Jump to content
Chapala.com Webboard



Recommended Posts

On 10/6/2020 at 8:17 PM, lakeside7 said:


1)  With respect I would suggest that there are quite a number of people with homes in the US and Mexico and are legit..why in the world would having a home/vacation place here or any place overseas disqualify you?  

On 10/6/2020 at 6:27 PM, lakeside7 said:


2)Many attendees like me do not have APlans are are paying significant amount of monthly premium fees. 


3)Now that we have your attention perhaps you can explain/share with "us" who many be considering switch to a APlan and "saving money" what are the Pro's and Con's of each policy.  


4)For myself I see it as a loop hole that you may or may not choose to take...and the longer you live in Mexico you begin to see and experience many loop holes as the norm....



(This will be a long Post, so those of you who are not the least bit interested can just cruise on by)


Expand the above quotes....



lakeside7, to address some of your comments and questions from the above quote.....

1). Having a home abroad surely does not disqualify one... not at all. Medicare could care less what you own/where. What 'disqualifies' one is trying to use Medicare out of the US for other than emergencies while traveling.  

2) This.... high premiums of up to $300 per month for a Supplement policy.... is exactly why millions of folks try/use a Medicare Advantage program in the first place. But there are other things that 'might' make one hesitate in getting, as you call it, an APlan. See the following for a partial explanation.

3) The short version:  In 2003 Medicare started offering a different version of Medicare called Medicare Advantage, Part C. These programs are NOT run by Medicare but by private-party insurance companies like Aetna, United Healthcare, et al. These programs MUST meet certain Medicare rules but have the option to offer different coverages and different pricing structures. This is not the place to describe just HOW an APlan can offer such good pricing... like $0 premiums!.... but there are good reasons. One of the reasons... and it is one of the largest ones.... is that ALL APlan policies are run like an HMO... the plans are location specific, there is an In-Network requirement. One can ONLY go to Doctors, Hospitals, etc who are qualified APlan insurance company... In-Network it is called.... and your current Doctor/Hospital of choice possibly may not be in the Network. This way the APlan 'has control over' the Doctors etc. and can control costs. 

Another requirement of an APlan is that you must have a specified PCP (Primary Care Physician) that the plan recognizes and he/she must be seen every time first. This PCP and your APlan 'controls' your use of the Network.  If you think you need an X-Ray or a Colonoscopy or a eye exam or a bad rotator cuff looked at, you can't just waltz into that Specialist's office, you must first go to your PCP and then he/she must refer you to that Specialist.... and that Specialist must also be In-Network!  

Same with hospitals, even emergency rooms... you can only go to ones that are In-Network. If you favorite hospital is not In-Network you can go there but you will pay a much higher cost out of pocket to do so. 

Also, similar to Original Medicare, with an APlan there are usually out of pocket costs such as deductibles, office visit payments, drug deductibles, Out Patient hospital visits, MRIs etc etc that one must pay when they are visited. My office visit cost is $10 but an annual extensive medical checkup is $0.... the insurance company wants to keep you healthy and well. A visit to my orthopedic Doc Specialist is $40 for an office visit.

And with an APlan policy, meds are usually covered but with some deductibles and without an additional monthly premium for Plan D drugs. If one has Original Medicare, Plan D drug coverage is NOT covered but for an additional $ premium ($45/mo?)one can add it on.  As example my APlan deductible for my high blood pressure med is $2 for a month's supply at a local pharmacy OR I can get a 90-day supply of it mailed to me for $0. Some meds are higher... $10-$40 co-pay.... at a local pharmacy but certainly not outrageously high unless one is on a exceedingly expensive drug like maybe for RA. And for all of this I am paying nothing extra for Plan D drugs. 

But with an APlan I can't just waltz into a doctors office or hospital for a non-emergency reason in, say, Poughkeepsie N.Y., and expect to not pay an arm and a leg for that visit. But I CAN do that with Original Medicare/Supplement...assuming that particular Doc in Poughheepsie is taking new Medicare patients!...and not pay a dime as it is covered by those policies. It's part of why one is paying up to $300 per month.

I could go on but these are I think the highlights of the differences between an APlan and Original Medicare w/Supplement as you are doing with Aetna. So why would the 22-million-in 2019 citizens change to an APlan with all these extra restrictions?  Well IMO it is usually because of the cost differential.... the monthly premium is usually between $0-$50 per month with these plans... mine has been $0 for the last 14 years.... instead of maybe $150-$300 per month depending on one's exact Medicare Supplement Policy coverage. So if one is fairly healthy, why pay $150-$300 per month for something one will rarely use when one can pay $0 plus a few minor charges occasionally.  I can tell you that I am multi-thousands ahead of the game... let's call it $40,000... but I've been a pretty healthy guy. IF something BIG were to happen to me... heart attack or cancer.... I am still covered quite well by my APlan, cannot be charged more than $7,400 annually and can always change back to Original Medicare "any" time I wish without penalty. In those 14 years I have never paid out more than about $500 a year for all my medical needs and most years it is only about $200 total.

4) loopholes: you are speaking here of life in Mexico and yes there seems to always be a loophole one can test. BUT this discussion is about United States Medicare insurance. IMO trying to come up with loopholes with one's medical insurance is playing with fire. Trust me, there is no better qualified entity than Medicare or an Insurance company in finding their own loopholes with which they can try to deny payment. Why serve them up with an easy one. 

Hope this helps lakeside7






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

I just spoke with a sales person about changing from a Medicare supplement to Medicare Advantage.  I was told that I could switch back within ONE year without answering medical questions and being subject to underwriting.  I'll probably stay with my current plan which, although not cheap, has served me well and certainly paid for itself.

Link to comment
Share on other sites

On 10/6/2020 at 9:17 PM, lakeside7 said:

With respect I would suggest that there are quite a number of people with homes in the US and Mexico and are legit..why in the world would having a home/vacation place here or any place overseas disqualify you? 

On 10/5/2020 at 12:28 PM, Jubilacion said:

From Medicare.gov (Medicare's own website):

  • Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn't otherwise cover the care.

  • Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S.


Lakeside7 thanks for the additional details. First off, I highly endorse Spencer's comment to avoid signing any promissory agreement with SAH or other medical provider if they are so certain your Medigap or Advantage Plan will pay for services and is a legitimate insurance claim. That still won't exempt you from an Insurer or Medicare coming after you for filing a fraudulent claim.

Specifically on your comment above, that owning a home in the US and Mexico should not exempt you from Medicare...and it does NOT, however it does prohibit emergency Medicare treatment (see above directly from Medicare.gov) unless emergency treatment begins during the first 60 days of your trip, a trip with a date that began in the US, not Mexico or another international location. How do we know? Because Medicare and Medicare Advantage Plans are NOT available outside of the US with very few exceptions.

Regarding SAH Lakeside Medicare Advantage Plan presentation, good to hear you thought the sales rep Jeff didn't make any false claims, however just google Medigap and Medicare Advantage Plans and skim though some of the broker ads who want to sell you a policy and nowhere will you find ANY insurer offering any service or treatment that is not emergency and medically necessary, while travelling, all with a 60-day travel window from the US. That's why some of us with knowledge of Medicare are confounded by these claims of service here Lakeside. Who is the insurer Medicare Advantage Plan being promoted by that sales rep?

  • Like 2
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.

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.


  • Create New...