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MEDICARE COVERAGE OUT OF COUNTRY AVAILABLE FOR EXPATS?


ezpz

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Nothing has changed in Medicare rules regarding out of country care.

https://www.medicare.gov/

Medicare generally doesn’t cover health care while you’re traveling outside the U.S. Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands are considered part of the U.S. There are some exceptions, including some cases where 

Medicare Part B (Medical Insurance) may pay for services that you get on board a ship within the territorial waters adjoining the land areas of the U.S.

Medicare may pay for inpatient hospital, doctor, and ambulance services you get in a foreign country in these rare cases:

You're in the U.S. when a medical emergency occurs that requires immediate medical attention to prevent a disability or death, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.

You're traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.

You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

In some cases, Medicare may cover  medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won't pay for health care services you get when a ship is more than 6 hours away from a U.S. port.

Medicare drug plans don't cover prescription drugs you buy outside the U.S.

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  If you live outside of the US, you cannot use Medicare in a foreign country. Don't get caught using the company here that uses a California address to defraud Medicare. https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-living-abroad/medicare-coverage-for-those-who-live-abroad-but-plan-to-move-back-to-the-united-states-or-travel-back-frequently

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1 hour ago, ezpz said:

I have heard that they are now covering medical expenses out of country,  but I would like more info.  Anyone know anything about this?  I never go up north, I live here totally full time.  Gracias!

You heard wrong.

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5 hours ago, ezpz said:

I have heard that they are now covering medical expenses out of country,  but I would like more info.  Anyone know anything about this?  I never go up north, I live here totally full time.  Gracias!

Well here we go again...must be a slow down in news .....what good be more fact than "I heard" you need to go to a doctor ASAP and tell him you are hearing fairy stories

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14 minutes ago, ezpz said:

I wonder what shall I say to the person who told me this?

If I had to say anything to that person it might be, "could you show me where MEDICARE has written that Medicare is covering expenses OTHER THAN FOR EMERGENCIES WHILE ON VACATION out of the country'.  They of course will NOT be able to show you this proof... because it does not exist... but they may offer what "someone said", or show you a "sign that says facility/doctor X accepts medicare". 

 

 

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8 hours ago, RickS said:

If I had to say anything to that person it might be, "could you show me where MEDICARE has written that Medicare is covering expenses OTHER THAN FOR EMERGENCIES WHILE ON VACATION out of the country'.  They of course will NOT be able to show you this proof... because it does not exist... but they may offer what "someone said", or show you a "sign that says facility/doctor X accepts medicare". 

 

To be clear, MEDICARE does NOT pay for any emergencies while on vacation outside the US (other than the 3 vey limited situations cited by @Mostlylost in her post above).

Certain MEDIGAP policies pay for emergencies outside the US usually within 60 days of leaving the US.  If you don't have a MEDIGAP policy (private supplemental) insurance, you have no emergency vacation coverage, unless you buy private travel insurance (which won't cover expats).  

 

 

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3 minutes ago, Ian Greenwood said:

Our new Medicare supplemental plan ( part c ) covers us for emergency care worldwide without any time restrictions….there are of course co pays but no deductibles .

Ian ,I am sure it does, question do you have to pay bill first and then claim from ins company...I think you would have to be "lucky" if the hospital would bill directly to the ins company ...or maybe not...remember you may not be in the Guad or Lakeside area when you have an incident

To other folks out there do not leave home without having a medical insurance plan period, it does not take too many trips to the hospital to make a BIG hole in your savings

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Can't agree about the need for a medical insurance plan.  Have had some pricey trips to the hospital over the last years but am still WAY ahead of retaining Medicare, let along carrying private insurance at the amount they charge for older folks.  Plus, if a person has any "pre-existing conditions", guess what?🙄

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17 hours ago, Ian Greenwood said:

Our new Medicare supplemental plan ( part c ).............

Actually a Medicare Part C plan is NOT a supplement plan....Supplements being an added private party insurance coverage for the 20% that Original Medicare doesn't cover.

Part C is an entirely different animal and describes a Medicare ADVANTAGE plan which is offered in total by private insurance companies. While these plans MUST at least meet Medicare standards/pricing, they are "divorced" from Medicare. Many/most give 'extra' benefits over and above Original Medicare but that's another (good) story.

My experience with Advantage plans.... I've had them since 2009... with respect to this conversation is that, while they may cover some emergency situations OUTSIDE THEIR JURISDICTION and maybe even out of the country, it is as lakeside7 suggests.... on a repayment basis.     i.e. a Mexican doctor/hospital is NOT going to be able to 'bill' your insurance company; you must pay the bill here and get reimbursed later 'back home'.

Ian Greenwood, I would be interested to know IF you have actually used this feature of your Part C Advantage insurance here (or anywhere worldwide) or is what you said "just" what the plan paperwork says you can do?

 

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Then your friend should definitely attend and call the speaker out on it. The speaker is Jeff Goble and it says that he is a health insurance agent specializing in Medicare plans and that he is licensed  in all 50 states of the U.S. His contact information is via whatsapp or call 1(916)601-7128 or e-mail JGOBLE@HEALTHMARKETS.COM

The above information taken directly from the full page ad.

 

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There was an interesting scam happening some years ago. (I think it was back in our San Miguel era.)

The way it worked:  a medical group also had an office in Irvine, CA and guess where the billing to Medicare was directed from...as though the patients were treated in the Irvine office.

 Eventually, the truth emerged and the scam was exposed. I didn't follow the story in the newspapers closely enough to find out who got prosecuted for what, but what a way to try  going!! 

That page 35 information is very different but has the same aroma.  Note the sentence referring to "your U.S. zip code"  CURRENTLY????

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10 hours ago, gringal said:

Can't agree about the need for a medical insurance plan.  Have had some pricey trips to the hospital over the last years but am still WAY ahead of retaining Medicare, let along carrying private insurance at the amount they charge for older folks.  Plus, if a person has any "pre-existing conditions", guess what?🙄

We're in a similar boat, Gringal.  When we moved here from Canada more than 16 years ago, we applied for private medical insurance but were turned down due to pre-existing conditions.  With not having to pay for private insurance, 'NOB'  property taxes or heating and air conditioning, we're ahead of the game.  We've had several operations/procedures including  brain surgery, pacemaker replacement, coronary artery stents (5 for me and 2 for spouse), as well as other operations.   

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2 hours ago, gringal said:

There was an interesting scam happening some years ago. (I think it was back in our San Miguel era.)

The way it worked:  a medical group also had an office in Irvine, CA and guess where the billing to Medicare was directed from...as though the patients were treated in the Irvine office.

 Eventually, the truth emerged and the scam was exposed. I didn't follow the story in the newspapers closely enough to find out who got prosecuted for what, but what a way to try  going!! 

That page 35 information is very different but has the same aroma.  Note the sentence referring to "your U.S. zip code"  CURRENTLY????

I recall that happening and was a willing participant for having stents implanted ...should I be hung up, drawn and quartered, . For a country that prides its self for finding a facilitator to find a way through legal rules and regulations, many Gringos here are sounding like a lot of wimps 

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Man mamma….all one needs to do is a little research…not ask someone who is retired…probably to pasture before some of these new AARP / United healthcare insurance instruments were available .  In policy contract terms and agreements ( patriot policy ) …the language is quite simple .. covered for all emergency treatments in all countries at all times .Here in Ajijic our PPO is the new hospital ( Ribera’s ) on the Libremente  who bills United etc directly  ..it was necessary to register at the hospital…Will it be perfect ……doubtful …but one of our friends recent 21 day stay in a Guad hospital resulted in almost a six figure US dollar bill… healthcare costs have increased dramatically since we arrived 12 yeats ago . Self insurance may become a thing of the past…At least six couples…friends of ours have moved back north US and Canada because of health issues and two more are working on it.

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"Man mamma….all one needs to do is a little research…not ask someone who is retired…probably to pasture before some of these new AARP / United healthcare insurance instruments were available"(Ian Greenwood)

...a teensy bit condescending, perhaps? 

I would appreciate your sharing your source of information regarding the new insurance instruments available to us expats. However, I will see what I can learn from Senor Google today.

My mind is open about how well this could work, but that bit about "your U.S. zip code" is a puzzler.  Of course, I realize that there are a number of expats who use someone else's U.S. address for mail and many other purposes.  Maybe this plan will work for them. Personally, I live in Mexico for all purposes.  That includes SSA and my major financial institution.

 

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I just googled the site (AARP/Medicare Advantage) and this is what came up:

__________________________________________________________________________________

"America’s Top Medicare Advantage and Medicare Supplement Plan Provider*

Your ZIP Code
 

Error: Please enter a valid ZIP Code"
_________________________________________________________________________________

(I had entered my Mexican zip code "45920")

I think we have the answer.   Lie required.

An interesting site to check out for other options:

https://www.internationalinsurance.com/health/north-america/mexico.php

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8 hours ago, gringal said:

"Man mamma….all one needs to do is a little research…not ask someone who is retired…probably to pasture before some of these new AARP / United healthcare insurance instruments were available"(Ian Greenwood)

...a teensy bit condescending, perhaps? 

I would appreciate your sharing your source of information regarding the new insurance instruments available to us expats. However, I will see what I can learn from Senor Google today.

My mind is open about how well this could work, but that bit about "your U.S. zip code" is a puzzler.  Of course, I realize that there are a number of expats who use someone else's U.S. address for mail and many other purposes.  Maybe this plan will work for them. Personally, I live in Mexico for all purposes.  That includes SSA and my major financial institution.

 

Why don't you attend the aforementioned seminar being given by Jeff?

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19 hours ago, lakeside7 said:

many Gringos here are sounding like a lot of wimps 

If you don't want to be a wimp, try Mexican General or Public Hospitals. The last time I was in, a large mixed ward, maybe 14 beds, two very nice homeless families living in the ward overnight, and, unbelievably, no privacy curtains. Everything just hanging out.

The nursing and doctor care was excellent. In the process of upgrading they had those new foam hospital beds, very comfortable. No TV. Just people watching and me mangling the Spanish language. Although almost all the doctors and most of the nurses spoke English and were anxious to keep up their skills. That time I only saw another young man die. it was totally expected, even by his own family.

I was on an expensive type of antibiotic drip for 12 days or more. The food was mostly plant based Mexican style, which have I now developed a taste for, even soy chunks. No cost whatsoever. Next time I know to try to avoid medical treatment on that floor.

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