Medicare notes for US expats in the DR

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mountainannie

Guest
FYI -

If any USA expats are under 65 and considering returning to the USA in their later years --

info on the rules for Medicare -

If you are eligible for "free" Medicare (have worked and paid in for 40 quarters) and do not sign up for Part A (hospital insurance) in the original enrollment period, you will pay a penalty of 10% for twice as long as the time that you did not enroll. (did not enroll until age 67 - you will pay the penalty for 4 years)

If you do not sign up for Part B (doctors) when first eligible (last year premium was $135.50 per month for most)
If you do not sign up for Part B when first eligible, your premium may go up 10% for each year that you were not enrolled. THIS PENALTY IS PERMANENT.

Thus - if you do not file for Part B until you are 75, your premium will be 100% of $135 (I am not sure exactly how they compute the compounding - but you get the picture).

There is also a penalty added if you do not sign up for Medicare Part D (drug plan) when you are first eligible. That penalty is fixed now at 1% per month. Average cost of this insurance is about $33 per month. THIS PENALTY IS PERMANENT.

Enrolling in some Medicare Advantage plans may circumvent the penalties and costs for both PartB and Part D --

Note that Medicare only covers 80% of costs - you are responsible for the other. Some Medicare Advantage plans cover the entire costs but also limit the range of doctors and hospitals that are included and require referrals to specialists.

Medicare Supplemental Insurance plans which cover a certain percentage of the other costs are available at varying costs but must also be enrolled in at age 65 in order to guarantee acceptance. Otherwise, a health questionaire or exam may be required.

I do not know how enrollment in Medicare or Medicare Advantage plans work for those who do not have a USA address. Perhaps others can speak to this.

(estimated mean capital spending in the last year of life is $80k https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0174)
 
A

AlterEgo

Guest
As far as Part B, there can be extenuating circumstances. I was covered under Mr AE’s health insurance for some time, and when he decided to retire all I needed was a paper from his employer showing when coverage was terminated for me to pick up B without any penalty. I’m wondering if they would accept Dominican insurance the same way.
 
C

cobraboy

Guest
One needs to take Part B when they first sign up for Medicatre, or you are forever screwed.

Just do it. The decision should not be an option.
 
S

SKY

Guest
There are Medicare Advantage plans available where you do not need a referral to visit any specialist and pay no co pay. United Health Care for one has some depending on your address in the US. Many others do also. Highly recommended to get one.

I do not think it is possible to get a Medicare Advantage plan without a US address, as the plans are different all over the US.
 
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windeguy

Guest
One needs to take Part B when they first sign up for Medicatre, or you are forever screwed.

Just do it. The decision should not be an option.
For me , Part A is free, Part B is currently $135.50 a month. I have no US based address and none is needed for Parts A and B.

I have one year minus 4 days to consider my options on this. Regarding add-ons to medicare I found this:


If people decide to retain their Medicare, they should know that basic Medicare – including Medigap plans — will cover them right away should they return to the U.S. They do not need to establish residency in the U.S. to be covered. However, they do need a local residence to use Medicare Advantage and Part D prescription drug plans.

Basic Medicare permits enrollees to get care anywhere in the U.S. from doctors and hospitals that accept Medicare patients. Basic Medicare includes Part A for hospital coverage and Part B for doctors, outpatient expenses and durable medical equipment. Many people with basic Medicare also purchase Medigap plans, which provide supplementary coverage that plugs many of the coverage holes in basic Medicare.

Medigap plans are regulated by the states, and a person must be a resident of a particular state before being able to purchase a Medigap plan from insurers in that state. After that, however, it turns out that their Medigap plan will cover them anywhere in the U.S., and they need not have an established U.S. residence to use their policy.


https://www.pbs.org/newshour/economy/retired-expats-question-remains-keep-medicare-coverage-not
 
W

windeguy

Guest
One needs to take Part B when they first sign up for Medicatre, or you are forever screwed.

Just do it. The decision should not be an option.
As someone who hates most forms of insurance with a passion, I may be forced to admit this is true even for me. I am just now looking into why I should pay $135.50 a month for something I might never use.
 
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windeguy

Guest
Medigap

Just looking into Medigap plans that are another way to supplement Parts A and B. However, a state residency seems to be a requirement to sign up for a Medigap plan and I have no such residency in the US.
 
S

SKY

Guest
Forget Medigap, if you live in the DR and want a plan go for Medicare Advantage. All you need is an address in the US, not residency. I can give you a plan in Miami that pays in full everything, including all hospital bills with no co pays for specialists and NO referrals necessary. And I have yet to find a Doctor that did not take it. Also pays up to about $5,000 a year for prescription drugs, $200 a year for eyeglass's, free gym membership in top flight gym, etc. I can go on and on with this, but you get the picture.

I forgot to mention there is no additional premiums besides the money you already pay for Part B.
 
P

playacaribe2

Guest
As someone who hates most forms of insurance with a passion, I may be forced to admit this is true even for me. I am just now looking into why I should pay $135.50 a month for something I might never use.
I say the same thing every time my homeowners/car insurance/life insurance premiums are due......it, like any insurance, is something you have and hope you never use....the latter being inevitable.


Respectfully,
Playacaribe2
 

karmatourer

Member
Nov 15, 2018
61
19
8
Open enrollment open now until 1st week of December. Medicare website is a good starting point whether you are currently enrolled or not. There are 30 plans in my area code to choose from and its easy to compare apples to apples on the website.
 

windeguy

Well-known member
Jul 10, 2004
31,858
623
113
I say the same thing every time my homeowners/car insurance/life insurance premiums are due......it, like any insurance, is something you have and hope you never use....the latter being inevitable.


Respectfully,
Playacaribe2
I do have car and medical insurance. The first is a legal requirement, the second is a personal requirement. The other two forms of insurance, life and home, I was never a fan of life insurance and I have ignored home insurance since leaving the US.

As for Medicare and its options, that will be a consideration in the not too distant future.
 

SKY

New member
Apr 11, 2004
9,920
216
0
This Plan Actually Pays You Back $100 per month From Your Part B Premium

Medicare Advantage Plan
Simply Extra (HMO)
Compare
Office Copay

PCP

$0.00 copay

Specialist

$15.00 copay

Annual Deductible

$0

Out-of-Pocket Maximum

In-network:$3,400.00 out-of-pocket limit.

Your Total Monthly Premium
$0.00

This plan has a $100.00 Part B premium reduction. Simply Extra (HMO) is a Medicare Advantage Health Maintenance Organization plan with a Medicare contract.

Simply Healthcare Miami Dade, Florida
 

SKY

New member
Apr 11, 2004
9,920
216
0
You are wrong. You go to your Primary Doctor for all checkups at no cost. And you can go whenever you want with no limit.

PCP

$0.00 copay PCP is Primary Care Physician always free.

In fact the company insists on a checkup every year. And they will contact you if you don't go.
 

windeguy

Well-known member
Jul 10, 2004
31,858
623
113
You are wrong. You go to your Primary Doctor for all checkups at no cost. And you can go whenever you want with no limit.

PCP

$0.00 copay PCP is Primary Care Physician always free.

In fact the company insists on a checkup every year. And they will contact you if you don't go.
It is good to be wrong in this case. I could not find that an annual physical exam is covered, just a wellness exam which is essentially a conversation. Where does it say annual physicals (which is what I mean by checkup) are covered?

Here is what I keep finding about an annual physical exam:



Health AARP Medicare Question and Answer Tool

Will Medicare pay for a yearly physical examination?

Medicare does not pay for the type of comprehensive exam that most people think of as a “physical.” But it does cover a one-time “Welcome to Medicare” checkup during your first year after enrolling in Part B and, later on, an annual wellness visit that is intended to keep track of your health
.

https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-physical-exams/
 

SKY

New member
Apr 11, 2004
9,920
216
0
It is good to be wrong in this case. I could not find that an annual physical exam is covered, just a wellness exam which is essentially a conversation. Where does it say annual physicals (which is what I mean by checkup) are covered?
Listen to me please. PCP is free and all Specialists on this plan the fee is $15. Your PCP will insist on seeing you at least once a year. You can get as many checkups as you want. Please, I have had this for years and don't need to argue about this.
 

SKY

New member
Apr 11, 2004
9,920
216
0
Medicare does not pay for the type of comprehensive exam that most people think of as a “physical.” But it does cover a one-time “Welcome to Medicare” checkup during your first year after enrolling in Part B and, later on, an annual wellness visit that is intended to keep track of your health.

This is NOT basic Medicare. It is different, as you get many more benefits in your Advantage Plan. Now you have that number I gave you awhile back. Call her with any more stupid questions please.
 

chico bill

Lobotomy Surgeon
May 6, 2016
6,385
256
83
It is good to be wrong in this case. I could not find that an annual physical exam is covered, just a wellness exam which is essentially a conversation. Where does it say annual physicals (which is what I mean by checkup) are covered?

Here is what I keep finding about an annual physical exam:



Health AARP Medicare Question and Answer Tool

Will Medicare pay for a yearly physical examination?

Medicare does not pay for the type of comprehensive exam that most people think of as a “physical.” But it does cover a one-time “Welcome to Medicare” checkup during your first year after enrolling in Part B and, later on, an annual wellness visit that is intended to keep track of your health
.

https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-physical-exams/
Part B does not cover it, you need Medicare Advantage or a supplement - My Humana supplement covers it, but not in DR - of course.

I assume if socialists get elected and Medicare for All becomes the insurance for everyone they will cover Americans around the globe ? After all medical treatment is cheaper outside the US right.
 

SKY

New member
Apr 11, 2004
9,920
216
0
Part B does not cover it, you need Medicare Advantage or a supplement - My Humana supplement covers it, but not in DR - of course.

I assume if socialists get elected and Medicare for all becomes the insurance for everyone they will cover Americans around the globe ? After all medical treatment is cheaper outside the US right.
What do you think the plan I posted is? Basic Medicare only covers 80%. Medicare Advantage plans cover 100%.
 

windeguy

Well-known member
Jul 10, 2004
31,858
623
113
Part B does not cover it, you need Medicare Advantage or a supplement - My Humana supplement covers it, but not in DR - of course.

I assume if socialists get elected and Medicare for All becomes the insurance for everyone they will cover Americans around the globe ? After all medical treatment is cheaper outside the US right.
There is virtually a zero chance a Medicare for All plan will be established in the US, so that is a moot point (at least virtually).

SKY, I will continue to ask stupid questions as I see fit as the time for my enrollment approaches. Many people on Medicare A and B, will not be getting free annual physical exams. I certainly hope to not be one of them.