Medicare and Expats

[Guest RichLB]

I've never written a Congressman before, but thought I'd give it a try. I've just sent the following message to my Congressman and think others might want to write a similar one to their own.

 

Dear Congressman,

I have an issue of concern to me and several other US Citizens. Although a California resident (and a voting one!!!) I live most of the year in Thailand. I am over 65 and therefore enrolled in Medicare and also carry supplementary health insurance. As you are undoubtedly aware, Medicare does not cover medical costs when outside the US. Since I have paid into the system my entire working life, it does not seem equitable to me to be excluded from coverage. Not only that, but it makes no sense as medical costs abroad are far less expensive (and therefore would save taxpayers money) than those available in the US.

As my Congressman, I would like you to resolve this unfairness and find a way to eliminate the disenfranchisement of thousands of expats who are denied coverage by a fund to which they have contributed merely because they elect to spend time out of the country. I realize it is unlikely a member of Congress will devote much time to absentee constituents, but I assure you your efforts would be appreciated. At the very least, can you tell me how my government justifies ignoring us?

[Guest lvdkeyes]

I've never written a Congressman before, but thought I'd give it a try. I've just sent the following message to my Congressman and think others might want to write a similar one to their own.

 

Dear Congressman,

I have an issue of concern to me and several other US Citizens. Although a California resident (and a voting one!!!) I live most of the year in Thailand. I am over 65 and therefore enrolled in Medicare and also carry supplementary health insurance. As you are undoubtedly aware, Medicare does not cover medical costs when outside the US. Since I have paid into the system my entire working life, it does not seem equitable to me to be excluded from coverage. Not only that, but it makes no sense as medical costs abroad are far less expensive (and therefore would save taxpayers money) than those available in the US.

As my Congressman, I would like you to resolve this unfairness and find a way to eliminate the disenfranchisement of thousands of expats who are denied coverage by a fund to which they have contributed merely because they elect to spend time out of the country. I realize it is unlikely a member of Congress will devote much time to absentee constituents, but I assure you your efforts would be appreciated. At the very least, can you tell me how my government justifies ignoring us?

It will be interesting to see if you get a reply. I sent a letter to Nancy Pelosi several months ago and never got a response.

[Bob]

Nice try, Rich, but I'd think you have better odds at winning the lottery. The Medicare system is functionally broke already and, in my view, there is absolutely no way that they are going to add a feature that costs it more money. Plus, even if they did pass a law, the likelihood that a Thai hospital would comply with their paperwork requirements or not require you to pay up front in the first place is also unlikely in my view.

 

I understand that Thai medical insurers won't cover falang who are 65 years or older (with some exceptions - one that comes to mind is I saw that one insurer advertised that it would cover 65+ year-old falang if that falang had already had their insurance with that company for 10 or more years). If that's truly the case, I'll be going fairly bare in a little over 3 years (but, frankly, I'm going to shop around then and find out for sure if I can buy insurance to cover catastrophic expenses possibly incurred in Thailand). Alternatively, presuming I get some nasty disease requiring long-term treatment and also presuming I have time, I'll be heading back to the states to use my Medicare coverage.

[PattayaMale]

I've never written a Congressman before, but thought I'd give it a try. I've just sent the following message to my Congressman and think others might want to write a similar one to their own.

 

Dear Congressman,

I have an issue of concern to me and several other US Citizens. Although a California resident (and a voting one!!!) I live most of the year in Thailand. I am over 65 and therefore enrolled in Medicare and also carry supplementary health insurance. As you are undoubtedly aware, Medicare does not cover medical costs when outside the US. Since I have paid into the system my entire working life, it does not seem equitable to me to be excluded from coverage. Not only that, but it makes no sense as medical costs abroad are far less expensive (and therefore would save taxpayers money) than those available in the US.

As my Congressman, I would like you to resolve this unfairness and find a way to eliminate the disenfranchisement of thousands of expats who are denied coverage by a fund to which they have contributed merely because they elect to spend time out of the country. I realize it is unlikely a member of Congress will devote much time to absentee constituents, but I assure you your efforts would be appreciated. At the very least, can you tell me how my government justifies ignoring us?

 

I really applaud your effort. I will write to my congress leaders also. I suggest this may be a good change to write also to the White and our local chapter of Democrats abroad even if you are not a Democrat.

 

I too am scptecial that we will get any results, but I am certain that if enough people do[ (AARP is really an insurance group) but has alot of memebrs], we have a chance.

[Guest fountainhall]

I understand that Thai medical insurers won't cover falang who are 65 years or older (with some exceptions

You really should have a chat with travelerjim who has had vast experience in the insurance business. Following a meeting with him, I cancelled a policy I had had for more than 15 years and whose premiums were rising at a horrific rate. I was then over 60 but he found me a policy with a premium vastly less expensive and more suited to my circumstances here.

[Guest tdperhs]

With your permission, I would like to use your letter as a generic and send copies to my representatives in the federal House and Senate. I could write my own but yours has the virtues of succinctness and focus. Having read some of my posts, I am sure that you have learned that brevity and narrowness of focus are not my best literary virtues. My reps are in NV. I moved my permanent address there (No state income tax) when I relocated to Thailand.)

I have taken a solemn vowel to avoid any deprecating illnesses before I am 85.

[Guest]

With very few modifications, the same letter could be written in the UK.

 

It seems OK for the NHS to get doctors in from abroad & pay them an absolute fortune. However if we choose the much cheaper option of getting treatment in a low cost country, we are on our own. This seems totally wrong.

 

Any healthcare in lower cost countries should be encouraged.

 

Anything else is a restriction on free trade. Of course the improvements in efficiency, quality and service that result from competition are perversely not permitted in healthcare.

[Guest TOQ]

You really should have a chat with travelerjim who has had vast experience in the insurance business. Following a meeting with him, I cancelled a policy I had had for more than 15 years and whose premiums were rising at a horrific rate. I was then over 60 but he found me a policy with a premium vastly less expensive and more suited to my circumstances here.

 

I agree that TravelerJim is the person to contact. I also have a policy with him and it covers pre-existing conditions as well. Premiums are very reasonable.

 

john

[Guest RichLB]

With your permission, I would like to use your letter as a generic and send copies to my representatives in the federal House and Senate.

Permission granted - and to anyone else who would like to use this letter or any part of it.

[Guest fountainhall]

With very few modifications, the same letter could be written in the UK . . . Any healthcare in lower cost countries should be encouraged.

A few years ago, I seem to recall reading somewhere that the UK's National Health Service did send some patients on long wait lists for non-emergency treatments to places like India. This was in an effort to reduce waiting time for things like hip replacements to a couple of months from well over a year. Even if that still exists, though, I am certain it is not elective. The NHS bosses will make the decisions.

 

Adding to z909's comments, it seems even more unfair that UK residents who paid into the National Insurance pot every year can get treatment in vastly more expensive European Union countries, but not outside the EU.

 

I'm in the odd situation of qualifying for virtually free treatment in both Britain and Hong Kong, but not in Thailand. So I have reduced the benefits on my newish policy. Whilst sufficient to cover any major emergency here, I will return to the UK should any long term treatment be required.

[Guest voldemar]

For those who does not know: quite a few American corporations and nonprofits (like private Universities) in US used to provide an excellent benefit for retrees: private health insurances which in many cases could have been used outside the country. It was possible because of favorable tax treatment of this benefit. Obamacare removed this tax brake and the benefit will be lost in most of the cases. This is,of course, pretty minor in comparison of what has been already done by current administration to totally destroy the country but will surely effect many expats. Good luck with letters to Nansi Pelosi and other US commies.

[Guest painai]

Good luck with letters to Nansi Pelosi and other US commies.

I think you've been watching too much Fox News on Sophon Cable.

[Guest lvdkeyes]

As I recall it was the previous administration that sank the US into the financial mess it's in now.

[Guest FanOfThailand]

I think you've been watching too much Fox News on Sophon Cable.

 

I would agree except I would would say watching too much as I like to call it...

ShOX ViEWS.

[billyhouston]

With very few modifications, the same letter could be written in the UK.

 

It seems OK for the NHS to get doctors in from abroad & pay them an absolute fortune. However if we choose the much cheaper option of getting treatment in a low cost country, we are on our own. This seems totally wrong.

 

 

What is even more galling about the UK NHS is that if, having paid your NI contributions throughout your working life, you have the temerity to become resident overseas then you cease to be eligible for NHS treatment should you return to UK. Meanwhile, every Tom, Dick and Harry newly arrived in UK gets free NHS treatment. Where's the justice in that?

[Guest fountainhall]

What is even more galling about the UK NHS is that if, having paid your NI contributions throughout your working life, you have the temerity to become resident overseas then you cease to be eligible for NHS treatment should you return to UK.

With respect, I am pretty sure you are wrong on this. If you are a UK citizen with an National Insurance number, you qualify for NHS treatment any time you are in the UK. Same way that you qualify for a UK pension. (Did I hear someone call that beer money a "pension"???)

[Guest travelerjim]

Nice try, Rich, but I'd think you have better odds at winning the lottery. The Medicare system is functionally broke already and, in my view, there is absolutely no way that they are going to add a feature that costs it more money. Plus, even if they did pass a law, the likelihood that a Thai hospital would comply with their paperwork requirements or not require you to pay up front in the first place is also unlikely in my view.

 

I understand that Thai medical insurers won't cover falang who are 65 years or older (with some exceptions - one that comes to mind is I saw that one insurer advertised that it would cover 65+ year-old falang if that falang had already had their insurance with that company for 10 or more years). If that's truly the case, I'll be going fairly bare in a little over 3 years (but, frankly, I'm going to shop around then and find out for sure if I can buy insurance to cover catastrophic expenses possibly incurred in Thailand). Alternatively, presuming I get some nasty disease requiring long-term treatment and also presuming I have time, I'll be heading back to the states to use my Medicare coverage.

 

Hi Bob,

 

Your stated opinion about the US Medicare system expanding medical care for those

outside USA is "right on the mark"! It will never happen!!

 

Indeed...Medicare is struggling to pay the benefits for those in the US...

NO need to increase Medicare costs by adding those of us living outside USA.

 

The Medicare system is broke...and so is Social Security.

When is the coming "train wreck" for the USA ???

..when it happens is any ones guess...

 

Other Nations are now finding themselves in deep financial troubles right now...

with many more to come...and USA is not far behind...if the truth was known..

we, the USA, is broke now!

 

But USA politics will compound the problem more,

as it has done for so many years, by inaction until the sh-t finally hits the fan...

as it came close to doing last year's downswing worldwide recession - near

depression situations.

 

Your comments about Health Insurance in Thailand...

 

Bob, if you are over 59...to my knowledge it is not possible to get insured from

Thai health insurance companies...

and they will look to deny every claim possible with regard to pre-existing conditions..

 

Thai insurance companies will NEVER cover HIV+ related claims...

regardless of the fact an insured was NOT HIV+ at time of policy issuance...

 

Any motorbike accident relate needed medical care will be reduced by 50%.

 

I even heard recently from an Australian expat that BUPA Thailand is not his

renewing health policies as he is now age 70 and he has been on the policy

since before age 59...a recent surprise to him and for several Expats here in Pattaya.

 

FYI...The companies I represent do offer better medical coverages than available

in Thailand...both for those under age 59..those in their 60's, 70's and even 80's.

 

I try to tailor my advice to Expats and provide policy information and offerings

to the needs of the Expat...that way they get what they need as a "best fit"

tailored for their situation...if it is good for them...then I am happy.

 

Medicare has a few twists for US/Americans...

which needs to be examined individually,

and situations differs from American to American...

the Expat American needs to know what their options are...

 

Should they take 'early Social Security"..age 62+ or ???

 

Should they "opt out" at age 65 of Medicare part B...

saving $96.40 monthly from their Social Security pension check...

and what is the consequences of doing so...

and if they do..can they get it back?

 

Do Americans need a Medicare Supplement?

if so, at what cost and when does it cover and for how long outside USA?

 

If one does not elect to get a Medicare Supplement and save the $$$ premiums..

of $100=200 monthly...can they get one if their is a need to return to the USA?

 

What other health insurance options are available to an Expat?

 

Do they cover "pre-existing conditions"...???

 

So many questions...like these and more...

 

Bob, I try to stay abreast of the news about Medicare,

health insurance options for Expats from USA and other Nations worldwide as well.

Keeps my mind active and challenges me to continue learning...which I enjoy doing!

 

And, might I add..re: Great Britain and Australia...national health care...

 

I have been following with interest these important

issues of continued health coverages for Expat UK and AU citizens...

both UK and Australia seem to be putting the clamp on their

citizens who reside outside their nations...

stopping them from receiving medical care when they return back home..it is their way of reducing the ballooning costs of expats medical care...collecting more taxes from current tax paying citizens who do reside year-round inside their nations...it does not seem quite fair...but with $$$ of medical care ballooning...and shortage of $$$ thereof...

it is causing UK and AU to examine and tackle the problem...by changing historically provided benefits...

not a happy scene for those Expats here in Thailand

from the UK and AU.

 

If I can be of assistance to you or anyone...

just pm me...I will be pleased to reply...

or have a cup of Starbucks with you.

 

Thanks,

 

tj

[Guest fountainhall]

issues of continued health coverages for Expat UK and AU citizens...

both UK and Australia seem to be putting the clamp on their

citizens who reside outside their nations...

stopping them from receiving medical care when they return back home..it is their way of reducing the ballooning costs of expats medical care

Thanks for clarifying this Jim. I had treatment a few times in the UK after becoming an expat, but my family are doctors and maybe that helped! I have now read up about the new regulations. It seems that if you return to the UK to reside, you re-register with a doctor and the benefits are restored. The key seems to be having an address in the UK and being registered with a doctor.

 

I had a similar situation last year when I tried to get a new photo ID driving licence - mine was an ancient piece of paper issued decades ago which car hire companies increasingly questioned. I wrote to the Licensing authority and was turned down because I do not live in the UK! The fact that I am a citizen of the UK is immaterial, apparently. And if I had lost my license, under ridiculous EU regulations I would have no way of obtaining a new one. After several letters when I was getting nowhere, I looked on-line and tried to apply that way, putting my sister's address on the form. Within a week, a new photo ID license had arrived!!

[Guest travelerjim]

Thanks for clarifying this Jim. I had treatment a few times in the UK after becoming an expat, but my family are doctors and maybe that helped! I have now read up about the new regulations. It seems that if you return to the UK to reside, you re-register with a doctor and the benefits are restored. The key seems to be having an address in the UK and being registered with a doctor.

 

I had a similar situation last year when I tried to get a new photo ID driving licence - mine was an ancient piece of paper issued decades ago which car hire companies increasingly questioned. I wrote to the Licensing authority and was turned down because I do not live in the UK! The fact that I am a citizen of the UK is immaterial, apparently. And if I had lost my license, under ridiculous EU regulations I would have no way of obtaining a new one. After several letters when I was getting nowhere, I looked on-line and tried to apply that way, putting my sister's address on the form. Within a week, a new photo ID license had arrived!!

 

fountainhall.

 

I gather from discussions on the beach or at happy hour with Expats from the UK..

the problem began with so many UK citizens retiring close by to the UK....

i.e. Spain,Portugal, among other E.U. countries...and with available low cost flights

back to the UK...their UK citizens would fly back for medical care...they were not paying into the UK tax system during the time they resided outside the UK...the costs for the UK were mushrooming and the UK decided they had to do something...as say NO to those residing outside the UK. There were many appeals and outcries of unfairness from UK Expats...it was such an unfair deal for them..but the UK prevailed.

 

The Aussies have similar infighting...especially dealing with disability payments received...as they are now ineligible for disability payments if they reside outside AU...this has happened to many this year ...in talking with AU Expats...they are fighting the changes..and AU has a budget busting national health care system which is hobbling their national finances.

 

In the US...there appears to be a significant move by several pension funds...i.e. CA and TN..and teacher's pensions..to make their health medical benefits

"match" those of US Medicare...which means that their retirees who live outside the USA will no longer have

their medical care costs covered...unless the medical care was approved for coverage by Medicare rules.

 

Since Medicare does not cover medical care outside the USA, unless for truly ER - emergency room needed care during the first 60 days of a trip, these kind of retiree Expats could find themselves with NO medical health insurance unless they resided inside the USA.

 

I expect more of these cost saving cuts and measures to come in years ahead as states, pension funds and the like seek ways to curb and cut their outlays for medical care costs

for their retirees.

 

Thankfully for TN and CA retirees I know of who were to have their out of USA medical care cut..as described above...the states/teachers pension funds involved have taken the matter under further study/review for this year...so they have one more year of coverages...until??

Who knows!

 

The budget axes are busy at work...

and the Expat outside USA is at risk!

 

tj

[Guest fountainhall]

I gather from discussions on the beach or at happy hour with Expats from the UK..

the problem began with so many UK citizens retiring close by to the UK....

i.e. Spain,Portugal, among other E.U. countries...and with available low cost flights

back to the UK...their UK citizens would fly back for medical care...they were not paying into the UK tax system during the time they resided outside the UK...the costs for the UK were mushrooming and the UK decided they had to do something

Hi Jim

I think - and hope - there may be some confusion here. National Insurance in the UK is a contribution by employer and employee (or by the self-employed) to enable the employee to have the benefit of the national health service and a basic state pension. The payments in to the scheme cease after you have contributed for a certain number of years. Thereafter you remain entitled to all the benefits. In my case, I had elected to keep paying in for all the time I have lived overseas. My payments finally ceased last year and I am reasonably certain that I do continue to qualify for benefits in addition to pension. And since that basic pension is well below the threshold at which tax becomes payable, in my case I am no tax burden. So I cannot see how health benefits can be withdrawn.

 

If, as is usually the case, expats who elect to sell up and retire to other European countries enjoy a work-related pension from their former UK employer in addition to the state pension (there is no way any could live just on the state pension alone!), the combined total would be taxable if they had remained in the UK. So to that extent, such retirees could be seen to be a burden on the NH system.

 

Also, those who moved overseas during their working lives but ceased their NI contributions, may also be seen to be a burden. Hopefully I am not so regarded. But I am certainly going to double-check.

[Bob]

Thanks for the info, Jim. For the next 3 years, I'll hold onto my current coverage (BC/BS) as it will reimburse me for "covered" items that occur even in Thailand; however, I'll have to make some choices in 3 years and, although health care is relatively cheap in Thailand, the idea of going bare is not in my consitution. I'll be talking with you then a bit more specifically.

[billyhouston]

Alas, eligibility for free treatment under the UK National Health Service is now based on residence. However unfair this may seem, and it is, there's very little that one can do about it.

 

HMG website

 

This is catching out increasing numbers of people. Rather like the freezing of pensions if you reside in the wrong country, the fact that you have paid NI contributions throughout your working life is ignored.

[Guest travelerjim]

Alas, eligibility for free treatment under the UK National Health Service is now based on residence. However unfair this may seem, and it is, there's very little that one can do about it.

 

HMG website

 

This is catching out increasing numbers of people. Rather like the freezing of pensions if you reside in the wrong country, the fact that you have paid NI contributions throughout your working life is ignored.

 

Thanks Billy for the link...

it is informative and demonstrates the kinds of actions

being implemented or considered by a country struggling with

ever increasing health costs..the USA is struggling too..

but is failing to tackle the real problem, in my opinion.

 

This page is full of qualifications....and eye opening!

 

Are you a UK state pensioner spending more than 3 months living outside the United Kingdom? : Department of Health - Health care

 

Are you a UK state pensioner spending more than 3 months living outside the United Kingdom?

 

Residing more than 3 months a year in a non-EEA country?

 

If you are a UK state pensioner living more than 3 months of the year outside the UK in a non-EEA country you will be exempt from charges for NHS hospital treatment in England that is needed promptly for a condition that arose after your arrival in the UK (or where, in the opinion of a doctor or dentist employed by the trust, treatment is needed quickly to prevent a pre-existing condition increasing in severity).

 

You will also need to have lived lawfully in the UK for at least 10 years continuously at some point in the past.

 

This applies whether you spend a few months each year living in a non-EEA country and the rest in the UK or whether you are living there permanently and only return to the UK for short visits. This exemption extends to your spouse/civil partner and children (under the age of 16, or 19 if in further education) as long as they are staying in the UK with you on a permanent basis for the period of your visit here. NB

[Guest fountainhall]

Many thanks billyhouston and travellerjim. Very enlightening - and at the same time confusing! I have asked my brother (a UK doctor) for his views and suggestions. I'll post any relevant comments when I get his reply.

[Guest]

Typical of the grossly unfair policies that we find in the UK. I shall spend most of my life paying high taxes, much of which will be frittered away on subsidies for a hardcore of parasites who have no intention of working. People entering the UK from other EU countries are also entitled to quite generous benefits (although some of these also tend to do a good days work, to be fair).

 

Then if I retire and go abroad, my pension shall be frozen and I get no contribution towards healthcare. A very poor reward for a lifetime of taxation. Alternatively, a very good incentive to avoid as much tax as possible.

 

Rather than withdraw healthcare from those who paid taxes for 30~40 years, why not withdraw healthcare from those who are unemployed for more than 5 years? I know who deserves it more.