that this implies---including doctors, surgery, as an inpatient, and even nursing care and home care after you have left the hospital. This is straight from the official Medicare website. Part B is outpatient.

[CaptHaddock]

Part A covers, among many other items, doctor visits when you are an inpatient. If the hospital admits you (for good medical reason) you are covered and the hospital gets paid. Of course it does not cover outpatient treatment---no one is suggesting it does. If you don't have Part B, then yes, you are going to have to pay for outpatient care. It is hospital insurance. I don't know how much clearer it could be. Part A is hospital treatment, with all that this implies---including doctors, surgery, as an inpatient, and even nursing care and home care after you have left the hospital. This is straight from the official Medicare website. Part B is outpatient.

If you have an authoritative source that states that Part A covers doctor's services while an inpatient, please post the link. But the fact is that Part A does not cover such services. You are taking "hospital" in the common sense meaning of everything that takes place in a hospital because that's what "going to the hospital" means to you. In the context of health insurance in general and Medicare in particular, however, "hospital" services do not include the "medical" services which are provided only by doctors.

The following clip flatly and clearly contradicts your belief. If Part A covered all of the costs of hospital stays including doctors, then people wouldn't sign up for Part B.

Medicare Part A (hospital insurance)

Generally called hospital insurance, Part A covers services associated with inpatient hospital care (i.e., the costs associated with an overnight stay in a hospital, skilled nursing facility, or psychiatric hospital, such as charges for the meals, hospital room, and nursing services). Part A also covers hospice care and home health care.

Medicare Part B (medical insurance)

Generally called medical insurance, Part B covers other medical care. Physician care--whether it was received while you were an inpatient at a hospital, at a doctor's office, or as an outpatient at a hospital or other health-care facility--is covered under Part B. In addition, ambulance service, laboratory tests, and physical therapy or rehabilitation services are covered.

http://medicare.org/medicare-program.html

Therefore, without Part B you will not get admitted to a hospital unless you have some other way to pay for the doctors.

Edited March 13, 2015 by CaptHaddock

[CMBob]

Therefore, without Part B you will not get admitted to a hospital unless you have some other way to pay for the doctors.

I only disagree somewhat with your conclusion (the "therefore" part). Admission always happens regardless of insurance or ability to pay for emergency services. And typically occurs for all other needed services (well, not for optional, cosmetic, or the like). With Parts A and B, you're generally covered for at least 80% of all emergency or needed services.

One of the good things about Medicare is that a participating doctor or hospital can't just charge the government or you (for your part) whatever they feel like charging as they can only charge the Medicare approved amount for a given procedure/item (that requirement substantially reduces the ultimate cost to the patient).

[Langsuan Man]

Therefore, without Part B you will not get admitted to a hospital unless you have some other way to pay for the doctors.

I only disagree somewhat with your conclusion (the "therefore" part). Admission always happens regardless of insurance or ability to pay for emergency services. And typically occurs for all other needed services (well, not for optional, cosmetic, or the like). With Parts A and B, you're generally covered for at least 80% of all emergency or needed services.

One of the good things about Medicare is that a participating doctor or hospital can't just charge the government or you (for your part) whatever they feel like charging as they can only charge the Medicare approved amount for a given procedure/item (that requirement substantially reduces the ultimate cost to the patient).

If that were true then Medicare Supplement Insurance would not be offered by almost every major insurance company in the US and many organizations, like AARP for instance. You are forgetting about the yearly co-pays with Medicare and the deductible amounts that these supplemental policies cover. When you are hospitalized are you going to eat, I hope so, but Medicare is not going to pay for your food and is just one example of things that are not covered by Medicare. If you are taken to the hospital by ambulance do you think that Medicare is going to pay for the ambulance ?

I know of no one in the US who is covered by Medicare that does not have a supplemental policy to cover these "charges" that you say doctors and hospitals cannot charge

[neilrob]

Langsuan Man, I suggest you read the web site you yourself cited. Of course Medicare Part A pays for meals in hospital. Of course Part B will pay for an ambulance.

[Langsuan Man]

Love

Langsuan Man, I suggest you read the web site you yourself cited. Of course Medicare Part A pays for meals in hospital. Of course Part B will pay for an ambulance.

Not without a substantial deductible or copay, which is the reason most Medicare recipients have a Medicare Supplement Plan Edited March 14, 2015 by Langsuan Man

[CaptHaddock]

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.

Part A only covers hospital charges and maybe not all of those. I doubt if any US hospital would admit you without insurance to pay the doctors, medicine, etc. My guess is that Part A is probably completely useless by itself.

Medicare Part A IS hospital insurance. Part A coverage includes "inpatient care at a hospital, skilled nursing facility (SNF), and hospice. Part A also covers services like lab tests, surgery, doctor visits, and home health care". This is a direct quote from the official Medicare web site. Sounds worthwhile to me. Most hospitals accept Medicare as you can see by looking up coverage. Indeed, hospitals which at any time in the past have accepted certain types of Federal funds are legally required to accept Medicare patients and Medicare payment for their services---they don't have a choice. It is more of a problem to find a doctor who will accept Medicare patients, since quite a number do not, but this of course is a problem with Part B, which covers outpatient services, not Part A. Is your "doubt" and "guess" actually based on anything?

I believe I understand now where you got the mistaken idea that Part A is going to pay for a doctor's services. You found the page below on medicare.gov, an official govt website:

http://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html

This page is an example of the kind of bad writing that comes from low-paid govt workers. The heading of the page is:

What Part A covers

in large type. Below that is:

What's Covered?

in smaller, but still large type. The paragraph following begins:

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.

A reader might logically conclude since we seem to be talking about Part A, that Part A covers surgeries, doctor visits, and the other items mentioned. Nothing could be further from the truth. The writer of this paragraph has unaccountably and without warning fallen back at this point to a general discussion of Medicare, i.e. Part A, Part B and the rest. Part A does not cover all or indeed, any, of the services listed in that sentence. This becomes apparent as the writer returns further down the page to the matter at hand, i.e. what Part A covers and now is refreshing specific:

In general, Part A covers:

Hospital care

Skilled nursing facility care

Nursing home care (as long as custodial care isn't the only care you need)

Hospice

Home health services

So, where did the surgeries and doctor visits go? The items beginning with "Hospital care" are links that you can click on to get more detail. You may click away on all of them, but you will never come to a page that lists or even mentions surgeries or doctor visits that are covered by Part A. Because those are doctor's services covered by Part B, not Part A.

I am not trying to beat you over the head with this. The page in question is badly written and misleading. If you look further on any of the hundreds of websites that discuss Medicare you won't find any mention of doctor's services under Part A. I have tried to clear this up because it sounds as if you are relying on Part A for that heart surgery one day to keep you alive. If that's the case it would be better to know now why that plan won't work than then.

Edited March 15, 2015 by CaptHaddock

[thaigold]

Some say Part B for expats is a bet on furure health failure. I dumped Part B more than 13 years ago, and in doing so saved almost 700,000 baht in useless insurance. Also, BKKSnowBird - the Medicare is useless overseas. Remember, in the US, if you are well off, health care is a breez. If you are poor, it's free. Only the middle class takes the hit. Unfair? YES.

$104 is pretty cheap insurance. I think best to keep it.

[NancyL]

Some say Part B for expats is a bet on furure health failure. I dumped Part B more than 13 years ago, and in doing so saved almost 700,000 baht in useless insurance. Also, BKKSnowBird - the Medicare is useless overseas. Remember, in the US, if you are well off, health care is a breez. If you are poor, it's free. Only the middle class takes the hit. Unfair? YES.

$104 is pretty cheap insurance. I think best to keep it.

Thaigold, did you put that 700,000 baht you saved into a special savings account to access only in the case of a medical emergency?

You see, the problem with people who decide to pass on signing up for Part B is that often they don't have deep enough resources to cover themselves in an emergency and having kept Part B can be a real life-saving option.

[Seahawk1951]

on my ssa online account it states that you see a ssa official before opting out of part b. anyone ever hear of that?

[BarnicaleBob]

I started taking my social security at age 62. When I turned 65 I was automatically enrolled into Medicare and they started to deduct $104.90 a month from my SS checks. The following month I returned to the States to take advantage of this and have a total knee replacement done. However, a month before the surgery I opted to convert my Medicare over to a AARP Medicare program that cost the same as Medicare but provided better benefits including prescription medications (with a deductible or copay). Knee surgery went well and my total copay was under $600.00 for everything including follow up doctor visits and therapy. I have since flown back to the State twice, once for the other knee and once for a pacemaker replacement. So my plan is to keep my Medicare under the AARP insurance program and go to the States when I need something major. I might add I keep enough money on hand to cover an emergency hospital stay here and for tickets to the States if needed. In the long run I feel I come out ahead and that the $104.90 a month is well worth it.