Expats Getting on Medicare PART A, B, and D Returning to USA Without a Permanent Residence
This blog is for Expats trying to navigate getting Medicare enrollment started while living outside the US. Here is some good information to start with; Getting on part D seems the most onerous and how to buy individual part D plans per state with each list of available meds, deductibles and med and plan costs etc.
UPDATE March 22.2020; I've lived in Thailand since 2006. After looking at all the potential places to move back to in America I am now considering Hollywood Florida. But everything is on hold until the we figure out this horrible Virus that is attacking the entire world.
I had a lacunar stroke in Oct 2017. It's a warning stroke and so far I doing ok but have post stroke neuralgia attacks, chronic insomnia and must take a lot of medication. I've decided the best plan is to get on Medicare because it has much better comprehensive coverage; there's no upper dollar limit on Medicare benefits (see more below on Medicare limits).
I am looking to buy a condo in Florida if we can get past this outbreak situation. But it looks like I won't be moving until next year and will miss my 'Initial Enrollment Period" for Part B and have to pay the 10% penalty for signing up late during the 'General Enrollment Period' next year between January 1 and March 31, 2021, and coverage doesn't start until July 1, 2021. After I am enrolled in Part B, then I can pick a Part D plan for medication coverage, which varies by state.
See the Health Alert just posted at the bottom of this page from the U.S. Embassy Bangkok, Thailand (March 20, 2020).
Currently here in Thailand I'm using an American company for international medical insurance, a UnitedHealthCare plan through Seven Corners Insurance that offers $50,000 of 'pre existing condition' coverage with their 'Liaison Travel Choice' plan, and cost $14 less than Medicare (but not in any way as comprehensive and much less total coverage) My plan has a $1000 deductible and $100K overall coverage. You can increase your overall coverage but not the 'pre existing condition' coverage, $50K is the max until age 69. There is no drug plan and it's not considered a 'wellness plan', you only use it when you're sick or injured. You buy your own meds unless they are given when you see a doctor or go to the hospital.
Medicare is a much better option for the long term, it costs $144 a month if you make less than $87,000 a year. In general, there's no upper dollar limit on Medicare benefits. As long as you're using medical services that Medicare covers—and provided that they're medically necessary—you can continue to use as many as you need, regardless of how much they cost, in any given year or over the rest of your lifetime: https://www.aarp.org/health/medicare-insurance/info-02-2009/ask_ms__medicare_17.html
Signing up for Part B from overseas:
If you're living overseas you can sign up for Part B if you already received your Medicare Part A confirmation/card, they will send it to your foreign address if you put it in on the Social Security website. Then to sign up from overseas you have use a US address and change it on the Social Security website, they even allow PO box/mail forwarding service addresses. You will need to download a special form the CMS-40B. Then mail or Fedex that to the local Social Security office in the US. I'll put the links here soon.
ELIGIBILITY FOR PART D Medicare = Getting part A/B returning from outside the US (seems less complicated compared to part D) part D without a permanent residence sounds like a nightmare: Enrollees in part D MUST LIVE IN (have a permanent residence in) their plan’s service area. In the case of homeless persons, the following may be used as a permanent residence: a Post Office box or the address of a homeless shelter = WTF?
Anyone with Medicare is eligible to enroll in a Part D plan. To enroll in a PDP (PDP is an abbreviation for "prescription drug plan" a stand-alone Medicare Part D prescription drug plan), the individual must have Part A OR Part B. To enroll in an MA-PD (MAPD is an abbreviation for "Medicare Advantage plan that offers prescription drug coverage"), the individual must have Part A AND Part B.
PDPs only cover prescription drugs.
Enrollees MUST LIVE IN (have a permanent residence in) their plan’s service area. In the case of homeless persons, the following may be used as a permanent residence: a Post Office box or the address of a homeless shelter; WTF?
https://www.medicareadvocacy.org/medicare-info/medicare-part-d/
Can I sign up for Medicare Part D at any time?
You can enroll in Medicare Part D coverage during your Initial Enrollment Period (IEP) for Part D, which is the period that you first become eligible for Medicare Part D. For most people, the IEP for Part D is the same as the IEP for Medicare Part B and begins three months before you turn 65 years of age.
Find 2019 Stand-Alone Medicare Part D Prescription Drug Plans by state or national, costs and what drugs are included:
https://q1medicare.com/PartD-SearchPDPMedicare-2019PlanFinder.php?state=HI#results
Know This: The US Government persecutes you for being an Expat: You will be PENALIZED 10% for every year that you don't sign up for part B and I'm still researching the Penalties for late sign up on part D.
Health Alert – U.S. Embassy Bangkok, Thailand (March 20, 2020)
Is it really worth it to leave your foreign home as an Expat and return to America for Medicare?
UPDATE March 22.2020; I've lived in Thailand since 2006. After looking at all the potential places to move back to in America I am now considering Hollywood Florida. But everything is on hold until the we figure out this horrible Virus that is attacking the entire world.
I had a lacunar stroke in Oct 2017. It's a warning stroke and so far I doing ok but have post stroke neuralgia attacks, chronic insomnia and must take a lot of medication. I've decided the best plan is to get on Medicare because it has much better comprehensive coverage; there's no upper dollar limit on Medicare benefits (see more below on Medicare limits).
I am looking to buy a condo in Florida if we can get past this outbreak situation. But it looks like I won't be moving until next year and will miss my 'Initial Enrollment Period" for Part B and have to pay the 10% penalty for signing up late during the 'General Enrollment Period' next year between January 1 and March 31, 2021, and coverage doesn't start until July 1, 2021. After I am enrolled in Part B, then I can pick a Part D plan for medication coverage, which varies by state.
See the Health Alert just posted at the bottom of this page from the U.S. Embassy Bangkok, Thailand (March 20, 2020).
Currently here in Thailand I'm using an American company for international medical insurance, a UnitedHealthCare plan through Seven Corners Insurance that offers $50,000 of 'pre existing condition' coverage with their 'Liaison Travel Choice' plan, and cost $14 less than Medicare (but not in any way as comprehensive and much less total coverage) My plan has a $1000 deductible and $100K overall coverage. You can increase your overall coverage but not the 'pre existing condition' coverage, $50K is the max until age 69. There is no drug plan and it's not considered a 'wellness plan', you only use it when you're sick or injured. You buy your own meds unless they are given when you see a doctor or go to the hospital.
Medicare is a much better option for the long term, it costs $144 a month if you make less than $87,000 a year. In general, there's no upper dollar limit on Medicare benefits. As long as you're using medical services that Medicare covers—and provided that they're medically necessary—you can continue to use as many as you need, regardless of how much they cost, in any given year or over the rest of your lifetime: https://www.aarp.org/health/medicare-insurance/info-02-2009/ask_ms__medicare_17.html
Signing up for Part B from overseas:
If you're living overseas you can sign up for Part B if you already received your Medicare Part A confirmation/card, they will send it to your foreign address if you put it in on the Social Security website. Then to sign up from overseas you have use a US address and change it on the Social Security website, they even allow PO box/mail forwarding service addresses. You will need to download a special form the CMS-40B. Then mail or Fedex that to the local Social Security office in the US. I'll put the links here soon.
ELIGIBILITY FOR PART D Medicare = Getting part A/B returning from outside the US (seems less complicated compared to part D) part D without a permanent residence sounds like a nightmare: Enrollees in part D MUST LIVE IN (have a permanent residence in) their plan’s service area. In the case of homeless persons, the following may be used as a permanent residence: a Post Office box or the address of a homeless shelter = WTF?
Anyone with Medicare is eligible to enroll in a Part D plan. To enroll in a PDP (PDP is an abbreviation for "prescription drug plan" a stand-alone Medicare Part D prescription drug plan), the individual must have Part A OR Part B. To enroll in an MA-PD (MAPD is an abbreviation for "Medicare Advantage plan that offers prescription drug coverage"), the individual must have Part A AND Part B.
PDPs only cover prescription drugs.
Enrollees MUST LIVE IN (have a permanent residence in) their plan’s service area. In the case of homeless persons, the following may be used as a permanent residence: a Post Office box or the address of a homeless shelter; WTF?
https://www.medicareadvocacy.org/medicare-info/medicare-part-d/
Can I sign up for Medicare Part D at any time?
You can enroll in Medicare Part D coverage during your Initial Enrollment Period (IEP) for Part D, which is the period that you first become eligible for Medicare Part D. For most people, the IEP for Part D is the same as the IEP for Medicare Part B and begins three months before you turn 65 years of age.
Find 2019 Stand-Alone Medicare Part D Prescription Drug Plans by state or national, costs and what drugs are included:
https://q1medicare.com/PartD-SearchPDPMedicare-2019PlanFinder.php?state=HI#results
Know This: The US Government persecutes you for being an Expat: You will be PENALIZED 10% for every year that you don't sign up for part B and I'm still researching the Penalties for late sign up on part D.
Health Alert – U.S. Embassy Bangkok, Thailand (March 20, 2020)
Location: Thailand
Event:
The Royal Thai Government (RTG) has implemented enhanced screening and quarantine measures to reduce the spread of COVID-19. Travelers should be prepared for travel restrictions to be put into effect with little or no advance notice. U.S. citizens who are considering returning to the United States are urged to work with their airlines to make travel arrangements while flights are still available. On March 13, 2020, the RTG’s Ministry of Public Health added the United States to its list of countries with ongoing local transmission. Travelers entering the Kingdom of Thailand who have been in the United States within the prior 14 days are subject to self-monitoring and reporting requirements upon arrival.
Effective as of 12:01 am, Sunday March 22, The Thai government now also requires such travelers to have a health certificate issued within 72 hours before arrival in Thailand certifying that they are “free of coronavirus,” as well as proof of medical insurance with at least $100,000 of overseas coverage. The health certificate must certify the traveler has displayed no evidence of acute respiratory infection in the 48 hours prior to departure from the U.S. The self-monitoring and reporting requirements upon arrival in Thailand remain, even with the health certificate and health insurance. All U.S. Citizens must prepare themselves to produce these two documents if they wish to be allowed to arrive in Thailand after 12:01 am, Sunday March 22. U.S. Embassies and Consulates will not be in a position to assist with regard to these documents.
All travelers arriving in Thailand will also be required to download the AOT Airports Application. Once the app is downloaded, travelers must fill in the required information in the COVID-19 Inbound Passenger Control Section and present this to immigration officials at all international airports. The language of the RTG Ministry of Health requirements is available on its website. Visit the Ministry of Public Health website for additional information on these new measures.
Very helpful info you’ve shared here. My circumstances are a little different in that I am not yet an expat. BUT I need a serious neck surgery that US does not do. About the UnitedHealthcarePlan you got, had you already had the stroke (hope you are doing ok) when you enlisted the global coverage? I have an injured neck. Need surgery in January. Do you think that your plan would work?
ReplyDeleteHello Lydia,
Deleteit's difficult to say if the United Health Care plan through Seven Corners would cover your neck surgery. Yes they say there is $50,000 in pre existing condition coverage but I am not sure what all the conditions/restrictions are. You would have to read the policy details closely and probably have to be on the plan for at least 90 days to get a claim like this paid. It's confusing the way they word the pre existing condition coverage details.
But there are several great hospitals here where you can see prices and get a quote on your surgery, I recommend
Bumrungrad International Hospital in Bangkok: https://www.bumrungrad.com/en
I can find out the back doctor surgeon my friend used here in Pattaya at Bangkok Hospital Pattaya, he was very happy with his surgeon:
https://www.bangkokpattayahospital.com/en/about-hospital-en/overview-en.html
Regarding my insurance coverage when I had the stroke, I was on a plan through the WEA: Worldwide Expats Association, they are basically a criminal operation based in Florida. They refused to pay any of my medical bills because they said I had only been on their plan for 22 days even though I applied 60 days early to comply with their 30 day rule, but they bury you in red tape and "Pre Authorization" nonsense with a mountain of forms and paperwork. The Seven Corners company is legit, they are the administrators for the United Health Care plan; I have 2 friends who have been paid for thier claims, one friend needed hernia surgery and the other friend needed back surgery. So I am staying with them even though they raised my rate by 60% when I turned 65 in early March this year. The rate went from $80 a month to $130. They said it went up because I turned 65 and they had an overall rate increase. So I will raise my deductible to get a lower rate when I renew.
Health Alert – U.S. Embassy Bangkok, Thailand (March 20, 2020)
U.S. citizens who are considering returning to the United States are urged to work with their airlines to make travel arrangements while flights are still available. On March 13, 2020, the RTG’s Ministry of Public Health added the United States to its list of countries with ongoing local transmission. Travelers entering the Kingdom of Thailand who have been in the United States within the prior 14 days are subject to self-monitoring and reporting requirements upon arrival.
Effective as of 12:01 am, Sunday March 22, The Thai government now also requires such travelers to have a health certificate issued within 72 hours before arrival in Thailand certifying that they are “free of coronavirus,” as well as proof of medical insurance with at least $100,000 of overseas coverage. The health certificate must certify the traveler has displayed no evidence of acute respiratory infection in the 48 hours prior to departure from the U.S. The self-monitoring and reporting requirements upon arrival in Thailand remain, even with the health certificate and health insurance. All U.S. Citizens must prepare themselves to produce these two documents if they wish to be allowed to arrive in Thailand after 12:01 am, Sunday March 22. U.S. Embassies and Consulates will not be in a position to assist with regard to these documents.
All travelers arriving in Thailand will also be required to download the AOT Airports Application. Once the app is downloaded, travelers must fill in the required information in the COVID-19 Inbound Passenger Control Section and present this to immigration officials at all international airports. The language of the RTG Ministry of Health requirements is available on its website. Visit the Ministry of Public Health website for additional information on these new measures. See my blog for the links.