Jump to content
Chapala.com Webboard

Medical concerns about moving to Ajijic


DavidRC
 Share

Recommended Posts

 

23 minutes ago, AngusMactavish said:

Emergency service are covered here when one is a Medicare Advantage subscriber.

Yes, but in order to have a Medicare Advantage policy in the first place one MUST LIVE FULLTIME in the service area NOB wherein it was obtained. Could one game the system and fraudulently obtain a policy by saying they actually lived in the service area when they truly did not and actually lived in Mexico full time? Maybe, but the operative words here are ‘game’ and ‘fraudulently’.

As Bisbee Gal has suggested, the subject here is “Medicare” in Mexico for persons living in Mexico.... not visiting nor gaming the system to make it appear that one lives in the US.  It just does not exist. Period. 

 

Link to comment
Share on other sites

Again, you can maintain a DOMICILE in the US and get an Advantage plan. One can have many residences in various countries and living full time in one would be impossible. Your domicile is where you say it is. I really don't care what you do or think.

  • Like 2
  • Sad 1
Link to comment
Share on other sites

Medicare Advantage plans are based on where you actually live. 

From Medicare.gov

Who can join a Medicare Advantage Plan?

You can generally join a Medicare Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), or Medical Savings Account (MSA) Plan if all of these apply:

  • You live in the service area of the plan you want to join. The plan can give you more information about its service area. If you live in another state for part of the year, check to see if the plan will cover you there.
  • You have Medicare Part A and Part B.
  • You don't have End-Stage Renal Disease (ESRD).

Find someone to talk to

Find someone to talk to in your state Select your state...                     Alabama                     Alaska                     American Samoa                     Arizona                     Arkansas                     California                     Colorado                     Connecticut                     Delaware                     District of Columbia                     Federated States of Micronesia                     Florida                     Georgia                     Guam                     Hawaii                     Idaho                     Illinois                     Indiana                     Iowa                     Kansas                     Kentucky                     Louisiana                     Maine                     Marshall Islands                     Maryland                     Massachusetts                     Michigan                     Minnesota                     Mississippi                     Missouri                     Montana                     Nebraska                     Nevada                     New Hampshire                     New Jersey                     New Mexico                     New York                     North Carolina                     North Dakota                     Northern Mariana Islands                     Ohio                     Oklahoma                     Oregon                     Palau                     Pennsylvania                     Puerto Rico                     Rhode Island                     South Carolina                     South Dakota                     Tennessee                     Texas                     U.S. Minor Outlying Islands                     Utah                     Vermont                     Virgin Islands of the U.S.                     Virginia                     Washington                     West Virginia                     Wisconsin                     Wyoming 

Is your test, item, or service covered?

Search Medicare.gov for covered items 
 

Footer

 
Link to comment
Share on other sites

Hopefully people will call their Medicare Advantage plans and ask them if they can continue to be a member if they move to MX and find the answer for themselves.  Some things like health insurance are too important to screw around with.  If others want to lie to their insurance carrier about where they live, good luck with that.  

I agree, Rick....adios to this topic!

  • Like 1
Link to comment
Share on other sites

One last thing...

This is a post from Oct. 27, 2017.  Link here:  http://www.chapala.com/webboard/index.php?/topic/74151-keep-medicare/&tab=comments#comment-555279

 

Quote

 

AngusMactavish

Posted October 27

Dump Part B, Advantage or not. You always have Part A and that is the big buck coverage. Actually you can not qualify for an Advantage plan if you live here unless you tell some stories.

 

 

Link to comment
Share on other sites

Too bad some have poor English skills. The story is the difference between one's residence and their domicile. If I had a house here and one in France, I could still claim a US domicile and get an Advantage plan. I quit my US domicile and the named plan because I have no intention of returning to the US, but prior to that I would go back every six months for my tests and drugs. You can too.

  • Like 1
Link to comment
Share on other sites

....And that gives you Medicare coverage SOB? I don't think so. As long as you pay Part B you can always return NOB and use your Medicare. As has been said before, gaming the system is not out of the realm of possibility but anyone COUNTING on doing so might be in for a big (monetary) surprise and possibly more if you are actually engaged in Medicare fraud. Perhaps you might get to meet Michael Flynn.  B)

  • Like 1
Link to comment
Share on other sites

.....As long as they don't dig too deep into your actual living arrangements. Kind of like using Canadian satellite outside of Canada. Be careful what you say and sign your name to. And NEVER submit your claim through the USPS. That becomes mail fraud if they want to make an example of you. When I worked as a medical claims manager for a major insurance company a walk-in claimant who "just wanted to make sure we received his paperwork" set off all fraud alarms. The good ones know how to avoid Federal crimes. Without pulling up actual contract language I would be willing to bet what is required is "residence" and domicile is probably nowhere to be seen. These people know all about gaming the system. But, I have been wrong before.

  • Like 1
Link to comment
Share on other sites

6 minutes ago, AngusMactavish said:

Your living arrangements have no bearing upon your domicile. Some people are actually world citizens with no literary, but their domicile is where they say it is. 

OK, you win!

Link to comment
Share on other sites

https://www.medicareresources.org/blog/2015/07/21/a-medicare-enrollees-guide-to-travel-coverage/

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

https://www.medicareinteractive.org/get-answers/medicare-covered-services/medicare-coverage-overview/does-medicare-cover-my-care-when-i-travel

It seems like it would be pretty easy to determine how long you are out of the U.S. through customs/immigration, stamps in your passport, your foreign immigration status, etc. The "intent" is not to cover us outside the U.S. and while you "might" be able to get away with lying about your status you are pretty much committing fraud. The facts are the facts.

Trying to trick the system is not something I would take a chance with regarding my health - especially in a life threatening situations. But to each their own. If you just do things right you don't have to worry. Seems pretty black and white to me.

This whole discussion seems pretty silly. Just do it right!

  • Like 2
  • Thanks 1
Link to comment
Share on other sites

REC, you quote Medicare, but I keep talking about the Advantage plan. Apples and kumquats.

Medicare Part C May Cover Your Trip Abroad

One of the biggest benefits for anyone with Medicare Advantage is that they can travel and still be seen by a doctor or receive emergency care if something were to happen on their trip. Since retirees often travel, it’s difficult to do so if you only have Original Medicare, which is just Part A and Part B. Some Medicare Advantage plans provide coverage benefits for all health care needs when enrollees go outside of the United States, but it’s best to check with your health insurance company first.

https://medicarepartc.com/medicare-advantage-traveling/

  • Like 1
Link to comment
Share on other sites

And everything discussed about Medicare and all it's associated components now could be radically different in the very near future. Things are potentially changing. So all of this is speculation. And the status of Seguro Popular is as well. It's all a crap shoot at any given time. Nothing is certain, I guess you just have to use your best guessing skills. 

Link to comment
Share on other sites

Just now, zerbit said:

And everything discussed about Medicare and all it's associated components now could be radically different in the very near future. Things are potentially changing. So all of this is speculation. And the status of Seguro Popular is as well. It's all a crap shoot at any given time. Nothing is certain, I guess you just have to use your best guessing skills. 

The "impression" I am getting from the various news sources is that for those currently on SS, things won't change and the possible changes with affect new beneficiaries.

SP seems to be getting more funding and is expanding its services.

I wish us all luck, but I doubt that expats will ever be able to use Medicare in Mexico as our regular health care payment option.

Link to comment
Share on other sites

16 minutes ago, gringal said:

The "impression" I am getting from the various news sources is that for those currently on SS, things won't change and the possible changes with affect new beneficiaries.

SP seems to be getting more funding and is expanding its services.

I wish us all luck, but I doubt that expats will ever be able to use Medicare in Mexico as our regular health care payment option.

And yet, allowing out of country care at a lower cost would save money and allow more care for those in the system if funds were not cut as a result of savings. 

The claim of rampant fraud is used to prevent this, but it actually just keeps US dollars in the pockets of US care providers. And both parties have had chances to allow Medicare to be used abroad and have resisted. I guess they just want the current fraud to benefit US crooks. 

Link to comment
Share on other sites

4 minutes ago, zerbit said:

And yet, allowing out of country care at a lower cost would save money and allow more care for those in the system if funds were not cut as a result of savings. 

The claim of rampant fraud is used to prevent this, but it actually just keeps US dollars in the pockets of US care providers. And both parties have had chances to allow Medicare to be used abroad and have resisted. I guess they just want the current fraud to benefit US crooks. 

There's this:  We expats have to fund our own health care needs, whereas if we had remained in the states, Medicare would have to spend money to take care of us under Part A.  Medicare saves money by having the current prohibition.  Some expats continue to pay for Part B "just in case", so Medicare gets to keep that money, too.  But...that's something we had to factor in when we decided to move to Mexico, so I guess we have no good cause to complain.

  • Like 1
Link to comment
Share on other sites

47 minutes ago, zerbit said:

And yet, allowing out of country care at a lower cost would save money and allow more care for those in the system if funds were not cut as a result of savings. 

The claim of rampant fraud is used to prevent this, but it actually just keeps US dollars in the pockets of US care providers. And both parties have had chances to allow Medicare to be used abroad and have resisted. I guess they just want the current fraud to benefit US crooks. 

Never mind the actual fraud itself, can you imagine the cost of trying to authenticate a medical bill from say, Egypt, Venezuela, Kenya or even Mexico? We have insurance that is good worldwide and I can tell you that even a huge company like Aetna (who also processes vast numbers of Medicare claims as does Travelers Insurance for the government) has a hell of a time with my simple hernia and cataract surgeries. Foreign doctors and hospitals are not used to billing things the way American providers are. It results in multiple back and forth inquiries which has to be expensive for the company. Yes, they finally did calculate the benefit correctly and paid the right amount but it's 4 months later and they just got it right. After assuming Mexican Pesos were the same as USD and cancelling a couple of checks that were sent to providers instead of us. If they didn't make it clear that they were not just going to pay on a typical receipt you get in Mexico (Date of service, diagnosis and proper code for that service which is usually missing, in my experience) they would be flooded with fraudulent claims and the manpower to investigate them would far exceed any cost savings. Trusting people's honesty on a claim submitted to an insurance provider would be a sure fire way to go broke.

Link to comment
Share on other sites

2 minutes ago, pappysmarket said:

Never mind the actual fraud itself, can you imagine the cost of trying to authenticate a medical bill from say, Egypt, Venezuela, Kenya or even Mexico? We have insurance that is good worldwide and I can tell you that even a huge company like Aetna (who also processes vast numbers of Medicare claims as does Travelers Insurance for the government) has a hell of a time with my simple hernia and cataract surgeries. Foreign doctors and hospitals are not used to billing things the way American providers are. It results in multiple back and forth inquiries which has to be expensive for the company. Yes, they finally did calculate the benefit correctly and paid the right amount but it's 4 months later and they just got it right. After assuming Mexican Pesos were the same as USD and cancelling a couple of checks that were sent to providers instead of us. If they didn't make it clear that they were not just going to pay on a typical receipt you get in Mexico (Date of service, diagnosis and proper code for that service which is usually missing, in my experience) they would be flooded with fraudulent claims and the manpower to investigate them would far exceed any cost savings. Trusting people's honesty on a claim submitted to an insurance provider would be a sure fire way to go broke.

There are always solutions to technical issues if we seek them out. I won't go into fraud, as that is created by for profit issues. 

Link to comment
Share on other sites

As I see it, the major point is that Medicare saves ALL  the cost of medical care for us by not providing for any care outside the U.S. except for travel.  Why would they want to change that?  If they are looking to save money these days, there is zero motivation to change their current policy.

  • Like 1
Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...