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Receiving Medicare (B) services in USA while having a Mexican address


TrueBrit

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I have my Mexican address on file with most state and US government agencies (I didn't want jury duty etc).  I have had no problem - I receive my Social Security.  I currently receive Blue Shield health insurance as part of a retirement package but when I turn 65 next week I will be eligible for Medicare and things change.  I have opted to sign-up with Medicare Part B and my current Blue Shield Health Insurance converts to a Medicare Part B supplemental insurance.  Now I know that Medicare does not cover services outside the USA.  I have separate health insurance coverage for Mexico.  However, in calling my ex-employee, Blue Shield, Medicare and the Social Security Administration, no-one can give me a definitive answer to this question.
 
If I have an address outside of the USA on file with SSA and I visit the USA, while INSIDE the USA can I take advantage of Medicare, i.e. will Medicare cover me for services performed in the USA by a doctor who accepts Medicare?
 
I have called the above several times and often get conflicting answers.  No-one can point me to any regulations that definitively answer this question.  Having the SSA agent tell me "I think so" is not very comforting.  Some have told me 'no' - with a Mexican address, Medicare will not cover you for anything inside or outside the US.  Even the gentleman giving the emergency medical flights presentation lakeside in the coming weeks could not answer it - and you think the success of his company would depend on knowing the answer to this question.
 
So, is anyone else in this situation?  And has had experience with Medicare inside the USA?  Is it worth keeping Medicare Part B? (as it is not free)
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I suggest that you get in touch with the SS administration, which has a website covering such questions.  Information from us folks on the web is worth what you pay for it, but I'll give you my best worthless opinion:  As I understand it, as long as you are eligible for Medicare and are signed up for Part B, you are entitled to receive care while you are  in  the United States. There have been a few scams alleging that you can do otherwise, but they didn't last long.  Your Mexican address doesn't matter. It's where your body is when you receive the care. 

I'd suggest you verify this with the SSA official site on the subject. 
 

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I'm also so expert, but I don't think your place of residence matters.  I believe if you are eligible, then where you receive the care is what matters.  Sometimes, it takes asking the question a different way to get a reply. I would ask it this way "does my address or place of residence affect my Medicare coverage?".  Another thought if you are really worried (which you are) is to give them a US address even if it is in c/o someone else.  You have probably tried this, but how about going to the website for an answer.

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I turned 65 a year ago; have lived in MX for 12+ years.  Do not have a US address other than Handy Mail.  No house in US for 20 years.

Here is what I was told and what I understand:

I was able to sign up for Medicare A and B regardless of where I lived (and have done so using Laredo mailing address same one I use for banking other business).  Part A and Part B can be used only in the US, if I can get myself there for treatment.

Part A covers hospitals and some doctor expenses. Part A is free.

Part B covers doctors visits, other doctor bills, tests, treatments etc. that aren't covered under Part A.  HOWEVER, more and more medical expenses are being shifted from Part A to Part B BECAUSE under Part B, Medicare pays 80% only of bills.  Part B costs me around $110 a month; it can be more if your income is high. 

Most folks in US, buy a "Medigap" policy to cover that 20%that Part B doesn't cover (which can be quite substantial with a serious medical event).  Those policies run between $150 and $200 a month.  HOWEVER, Medigap policies are only issued to persons residing in the US and your premium is based on your zip code.  I  made a few calls and got some online applications, all of which required me to affirm I had a US residence.  I was not willing to lie on the application about residence, so I do not have Medigap coverage.  That means if I decide to go to the US for medical treatment (say surgery, chemo), I am liable for up to 20% out-of-pocket expenses that are not covered by Part A or Part B.  

While I expect  to live out my days here in Mexico, for the time being I am buying Part B just in case I decide to go back to the US for medical treatment or other reasons.

I have not gotten quotes from Mexican insurance as I have been told at age 66 with a pre-exisiing condition (HBP) that I would either be turned down or very high premiums with several years waiting on pre-existing condition.  

 

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As you can see most or all are in agreement. The following has yet to be discussed so I will start. I have lived here for 12 years also and HAD the part B with medicare and have spent over $13,000 on part B without ever using it. Recently I needed surgery and checked with the doctors both here and back home who both knew my condition, needs and cost. I oped for having the surgery with a highly recommended doctor here in Guadalajara. Why? This doctor in Guad. has 6 to 8 years of U.S. training, no flying round trip or staying with family or friends etc. The FULL cost for ALL medical needs including 4 post surgery house calls were approximately $ 4,000 USD here as opposed to paying out of pocket for the 20% part B $6,500 USD to $9,500 USD plus air fair etc, etc. So I am now saving over $1,000 per year by having dropped part B with intentions of continuing to live my life out here. Wish I had dropped Part B when I first moved here, that would be another $ 13,000 USD in my pocket. If I decide to move back home tomorrow or next year I can pickup part B again by paying a penalty. 

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I've told this story before, but if you haven't heard it, here goes:  I cancelled our Part B coverage for me and my spouse a dozen years ago. Given a rate of 100 U.S. per month per person, we now have a "medical savings account" of over $30,000 U.S.  Since we are happy with Mexican medical care and have no desire to return to the U.S., especially if sick already, we expect to continue covering our needs out of pocket, backed by IMSS for any real disaster.  This may not be the way others are comfortable going, but so far, this works for us.  We are also assiduous in taking care of our own health in the simple ways and haven't needed much care.

There are a few companies that will airlift you to the U.S. for care, but of course they won't do this until you've been "stabilized" here......which can mean the difference between life and death before you ever get on the plane.  Personally, I shudder to think of being in that situation. I'd rather stay here, but that's just me.

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6 hours ago, gringal said:

I suggest that you get in touch with the SS administration, which has a website covering such questions.  Information from us folks on the web is worth what you pay for it, but I'll give you my best worthless opinion:  As I understand it, as long as you are eligible for Medicare and are signed up for Part B, you are entitled to receive care while you are  in  the United States. There have been a few scams alleging that you can do otherwise, but they didn't last long.  Your Mexican address doesn't matter. It's where your body is when you receive the care. 

I'd suggest you verify this with the SSA official site on the subject. 
 

I have contacted Medicare and SSA on several occasions, but they were less than definitive.  One time the person kept quoting me the regulation about no Medicare coverage outside the US.  I got opinions but no-one could point to any government regulation that was definitive.  I was talking to them this morning and even with some extra info from me they were still arguing amongst themselves what would happen if I submitted a Medicare claim for services performed in the US.

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6 hours ago, ajijicbound said:

thanks for the link. it appears to be for non-US residents establishing residency in order to obtain Medicare.

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6 hours ago, John Galt said:

I'm also so expert, but I don't think your place of residence matters.  I believe if you are eligible, then where you receive the care is what matters.  Sometimes, it takes asking the question a different way to get a reply. I would ask it this way "does my address or place of residence affect my Medicare coverage?".  Another thought if you are really worried (which you are) is to give them a US address even if it is in c/o someone else.  You have probably tried this, but how about going to the website for an answer.

I thought exactly the same thing.  I assumed this for a while until someone in my retirement assistance center of my past employer mentioned that she didn't think so.  And so began my effort to find out a definitive answer.  I have been to the SSA website, I have called several times and I have yet to find a documented definitive answer.  Lots of opinions even between the people in the SSA call center.

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6 hours ago, lakeside7 said:

My two cents...you are OK for Medicare, however your supplementary insurance may require that you have a US address??

I found out that regardless of Part B eligibility, my Blue Shield Medicare Part B supplemental insurance would cover me for six months.  After that....nothing.  It was then I started to question my assumption that I would automatically be eligible for Medicare in US regardless of residency address,

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5 hours ago, hammerhead said:

As you can see most or all are in agreement. The following has yet to be discussed so I will start. I have lived here for 12 years also and HAD the part B with medicare and have spent over $13,000 on part B without ever using it. Recently I needed surgery and checked with the doctors both here and back home who both knew my condition, needs and cost. I oped for having the surgery with a highly recommended doctor here in Guadalajara. Why? This doctor in Guad. has 6 to 8 years of U.S. training, no flying round trip or staying with family or friends etc. The FULL cost for ALL medical needs including 4 post surgery house calls were approximately $ 4,000 USD here as opposed to paying out of pocket for the 20% part B $6,500 USD to $9,500 USD plus air fair etc, etc. So I am now saving over $1,000 per year by having dropped part B with intentions of continuing to live my life out here. Wish I had dropped Part B when I first moved here, that would be another $ 13,000 USD in my pocket. If I decide to move back home tomorrow or next year I can pickup part B again by paying a penalty. 

Thanks hammerhead, I am slowly coming to the realization that this is probably the best option for me.  And I think "hammerhead" is not a covered condition ;)

3 hours ago, gringal said:

I've told this story before, but if you haven't heard it, here goes:  I cancelled our Part B coverage for me and my spouse a dozen years ago. Given a rate of 100 U.S. per month per person, we now have a "medical savings account" of over $30,000 U.S.  Since we are happy with Mexican medical care and have no desire to return to the U.S., especially if sick already, we expect to continue covering our needs out of pocket, backed by IMSS for any real disaster.  This may not be the way others are comfortable going, but so far, this works for us.  We are also assiduous in taking care of our own health in the simple ways and haven't needed much care.

There are a few companies that will airlift you to the U.S. for care, but of course they won't do this until you've been "stabilized" here......which can mean the difference between life and death before you ever get on the plane.  Personally, I shudder to think of being in that situation. I'd rather stay here, but that's just me.

The gentleman giving the presentations at Sunrise Café about emergency flights back to US couldn't answer my question and it would appear as if his business depended on knowing the answer.

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I am registered with Social Security with my Ajijic address, so i assume that is my address for Medicare as well. I have had my Blue Cross-Blue Shield of IL Medigap since 2008, when I was 68. I also own a condo in Chicago. That is where my Medigap  I had cataract surgery in 2013 & 2015 in IL, as well as my normal annual physical and flu shots as a national-chain pharmacy. I have not had any difficulties with Medicare which knows I live in Mexico, nor with BC & BS.  I have since leased my condo, though I still own it. I have changed my banking and credit cards info to my Laredo box, but have never changed it with BC & BS.

The Part B & Medigap savings has been a passing thought, but insurance is insurance, so i have considered it money well spent.  I had never thought before about my Medigap possibly being a problem with USA coverage. Now, it is a question that needs an answer.

 

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1 hour ago, NLU said:

I am registered with Social Security with my Ajijic address, so i assume that is my address for Medicare as well. I have had my Blue Cross-Blue Shield of IL Medigap since 2008, when I was 68. I also own a condo in Chicago. That is where my Medigap  I had cataract surgery in 2013 & 2015 in IL, as well as my normal annual physical and flu shots as a national-chain pharmacy. I have not had any difficulties with Medicare which knows I live in Mexico, nor with BC & BS.  I have since leased my condo, though I still own it. I have changed my banking and credit cards info to my Laredo box, but have never changed it with BC & BS.

The Part B & Medigap savings has been a passing thought, but insurance is insurance, so i have considered it money well spent.  I had never thought before about my Medigap possibly being a problem with USA coverage. Now, it is a question that needs an answer.

 

Having worked in hospital information systems for 20 years, there exists an adversarial relationship between insurance companies and hospital/patient.  No real surprise there.  The insurance companies only tend to challenge large bills and they will use any means necessary to avoid payment.  They will search for anomalies in applications as evidence of deceit.  I have always been scrupulously open and honest with insurance applications as I don't want to give them any ammunition for a claim denial.

It may well be that the problem does not exist and that Medicare doesn't care about a foreign address.  I have understood during phone conversations with SSA that they aren't really sure - well the agents who answer the phone anyway.  I know for a fact my Medicare B supplemental insurance will not cover me after 6 months with an address outside of the country.  However in true insurance company form, they were quite happy to accept my premium without informing me of this.  I had to ask directly before they clarified their policy and told me, yes they would still accept my payments after six months, and no, they would not pay for any claim after that time.

The problem as I see it is that we don't have access to the information we need to make a decision.  Because of this my plan was to try Medicare in US and see how the claim was processed.  This is not an ideal way to approach healthcare insurance decisions.

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1 hour ago, Kyle said:

When BCBS found out we lived in Mexico they canceled our Medigap ins.  Be very careful, if you file a claim I am sure they will find any way to not pay

This link makes it clear that only emergency care outside of the U.S. is covered:

https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html

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1 hour ago, Kyle said:

When BCBS found out we lived in Mexico they canceled our Medigap ins.  Be very careful, if you file a claim I am sure they will find any way to not pay

This link makes it clear that only emergency care outside of the U.S. is covered:

https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html

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SS and Medicare don't care where you live.  However, Medicare will only pay for services performed inside the US except for some very limited exceptions.

Medigap premiums and payments are based on where you live.  Most require that you live in the US and some will only pay within a certain area of where you live.  Read the policy very carefully.

IMSS is dirt cheap and if you get accepted they have a 2 year exemption on certain things.  

Seguro Popular is available to people with Permanente over 60 free.  They may cover with other visas, just don't know.

I don't have Part B or any other insurance other than Seguro Popular.  I pay out of pocket with the savings and use Seguro Popular as a backup.

IMHO, medical care is better in MX than in the states.  Over my life, I've had several instances to compare care on both sides of the border.  I prefer the MX version much better.

 

 

 

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There are a lot of reasons for a US citizen to have some kind of physical address of record in the US. Certainly applies to financial firms, most of whom will not have you as a client if you reside in Mexico. To avoid jury duty? Seriously? 

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8 hours ago, jrm30655 said:

 

IMSS is dirt cheap and if you get accepted they have a 2 year exemption on certain things.  

Seguro Popular is available to people with Permanente over 60 free.  They may cover with other visas, just don't know.

 

 

 

 

IMSS will exclude you from joining for some chronic diseases; HIV positive, chronic kidney disease, COPD, mental illness, drug and alcohol addction, and more. They have a  6 month, 1 year , 2 year and 3 year waiting period on other chronic diseases and treatments and operations needed, It depends on what condition you are in when applying.

Seguro Popular takes legal residents of Mexico. Residente Temporal or Residente Permanente and anyone, any age can join with any pre-medical conditions and only about 2% of the 49,000,000 members pay an annual fee for their family. Renters and people without a vehicle do not pay

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From the IMSS website:

Exclusions to join,

Google Translation:

"• not  subject to insurance people who have: malignant tumors, chronic degenerative diseases (late complications of diabetes mellitus), diseases: Hoarding (Gaucher disease), chronic liver disease, kidney failure: Some pre-existing, such as illness chronic valvular heart disease, heart failure, sequelae of ischemic heart disease (arrhythmia, angina or myocardial infarction), chronic obstructive pulmonary disease with respiratory failure, among others
chronic systemic connective tissue diseases, addictions like alcoholism and other substance abuse, mental disorders such as psychosis and dementia; congenital and acquired immunodeficiency syndrome or Human Immunodeficiency Virus positive of diseases (HIV)"

 

http://www.imss.gob.mx/tramites/imss02014

It also states there is a minmum of 2 family members to join.

"Individual must be at least 2 people, the head of the family group and your immediate family, as spouse or concubine , children, father, mother, or your additional family members, such as grandparents, grandchildren, siblings, cousins, children of siblings, siblings of parents. If you are the owner of the family group and if you reside abroad, you can also purchase this insurance for your family."

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If you want official information, here is the link:

http://www.medicareinteractive.org/get-answers/medicare-and-other-types-of-insurance/medicare-and-living-abroad/medicare-coverage-when-living-abroad

Speculation is not the best way to approach health care decisions.  Senor Google is much more useful as an advisor.

 

 

I think it clear that we know this.

 

The question now is Medigap. This site does not mention it.

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