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Medicare Part B-- how to have a plan as an expat?


kimanjome

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2 hours ago, Mainecoons said:

In Texas our medigap policy costs basically zero.

In New Mexico it was a couple hundred bucks per month.

No idea why.

My buddy checked Medigap premiums with 100 percent coverage in San Diego recently and found it would be $345.00 per month. He is not in the low income bracket to get Medicare part D for medicines. Less than 100 percent coverage is lower, of course. It appears to be variable depending on where you reside from your and his experiences. I kept Medicare part B and won't be giving it up as we own a condo in San Diego but rent it and now very rarily spend anytime there but who knows down the road.

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1 hour ago, Tiny said:

I believe it is more if the doctor you choice will accept your coverage 

I was asking MC, sorry you misunderstood. As for us, we have never had a doctor refuse us because he/she/it/whatever did not accept medicare. 

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My medigap (which includes prescription coverage) is with my former employer (local government); I pay $84 a month for the two of us, total.  My fellow retirees are scattered all over the US and the world; the providers and their rates/plans are negotiated and contracted with my employer for 5 years.  I do not believe the rates are set by any state law.  My health plan administrator has assured us in writing, that should we want to use solely a Mexican address, that we would remain covered and told us they currently cover other retirees who do not have a US address.  Of course our coverage is limited outside the US (emergencies only in the 1st 60 days of any outside the US travel, same as for everyone under the plan regardless of home address).  

We have a home in the US and all of our doctors that we had pre-Medicare, all take Medicare, too.  In talking with friends in other states, that seems to be the rule, not the exception.

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Thanks, everyone.  I did some more digging. 

Most Seniors do NOT have Medigap;  latest statistics  say an average of  only 20-30% have it.  That is because 1) Medigap coverage is shrinking 2) Medigap costs are going up 3) The only way to obtain reasonably priced Medigap coverage is if you purchase it within 6 months of enrolling in Medicare.  After that, it is more expensive, and the private insurance companies can raise your rates due to age, and there is a look-back period for pre-existing conditions of 6 months, meaning, you have to pay for services until the Medigap policy kicks in.

At $150 or $200 a month Medigap might seem a fair price, but when you are looking at $350-$500 a month per person, that does become a bit more pricey.

As you may have guessed from my recent posts a health issue has arisen here with a spouse and we are looking at all the ways to deal with it.  Surprisingly (or not?),  it seems the best option for us now is to see a top-notch specialist in Guad--some of these physicians have fabulous credentials and are at the forefront of research with their US peers.  Not only that, the wait time to see one is a week, versus 3 months! NOB.  In the meantime we will find a new permanent address in the US we can call home, and go from there.     

 

 

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Regarding participation rates for Medicare Supplements: You have to look at both Medicare Advantage participants and "original" Medicare participants as well as those who would be under Medicare but due to low income are assigned to Medicaid.  

Here is an NPR story from a year ago https://www.pbs.org/newshour/economy/standard-medigap-plans-learning-new-tricks

Quote

 

First, some background. More than 12 million people had Medigap policies in 2015, representing 22 percent of the more than 55 million Medicare enrollees, according to the American Association for Medicare Supplement Insurance.

However, a much higher percentage of people using traditional Medicare have Medigap plans. That’s because about a third of Medicare enrollees have MA plans, which provide their own supplemental coverage and whose enrollees aren’t permitted to buy Medigap plans. Also, nearly 10 million low-income Medicare enrollees also qualify for Medicaid, and are not able to afford Medigap premiums. By my rough calculations, this means that 40 to 50 percent of basic Medicare enrollees purchase Medigap plans to help cover things that basic Medicare does not fully pay.

 

Sorry for your husband's predicament.  If you call a US specialist "cold" you may well wait a month or more for an appointment. 

However, if you have a former US doctor (say within the last few years), call him/her/them and ask them to arrange an appointment for your husband with a specialist.  Most likely you will be seen quickly, in less than a week.  This is has been my experience in FL, AZ, VA and PA.  In addition to our own medical needs, we were involved with managing the health care for our parents. 

I once had a doctor call me Christmas Eve late afternoon after seeing my MRI results and getting me an appointment for 12/26 with the head of a department at the Tucson Medical Center (I lived over an hour away in Bisbee).  Another doctor wanted me to see a specialist who was not on my (then) private insurer's "covered" list.  My local doctor arranged for that specialist to see me at a highly discounted flat fee (the specialist was only one who could have helped me in a tri-state area).  I was not particularly close with either of these referring doctors; one I had only seen once a year for 2 years.  Yet when I needed a specialist pronto, they each made it happen fast.  

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1 hour ago, Bisbee Gal said:

Regarding participation rates for Medicare Supplements: You have to look at both Medicare Advantage participants and "original" Medicare participants as well as those who would be under Medicare but due to low income are assigned to Medicaid.  

Here is an NPR story from a year ago https://www.pbs.org/newshour/economy/standard-medigap-plans-learning-new-tricks

Sorry for your husband's predicament.  If you call a US specialist "cold" you may well wait a month or more for an appointment. 

However, if you have a former US doctor (say within the last few years), call him/her/them and ask them to arrange an appointment for your husband with a specialist.  Most likely you will be seen quickly, in less than a week.  This is has been my experience in FL, AZ, VA and PA.  In addition to our own medical needs, we were involved with managing the health care for our parents. 

I once had a doctor call me Christmas Eve late afternoon after seeing my MRI results and getting me an appointment for 12/26 with the head of a department at the Tucson Medical Center (I lived over an hour away in Bisbee).  Another doctor wanted me to see a specialist who was not on my (then) private insurer's "covered" list.  My local doctor arranged for that specialist to see me at a highly discounted flat fee (the specialist was only one who could have helped me in a tri-state area).  I was not particularly close with either of these referring doctors; one I had only seen once a year for 2 years.  Yet when I needed a specialist pronto, they each made it happen fast.  

Very similar experiences to yours in Texas for us. I believe that one needs to be involved and plan ahead to be prepared when you need health care. The lack of preparation in advance can cause much angst.

 

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Bisbee Gal has the ‘more accurate’ statistic..... when one counts the number of people who have a medigap policy AND the 25% of Seniors who have a Medicare Advantage policy, then it is clear that over half the US seniors are ‘fully covered’.   BTW, the average cost of a Medi-gap “F” policy in the US, the Plan most often purchased, is $350/mo.  There is a version of the “F” plan that has very high deductibles and co-pays and it averages only $68/mo. but only comes into play after a lot of out-of-pocket expenses. 

While it is sad that half of the Senior US citizens don’t have a gap or Advantage policy coverage it should not be too big a surprise when one understands how many seniors live solely on their Social Security check from month to month.  And it’s not just Seniors of course. During the current government shutdown it has been an eye-opener to me to see/hear how many seemingly reasonably employed people state that they are living from paycheck to paycheck and don’t know how they will put food on the table much less pay a mortgage while in limbo. Very sad indeed. 

 

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We have just traveled back to Austin.  We were introduced to an Eatna plan there.  Medicare advantage plan. PPO, better than we had with United Health care and they credit back $102 per/ mo for me and my wife.  It is credited back to my SSI.  So basically my plan costs us about $32/ mo as apposed to $134 / mo.  They don't offer this plan all over, but is available in Travis county Texas along with come others.  Anyone interested my want to check it out.  Just my 2 cents worth. 

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7 hours ago, TRPhil said:

We have just traveled back to Austin.  We were introduced to an Eatna plan there.  Medicare advantage plan. PPO, better than we had with United Health care and they credit back $102 per/ mo for me and my wife.  It is credited back to my SSI.  So basically my plan costs us about $32/ mo as apposed to $134 / mo.  They don't offer this plan all over, but is available in Travis county Texas along with come others.  Anyone interested my want to check it out.  Just my 2 cents worth. 

PM sent, thanks

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Costs of Medigap Policies

The cost of Medigap policies can vary widely. There can be big differences in premiums that insurance companies charge for exactly the same coverage. As you shop for a Medigap policy, be sure you are comparing the same Medigap policy (for example, compare a Plan A from one company with Plan A from another company).

Each insurance company sets its own premiums. It is important to ask how an insurance company prices Medigap policies. How they set the price affects how much you pay now and in the future. Medigap policies can be priced or "rated" in three ways.

https://www.medicare.gov/find-a-plan/staticpages/learn/how-insurance-companies-price-policies.aspx?AspxAutoDetectCookieSupport=1

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9 hours ago, TRPhil said:

We have just traveled back to Austin.  We were introduced to an Eatna plan there.  Medicare advantage plan. PPO, better than we had with United Health care and they credit back $102 per/ mo for me and my wife..... snip.

That’s actually Aetna.... would almost be enough for me to move (back) to Texas. Almost

PPOs are a little different kettle of fish but I’m sure you researched that before the plunge. Good find!

 

 

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11 hours ago, TRPhil said:

We have just traveled back to Austin.  We were introduced to an Eatna plan there.  Medicare advantage plan. PPO, better than we had with United Health care and they credit back $102 per/ mo for me and my wife.  It is credited back to my SSI.  So basically my plan costs us about $32/ mo as apposed to $134 / mo.  They don't offer this plan all over, but is available in Travis county Texas along with come others.  Anyone interested my want to check it out.  Just my 2 cents worth. 

Frankly, I'm suspicious. I had Aetna insurance for several years through my employer and Aetna's first response to everything was a resounding NO! Aetna cannot be confused with Santa Claus.

Since qualifying for Medicare I have had a PPO plan based in the Portland, OR area. My plan costs me $134 (Medicare Part B equivalent) plus $19 out-of-pocket per month.  Not a bit of that is kicked back to SSI. However, an amount equal to Medicare Part B ($134/month) is automatically withheld from SSI leaving me with only $19/month to be paid by a separate check. No part of that $134 comes back to me.

I hope you are correct but I think there may be a misunderstanding.

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On ‎1‎/‎22‎/‎2019 at 12:12 AM, TRPhil said:

We have just traveled back to Austin.  We were introduced to an Eatna plan there.  Medicare advantage plan. PPO, better than we had with United Health care and they credit back $102 per/ mo for me and my wife.  It is credited back to my SSI.  So basically my plan costs us about $32/ mo as apposed to $134 / mo.  They don't offer this plan all over, but is available in Travis county Texas along with come others.  Anyone interested my want to check it out.  Just my 2 cents worth. 

Just talked with Aetna and yes if you have a mailing address in Travis county you get the discount.  Smoking hot deal.  (Proof of residency is a mailing address nothing more.)

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Insurance companies set rates for policies they which must be approved by state departments of insurance. States sometimes dispute or "discuss" rates with carriers but it always starts with the insurance carriers. Insurance companies must be registered and licensed in each state where they sell insurance and are subject to oversight by the State.

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4 hours ago, RickS said:

Which is a whole lot different than saying that ‘states set insurance rates’.....

I admit I used the wrong  when I used "set". Not thinking. I should have used "approved". My bad.  All I remember was the amount of work spent when we had to submit information to the State Insurance Commissions.

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  • 1 month later...
On 1/16/2019 at 4:18 PM, kimanjome said:

I do not have Medicare so I don't understand anything about it.  Calls to Medicare in the USA tell me one thing, while the Plan agents tell me another.  I am SO confused!

Every month my husband pays for Medicare Plan B.  Correct me if I am wrong, but this monthly payment is for "Insurance" and  it covers such things as office visits, lab tests, outpatient,  annual exams, etc.    It doesn't cover the charges 100%, but 80%.  Meaning, if my husband goes for an annual wellness exam and the doctor's fee (dictated by Medicare) is $100, then my husband pays $20.  If the doctor tells my husband he needs a full blood panel done $1,000, then my husband pays $200.  Is this true?  And, is there NO CAP to out-of-pocket contributions?  If my husband needed a $1,000,000- operation then he would be on-the-hook for $200,000 of it--is that right?

The Medicare agents with whom I spoke said my husband can also opt to join a Plan, since his monthly Part B contribution allows him to do so.  However, every plan I have looked at or spoken with a rep says you have to reside in the US at least 6 months of the year.  How do those of you here as residents have a Plan  NOB?  Use a family address?

Thanks for all the help and advice. 

 

 

Not sure if you have all your Medicare Part B questions answered. Ignore me if you have gotten your answers already. 

Here's what I think to just a few of your questions:

1. "If the doctor tells my husband he needs a full blood panel done $1,000, then my husband pays $200.  Is this true?"

True, unless you have supplemental insurance other posters talked about.

2. And, is there NO CAP to out-of-pocket contributions?"

No. There's a $185 a year deductible besides the 20% out of pocket cost.

3.  "If my husband needed a $1,000,000- operation then he would be on-the-hook for $200,000 of it--is that right?"

Not that much. Medicare Part A will kick in if your husband needs operation in the hospital. He will have $1364 per benefit period deductible in 2019 and no coinsurance for the first 60 days hospital. 

 

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Part B Medicare premiums have never been $500 per month. For us folks with an adjusted gross income of $85k (single)  it is currently around $135. Incomes (single) above $100+ is double that. The highest bracket is $500,000 and above and it approaches $500/mo. 

I don’t know Paco Loco but I suspect that if ‘his’ income was north of $500,000 he would have not skipped out on Part B when available. Or if he did, then he saved a ton of money by not signing up when 65.... like $6,000 per YEAR..... so his savings would have been $30,000. 

 

 

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