American Expats using Medicare as a way to cover medical needs

[Pib]

I read "full coverage" to suggest that the friend pays for both Part B and Medigap.

Could be...but a Medigap policy is a commercial policy, separate from Medicare, and purely optional to supplement the govt Medicare coverage. But the friend's Medicare Part B premium if he signed up at 65 and was fully vested in social security/medicare would be $104.90. Anything above that is optional stuff the friend is adding on like maybe a Medigap policy, Medicare Part D outpatient Drug coverage, etc.

[charliebadenhop]

I am not up to speed on all the correct terms-

Both my friends have what I am calling "full coverage" which includes everything including meds if needed.

Their medicare premium is around $120 a month (maybe $10 difference between the two of them) and the supplemental coverage costs them each about $150 a month (Again, with slight difference for each of them).

Supposedly, if you only pay for Medicare, you leave yourself open to a lot of different problems, and thus expenses.

Both people told me almost the same exact story, with both of them saying that a high quality supplemental policy is crucial.

Both of them have worked for more than 40 year, while paying income tax, etc.

So I ask again- At my age bracket, I can get an Inpatient only policy that costs around $370 a month.

How can it possibly make sense to pay for Medicare instead, and have to fly back to the States for treatment?

[Pib]

Yea, your friends could have a combo of Medicare Part B ($104/mo) plus purely optional add-on policies like a Medigap F policy that pretty much fully covers the person's Medicare copay/cost share/deductible with that Medigap policy probably running around $150/mo, and then a good Part D outpatient medications policy probably around $50/mo. So all of that would get up to a little over $300/mo. A lot of different Medigap and Part D policies out there various levels of coverage, deductibles, and premiums.

With such multiple policy coverage you would be pretty much covered on all inpatient, outpatient, and medication costs in the U.S. But the Medicare Part A/B is covering the great majority (around 80%) of all the medical costs/inpatient medications with the Medigap policy picking up the remaining 20%...and then the Part D medication covering outpatient medications cost.

Anyone who signs up for Medicare Part B who lives outside the U.S. would probably want to do so to have coverage for a serious illness which they would want to go back to the U.S. to have taken care of. Or maybe they know they will probably return to the U.S. when they reach a certain golden age and don't want to be stuck with the late signup penalties for life.

And as discussed earlier military retirees whether living in the U.S. or overseas must signup for Medicare Part B in order to continue Tricare for Life which provides coverage in or outside the U.S. to them and their dependents. If living overseas they end up with 75% reimbursement coverage provided by Tricare for Life....Medicare provides no reimbursement although you are paying the Part B premium in order to continue with Tricare upon reaching 65.

For military retirees living in the U.S. by signing up for Part B they get to continue Tricare coverage and also get Medicare coverage....when the dust settles they don't even need a Medigap policy or Part D medications policy as Medicare and Tricare combo coverage combines to cover 100% of in and outpatient costs and medications except may a few small deductibles--it definitely a good deal.

And then we have people who spent part of their year in the U.S. and part of their year overseas...they too will probably want Medicare Part B coverage for medical coverage and tax purposes (the Obamacare thing).

Each U.S. expat will be in a different situation, having different health concerns/issues, maybe be a military retiree, and have a different train of thought when it comes to should I or shouldn't I signup for Medicare Part B come 65 years of age. It can be a tough choice. But one thing for sure a commercial health care policy providing coverage equal to Medicare coverage will be very HIGH...probably around $400/month (or more).

[JLCrab]

From the above: And then we have people who spent part of their year in the U.S. and part of their year overseas...they too will probably want Medicare Part B coverage for medical coverage and tax purposes (the Obamacare thing).

That is commonly referred to on ThaiVisa as "the best of both worlds". So how are these 65+ aged persons covered for the up to 6 months or so that each year they are in Thailand? I know there are various travel plans but they get a bit pricey at older age and essentially you are then paying for 2 coverages when you are outside the USA.

[taxout]

"And then we have people who spent part of their year in the U.S. and part of their year overseas...they too will probably want Medicare Part B coverage for medical coverage and tax purposes (the Obamacare thing)."

No, you meet the Obamacare insurance requirement when you have Part A; no need to take Part B to avoid the no-coverage penalty.

"If you have Medicare Part A (Hospital Insurance), you’re considered covered under the health care law and don’t need a Marketplace plan."

https://www.healthcare.gov/medicare/

[DogNo1]

Perviously, American posters who are over 65 have stated that they self-insure while in Thailand (pay 100% of their costs out-of-pocket.) They are covered by Medicare while they are back in the USA. People over 65 find it to not be cost-effective to buy insurance in Thailand so I never heard of anyone who has both Medicare and Thai medical insurance. So far as travel insurance goes, I don't think that it covers long periods of time. I'm not sure what the time limitation would be. If you think that you will need medical care in the USA at any point, it is cost-effective to have both Part A and Part B. You cannot buy more than this if you are not residing in the USA at least part-time. If posters don't want to pay for Medicare and don't think that they will ever require medical care in the US, that's their choice. If they do need medical care in the USA, as many American residents who unexpectedly become indigent in Thailand have, it will be a problem without Medicare. I guess for them, Medicaid is an option but it is not a good one.

[JLCrab]

Paying 100% of your medical costs is not 'self-insuring' even if you set up a reserve account -- it is paying 100% of your medical costs. Even if you are enrolled in Medicare (Part A) if you live in Thailand full-time, it is cost-effective to pay for heath insurance in Thailand as long as you have been paying for health insurance in Thailand since about age 50.

Personally, I will be exempt from Part B penalties (I hope) under my current circumstances so that $100+ per month that might go toward Part B pays for a good chunk of my BUPA coverage in Thailand

[gk10002000]

I didn't sign up late for Part B because I had (and have) no idea when I might suffer a serious illness and need to be treated in the US. Incidentally, I talked to an American man from San Francisco yesterday who said that his wife was treated for cancer under Medicare for some time before she died and it didn't cost him a penny! All fees were waived. This makes three illnesses that I have heard of that cost the Medicare recipients nothing.

If it cost them nothing then I can guarantee you that they had a private supplement plan for Medicare Part B; the only way to have a major medical problem and not get eaten alive by co-pays, deductibles, and incidentals, is to have a Medicare Supplement plan like those offered by AARP or private insurance companies

My 88 year old mom had expensive intestinal surgery in Rhode Island while visiting there three years ago. She is a Florida resident. She has Med B and I think also a supplemental Blue cross plan? Several hundred thousand in expenses, not one cent billed to her or paid by her. I will try to find out exactly what coverage she has.

[Langsuan Man]

She has Medicare part A and B and uses her Blue Cross as her wrap around or supplemental insurance as some call it

I do know that FEP (Federal Employee Benefit Plan) with Blue Cross has a deal that if you continue with them once you go on Medicare, they waive all copays and yearly deductibles. Not because they want your premiums but so that they can get the big bucks for the Federal Government's contribution to the plan

I am one of those who spend part of the year in Thailand so while here I am covered by Blue Cross (pay first and get reimbursed later) and when in the US Medicare becomes my primary and Blue Cross becomes my " secondary "

[charliebadenhop]

Thanks for the info in the last couple of posts, as well as other posts.

[taxout]

The Republicans have just come out with their proposals to replace Obamacare, and they include increasing Medicare eligibility from 65 to 67, with implementation starting in 2020. Not to say they'll get anywhere with that this year, but once a proposal like this is on the table, it's a warning that it may very well be coming sometime down the road.

http://www.nytimes.com/2016/06/22/us/politics/house-republicans-unveil-affordable-care-act-replacement.html

[Pib]

The Republicans have just come out with their proposals to replace Obamacare, and they include increasing Medicare eligibility from 65 to 67, with implementation starting in 2020. Not to say they'll get anywhere with that this year, but once a proposal like this is on the table, it's a warning that it may very well be coming sometime down the road.

http://www.nytimes.com/2016/06/22/us/politics/house-republicans-unveil-affordable-care-act-replacement.html

Republicans (even a few Democrats) have been laying similar proposals on the table for years...and there they stayed.

[TallGuyJohninBKK]

The Republicans have just come out with their proposals to replace Obamacare, and they include increasing Medicare eligibility from 65 to 67, with implementation starting in 2020. Not to say they'll get anywhere with that this year, but once a proposal like this is on the table, it's a warning that it may very well be coming sometime down the road.

http://www.nytimes.com/2016/06/22/us/politics/house-republicans-unveil-affordable-care-act-replacement.html

Excerpt from the NYT report:

One of the most important provisions of the 2010 health care law stipulates that insurers cannot deny coverage or charge high premiums because of a person’s medical condition or history. The House Republican blueprint would replace this guarantee with more complicated, less stringent standards.

No American could be denied coverage because of a pre-existing condition, the House Republican plan says. But the protection against higher premiums would apply only to people who maintain “continuous coverage.” If a consumer allows a significant break in coverage, insurers could charge more than “standard rates” and take a person’s health status into account in setting premiums.

[taxout]

" . . . and there they stayed."

My point is simply that if I were 55 today, I would not count on starting Medicare in 10 years, nor would I assume anywhere near the same coverage or Part B costs as today. Maybe it'll be the same -- older voters make a powerful bloc -- but I'd be planning based on worse (if not necessarily worst) case assumptions.

[Pib]

" . . . and there they stayed."

My point is simply that if I were 55 today, I would not count on starting Medicare in 10 years, nor would I assume anywhere near the same coverage or Part B costs as today. Maybe it'll be the same -- older voters make a powerful bloc -- but I'd be planning based on worse (if not necessarily worst) case assumptions.

I have no doubt Medicare will be tweaked over the next decade or so...what those tweaks will look like is anyone's guess. But social security security and medicare remain third rails which makes politicians delay (hide from) any hard tweaks until they just have to. Plus, a lot of proposals are just that...meant to pacify a certain group of voters especially during election years...however, the politician(s) making the proposal know they have a snowball's chance in hell in passing until the day "sh&t must hit the fan."

[taxout]

" . . .which makes politicians delay (hide from) any hard tweaks until they just have to."

No, what they actually do -- especially with Social Security and Medicare -- is quietly enact changes that don't take effect for several years, so they're not around to get blamed. For example, as a result of 2015 legislation, the Part B supplement on "wealthy" retirees will increase starting in 2018, and those retiring starting 2020 will find Medigap policies more restricted.

http://www.cahealthadvocates.org/news/basics/2015/Doc-Fix-and-HR2.html

[stevenl]

so they're not around to get blamed

So you would like these changes to be implemented straight away? I would say a few years notice so the people affected can prepare themselves is a much better idea.

[taxout]

If I thought that was the motivation, perhaps I would. But these changes never get much publicity at the time because they're too far down the road for anyone to care about and are usually hidden inside large bills dealing with other issues. That's politics.

[IMA_FARANG]

I live and receive mail in Thailand.

I have been receiving Social Security benefits monthly here in Bangkok, direct to my Thai Bank account since November 2014.

The SSA has sent me two Medicare/Medicaid cards since I turned 65 years old at my Thai mailing address.

[Langsuan Man]

I live and receive mail in Thailand.

I have been receiving Social Security benefits monthly here in Bangkok, direct to my Thai Bank account since November 2014.

The SSA has sent me two Medicare/Medicaid cards since I turned 65 years old at my Thai mailing address.

That is so you will have the cards if you return to the US. Useless in Thailand.

Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter what your income. Medicaid is a state and federal program that provides health coverage if you have a very low income

So I have serious doubts if you have a Medicaid card. And unless you are paying for it, the Medicare card that you have is only for part A, which is for hospitalization in the US