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


kimanjome
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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. 

 

 

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27 minutes ago, 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. 

 

 

medicare b  pays 80% of their approved amount, that being said normally a dr charges more than the approved amount so you normally pay more than the 20%

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I joined Medicare last fall. Signed up for a supplement (G) and a Part D plan. Pretty straightforward. I used Select Quote. One thing to be aware of is that supplement can be used in all 50 states as long as the provider accepts Medicare assignments. Medicare Advantage plans can be cheaper but are geographically specific and can only seek care in that specific area.

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I can't address ALL your questions, but here is a little about what I do:

I am a US citizen who has lived full-time in Mexico for 13 years. I maintain a US address at my son's house in the US, and he forwards my mail to IShop'n'Mail here in Ajijic via their Laredo address. My residence for Medicare and Medicare supplement plans and credit cards and a lot of other things is at his house. In phone calls I freely admit that as a wandering retiree, I love to travel, and I spend a lot of my time in beautiful Ajijic Mexico. This does not seem to be a problem--usually the person answering my inquiry is fascinated and would love to do this themselves when they retire;) I have also not had problems getting appointments to see doctors when I am in the US, altho, US healthcare being what it is, one has to make appointments well in advance unless you have an emergency. One wants to be registered with a doctor, so that if you have a serious medical problem, the doctor can be ready to see you when you arrive.

My one difficulty is that, as I get older, I no longer want to make that long trip to see all those doctors, but I do have to do that once every couple of years or so, especially to maintain a relationship with a primary care doctor who can arrange medical care if and when I need it. Perhaps needless to say, I go to doctors here for annual medical exams and most medical problems.

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Medicare IS confusing, we are new to it, too.  Some preventative care items have no co-pays like mammograms, bone-density tests, PSA tests.  

Here's a short blog by a man who had open heart surgery and he goes over what Medicare paid.  He had a Medigap policy, as do most Medicare patients.  He paid nothing out of pocket.  https://artchester.net/2018/04/heart-surgery-5-surgery-cost-medicare-hospital-staff/

After my mother had heart by-pass surgery I went over her bills with her and she had no out-of-pocket costs either; again, she also had a Medigap plan.  

 

 

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5 hours ago, monkey grease said:

medicare b  pays 80% of their approved amount, that being said normally a dr charges more than the approved amount so you normally pay more than the 20%

This is 100% contrary to my 12+ years on Medicare.  If a doctor agrees to take Medicare patients, they MUST adhere to the Medicare Approved Charges for everything that is covered. They may BILL Medicare for their normal fees but Medicare will not honor that charge and will pay only the approved amount. Your 20% is based on the Approved billing charge and not what the Doc might have billed.

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Well, as Mostlylost suggested to you, there are no simple answers and what is correct about one aspect does not necessarily  pertain to another aspect.  To make this even more difficult is the fact that there are "two kinds" of Medicare..... "Original" and "Medicare Advantage".... so far there is NOT an 'extra crispy' version.   There is not enough space on this page to explain how the two are alike and how they are not but I suggest that you might want to do some reading to find out more.... or you will be forever confused.

Medicare was originally set up with a Part A component.... basically covers hospital visits and some other things, but not doctors. Part A is covered with no additional fees for the consumer. Part B (not technically 'insurance', but coverage), added to Medicare later, covers the things you suggested in your Post. It is not free and ones pays for it generally as a deduction from their monthly Social Security check. It is currently about $130/mo and can, but does not always, increase annually.

An example of how coverage and percentages are not always the same can be explained by an example you (incorrectly) gave: you asked that, if your husband gets charged 20% for an annual wellness checkup, must he not also logically be charged that same 20% if he asks for a full blood panel? The answer is..... NO. Because there is no deductible for blood tests so Medicare pays 100% for that. This is just one example of how one cannot assume one thing because is true for another thing.  (P.S. Another error is assuming that your husbands annual wellness exam costs 'anything' to begin with.... that is one thing that Medicare covers 100% annually!).

Your other question about a cap on out-of-pocket expenses just cannot be answered because, again, it depends on several things. For example IF you husband also had a private Medigap policy as most people do....and paid yet another not-so-small fee for it.... that Gap policy would generally ‘pay for what Medicare does not cover, i.e. your 20%. Again, this is a generalization because there are so many nuisances to Medicare. 

Like Mostlylost I agree that one needs to spend some time studying all aspects of Medicare, Medicare Advantage, Medi-gap policies, Part A, Part B, Part D (drugs) etc etc.  It is not easy but until one at least understands the basics any discussion here or with an Agent is going to be very confusing and one will walk away asking the kinds of questions that you have asked. (I do NOT mean this in a snarly way, but merely as a recommendation for your sanity).

 

 

 

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OK here's what we did.  Established residence in Texas which we maintain now for banking and medical purposes.  Got a Medicare supplemental plan there, United Healthcare, excellent!  Established doctors in Arlington and Fort Worth.  Go for checkups, visiting friends, shopping once per year.  Get emergency care, reimbursed through our supplemental plan, here.  Get the other stuff done there.

So far so good.  Since we are too old to get any kind of decent health insurance here, this arrangement seems to work.  Considering adding Medivac at some point.

The quality of health care we have received in DFW has been uniformly excellent.  Here, a bit more variable but as we've learned how to arrange things better we believe the past pitfalls will be avoided.

Obviously this will only work as long as we can travel annually to DFW.  We are now looking at transferring our U.S. care and docs to the McAllen area to cut the trip in half.

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I’ve had a Medicare Advantage policy for quite a while so am sorta out of touch with what a Medi-gap supplement policy cost these days. Is yours ‘around’ $300/mo each?  Is it a Plan “F” policy?

While your approach, Paying Part B and a Supplement, seems to work for you I suspect that it would not be a very good option for many others Lakeside due to cost. $850/mo would go a long way in Mexico IF one could get a private policy... but that may be a big ‘IF’. 

If you decide to ‘migrate’ to McAllen for your coverage you might want to check up on a Medicare Advantage policy there.... there are several to choose from including, I think, United Healthcare which is who I have also. Premiums would be close to if not 0$ including Part D drugs. Just a thought....

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MC I suspect that you may have an Medicare Advantage policy.... no carrier would/could provide a true gap policy for free as they would have no avenue for profit. Medicare Advantage policies can/do offer for free as THEY are getting reimbursed handsomely by Medicare. This not true for Gap policies that depend on policy fees to cover costs and profit.

 

 

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11 minutes 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.

Are you allowed to select the doctors of your choice, without referrals, or must you use "their" doctors?

 

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On 1/17/2019 at 10:53 AM, Mainecoons said:

In Texas our medigap policy costs basically zero.

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

No idea why.

I believe that coverage is administered by state thus the rate is set by state.

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Well Tom no doctor is ‘required’ to offer his/her services to Medicare receipients and I think that is what Tiny was alluding to. But IF they do then they must accept the Medicare Approved Charges. I often see on the Forums comments that say it is very hard in the US to find a doctor who will accept Medicare patients  these days. This is contrary to my experiences over the years but I surely can’t attest to the entire US of A. I just don’t see/hear this as being a big problem but I’m sure there must be ‘pockets’ where it might be true.... California for one.

 

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25 minutes ago, Tiny said:

I believe that coverage is administered by state thus the rate is set by state.

Tiny, I don’t believe that ‘States’ set rates for Medicare policies. States DO have control over the  Medicaid program but that is a whole different kettle of fish. 

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8 minutes ago, RickS said:

Tiny, I don’t believe that ‘States’ set rates for Medicare policies. States DO have control over the  Medicaid program but that is a whole different kettle of fish. 

If you check what I had quoted before,  it was "medigap policy" coverage.

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