Will Health Care Act Require Expats to Have Insurance?

[TotallyOz]

I have been looking at health insurance again and it is really crazy how expensive it is. But, on Jan. 1, this will be required for all American citizens. What I now wonder is if this will also be required for expats living abroad? Or, will there be a certain amount of time you must be in USA in order to require the purchase.

 

I have looked into overseas policies and they all suck. Benefits are often not good and the paperwork required of you is intensive.

 

I mentioned a few weeks back about Geo Blue Travel Insurance. I finally decided to take the plunge and get it. It was an insane 888.00 a month but that was the perfect coverage for me. It asked all the medications, etc and I gave them. I currently only take Armor Thyroid and Metaformin. I explained this in the application as required. It asked for payment and I put in my CC number. I was instantly denied based on those drugs. I called them and basically they said anyone with any prior history will be denied.

 

On Jan 1, it is my understanding that pre-existing conditions are prohibited. Would that also include a plan that covers American's overseas? Would this policy have been able to deny coverage?

 

I currently have good USA Blue Cross / Blue Shield but it does suck overseas as you must have a written waiver before any care.

 

Do others think this will change Jan 1?

[TotallyOz]

Looks like it doesn't do that. And, many policies from several states that I have reviewed do not even offer out of US coverage through Blue Cross / Blue Shield.

 

I know the ACA is a great thing with preexisting conditions but it is also limiting many things that were once covered.

[Bob]

Going back to your question in this post, I think the answer is pretty simple:  If you're under Medicare (65 or older) or you're physically outside the US for at least 330 days per year, you don't have to comply (have qualifying insurance) under the ACA.  The question for you, then (given you're a puppy), is do you spend 35/36 or more days a year in the US?  If so, I don't think you have a choice and must purchase a qualifying policy or face the financial penalties.

[Guest travelerjim]

Michael,

 

Bob is correct...

 

The IRS has set the number of days you can be inside the USA in order to be considered an Expat living outside the USA.

Otherwise, unless age 65+, you must comply with Obamacare.

 

I suggest you have your doctor(s) in USA issue you 90 day prescriptions with renewal 3 times...thereby covering one full year. Get a full benefit health policy in the USA (you say you have one)...which covers

Rx's and your medical care needs when in the USA.

 

Some will cover that "holiday vacation" outside the USA...for urgent care & emergency care...

not for non-life threatening health care. And not Rx coverages.

 

Get a good US policy...then get a "travel policy" fo those many times you are outside the USA.

Your best use of $$$ and cost advantage to you.

IMHO, you are paying way too much for your health policies as you have related above.

 

Check the plans offered under Obamacare...look at the Platinum...for your US residence area.

 

Good Luck!

Happy and Healthy New Year 2014 to you and yours.

 

tj

[Guest travelerjim]

Also Michael...

 

Health insurance policies which are issued by a foreign insurer does not have to comply with Obamacare.

GeoBlue I believe is from the UK...therefore they can deny you coverage.

IMG is insured by Sirius International...a foreign insurer also.

 

Liberty Mutual Group Thailand is Thai based...part of LMG in USA.

Have you tried to get insurance from LMG Thailand?

 

tj

[TotallyOz]

Get a good US policy...then get a "travel policy" fo those many times you are outside the USA.

Your best use of $$$ and cost advantage to you.

IMHO, you are paying way too much for your health policies as you have related above.

Thanks for the advice.

 

I have a good US Policy. It is now really easy under the ACA. But, it seems that many Blue Cross / Blue Shield policies are limiting overseas claims to those that are life threatening. That is worrisome. You use to be able to go into any BCBS hospital and get reimbursed. That is no longer the case. I called Blue Cross of California yesterday and they said only life threatening emergencies are covered. Who defines it as life threatening?

[TotallyOz]

IMHO, you are paying way too much for your health policies as you have related above.

I didn't get the GeoBlue plan as I was turned down based on weight. I tried again yesterday and it was approved. Guess how much? 1300 a month. Insane. It does nothing more than my Blue Cross policy in USA that costs 430 a month except that it covers me more overseas.

 

Geoblue also has a policy that covers you for a reasonable amount IF and ONLY If you maintain credible US coverage. LOL

 

It is a real PITA for insurance for expats.

[Bob]

If you're trying to buy the premium coverage, you're going to pay through the nose; but, guess you already know that, Michael.

 

I've opted to go with some minimal (high-deductible) insurance for my 9-month sojourns here in Chiangmai and I simply figure that I'll head back to the states if/when I get something that requires expensive or specialized treatment.  I've simply been lucky so far to not have any medical expense, prescriptions, etc.

 

Michael, given you're younger than me and (based on what I've read over the years) well able to self-insure, why not simply go for a cheaper policy with a high deductible?  If, for example, you're out of the states for 9 months a year, paying $1,000 a month costs you $9,000 a year (plus, yes, whatever your US coverage is ripping you off for...); instead, get a $5,000.00 deductible policy that might cost you $1,000 in total for that 9-month time period.  I do recognize that some of the decision is based on present and pre-existing conditions so you do need to take those issues into account.

 

You're big pain-in-the-ass is the fact that the US policies of all stripes apparently don't cover (although often reimbursement rather than direct pay) for the same medical expenses incurred outside the US as they used to cover.  I probably had a very similar BC/BS policy as you had that did just that and, while not cheap, I didn't have the need for any other coverage while I spent many months outside the US. But, alas, apparently that type of coverage is no longer available and now you face the problem of double-covering yourself for the same time periods with somewhat lousy coverage outside the US.  On the bright side, we could both be hit by busses today and no longer have to worry about it....

[Up2u]

I guess I am lucky (or not?) but I have signed up for a Medicare plus plan offered by my employer and administered by Anthem Blue Cross. It supposedly pays for medical costs worldwide. There is a 400 dollar deductible and 4000 dollars annual out of pocket max. After 400, they pay 70% worldwide (not 80‰ like Medicare). So if I understand everything a kidney transplant at BHP and would cost me 4000 dollars.

[Bob]

Geez, Up2u, you might want to verify that you have the coverage you think you have. I think that a "medicare plus plan" is otherwise called a "medicare advantage" plan.  I carefully researched a few of those last year and all of them excluded medical care outside the United States with the one exception that they'd cover emergency stuff (somewhat strictly defined) during the first 60 days only of your trip outside the US.

 

A "medicare advantage plan" (a plan under Part C of Medicare) is a private plan with a private insurer (the insurer takes care of all your Medicare parts A and B and the federal government pays them for doing so).  Now, it is possible that you have a very unique plan with a large employer that provides what you indicated.  I doubt it but I hope so.

 

And I'm really puzzled by your statement "not 80% like Medicare."  Medicare doesn't cover squat outside the US except in very limited circumstances.

[Guest travelerjim]

Up2U,

 

Bob is correct.

 

I strongly advise you to ask for the "worldwide" guarantee of coverage "in writing".

 

From Bob's research...and mine too...they will tell you one thing but when

pressed to "put it into writing" ...they will not...including Humana & AARP's United Healthcare.

 

Talking over the phone they will say yes...you are covered "worldwide"...but that is for URGENT CARE

and EMERGENCY CARE only...when outside the USA on holiday. But the devil is in the issue

of "are you eligible for the medicare advantage plan" ??? I presume you have your USA address as the address

of record for the insurance. ??? Therefore, how would they know you are not a "resident" there now?

 

Why Not?

Because, for you to have been "eligible" for the Medicare plus (Advantage) plan you have

signed up for...you must be a "resident" of the area/zip code/county where the plan is offered.

 

"Resident" means you plan to reside at that address "more than 6 months" annually...

otherwise, you are NOT eligible for enrollment in the Medicare plus or Advantage plan...

 

Many employers have made this change to their retiree health plans...mine too.

 

You might ask your employer...as I did...

If I am not in the area served by the Medicare Advantage Plan...do I still get coverage?

In my case, the answer was YES..and I am in a PPO - Out of Network plan..worldwide

as a retiree of MetLife...covered under health insurance for the Met retirees administered by UHC United Healthcare.

 

IF I lived in my US address, I would have NO choice other than be enrolled in the UHC Medicare Advantage plan.

 

Good Luck...please keep us advised...so we can be better informed too...and share the info with others.

 

Thank you,

 

tj

[Bob]

I'd note that I inquired about obtaining both of the medicare advantage plans offered in my area (there were only two plans by two different carriers available there) and both of them told me that I didn't qualify for either for the reason that, although I have a home and address in the US, I'm not there at least 6 months out of the year.  My experience verifies what Jim notes above about the residency requirements. 

[Up2u]

TJ and Bob, I have researched this thoroughly and yes the coverage is worldwide from any licensed medical provider. Anthem BS is only the administrator and has agreements with medical providers worldwide. You don't have to use them. BHP and Payathai(Sri Racha) are the only ones on their approved lists in Chonburi, but many in Bangkok. When I am states side Medicare pays 80% of the bill back to my employers plan. My benefit is for 70% up to my annual max which means I pay 30% or the plan makes 10%. I guess this is why the plan is the cheapest offered by my employer. The drug plan is better than Medicare Part D (no donut) , so I will get my drugs shipped to a friend's house in California and he has offered to be my mule. After the annual deductible max of 4,000 USD is reached, I pay nothing whether it is in California or Thailand or London. It is not technically a Medicare plus plan. I am on the hook for 30% in USA or Thailand up to my annual deductible max. Emergencies are emergencies, anything else should be preauthorized. If I lived states side I wouldn't have this plan.

[Bob]

Up2u, sounds like you have a good deal.....and, given you've clarified that Medicare reimburses your plan provider for part of the stateside medical expenses, it's pretty clear to me that you have what we'd call a Medicare advantage plan (a plan where a private insurer provides the Medicare Parts A and B plus additional benefits and the government reimburses them for the A & B coverage).

 

But you must have a very special advantage plan as none of the ones I've ever read about in the states ever provide any payment (direct or indirect) for medical expenses outside the US except for emergency stuff (somewhat strictly defined) during the first 60 days of a trip outside the US.  My guess is your employer latched onto a very good health care insurance provider, made its own deal with them, and you're enjoying the benefits.  Wish I had something like that as I can't buy it anywhere.

 

[Edit:  You mentioned your provider - Anthem - which provides BC/BS coverage in some states (unfortunately, not my home state of Michigan).  BC/BS was one of the two providers that offered a Medicare Advantage plan in my area of Michigan but, unfortunately, they wouldn't cover me because of the 6-month residency requirement (and they'd only provide the 60-day emergency coverage noted above anyway)]. 

[Guest travelerjim]

Up2U has an extraordinary plan...

possible a government plan had he retired as a state/federal/teacher union ...government employee in California..

or known as CALPERS  in CA.

 

The Gay Pattayan - who passed away 5 years ago was under CALPERS. 

Sadly, he did not know the real value of what he had... IMHO.

 

You are a lucky fella UP2U...

watch out for plan design changes in years to come...

it appears many corporations and retiree plans are changing...

and only paying benefits IF Medicare pays...otherwise...NO benefit.

 

Also...,many health plans will be subject to the Cadillac Tax in 2016.

I believe it is 3.8% of the plan value...and taxable.

 

That is the reason Teamsters and unions are screaming NOW..

they realize their Cadillac (rich benefit) plans will be taxed in 2016.

(conveniently after the Presidential elections of Nov 2015)...hehehe.

 

tj 

[Up2u]

Yes, it appears to be a good plan for my purposes. I believe 2lz2p has a similar plan and he unlike me was a former government employee. Like I said the plan is cheap comparatively speaking. The plan actually makes money off me when I am in USA which should offset their costs if I file a claim overseas. With high deductibles sometimes these plans are called catastrophic coverage.

[Bob]

Good discussion. Up2u, you've got the best medical plan I've ever heard about other than, of course, those with VA or other governmental packages. Now, of course, the job of all of us is to avoid spending any of the government's/insurer's money...hehe.

 

Given this whole post really doesn't have anything to do with Gay Thailand and is likely boring to death all non-US posters, perhaps the Moderator ought to move the whole thread to the beer bar. 

[vinapu]

Thread it's well titled so those uninterested like me can easily avoid it, wouldn't worry about moving. Let Americans to have their day !

[Up2u]

Good discussion. Up2u, you've got the best medical plan I've ever heard about other than, of course, those with VA or other governmental packages. Now, of course, the job of all of us is to avoid spending any of the government's/insurer's money...hehe.

 

Given this whole post really doesn't have anything to do with Gay Thailand and is likely boring to death all non-US posters, perhaps the Moderator ought to move the whole thread to the beer bar.

 

 

Bob, you and TJ, raise a good issue about Medicare and residency. On paper, I have a California address and pay utilities but in reality I reside in Pattaya. My concern has always been what if I have major medical event here in Thailand. With this plan I hopefully got that covered (fingers still crossed), I know Americans with similar plan who have filed claims with no problems and they live in Thailand too and visit the states once a year. I have contacted Anthem and BHP and they do have an agreement on medical costs. My plan has no network that I must use although there is a cost advantage in using Anthem BS providers when in USA.

 

... and yes, apologies to non-Americans who are reading this but health care is a big issue for gay farangs who call Thailand home.

[kokopelli]

Up2U has an extraordinary plan...

possible a government plan had he retired as a state/federal/teacher union ...government employee in California..

or known as CALPERS  in CA.

 

Same-same as some others, with my government pension, my medical costs are covered by secondary insurance when outside of the USA. No co-pays, no deductibles, and free. Just hope they don't change it!

[2lz2p]

Yes, it appears to be a good plan for my purposes. I believe 2lz2p has a similar plan and he unlike me was a former government employee. Like I said the plan is cheap comparatively speaking. The plan actually makes money off me when I am in USA which should offset their costs if I file a claim overseas. With high deductibles sometimes these plans are called catastrophic coverage.

 

US Gov't employees receive their health insurance through the Federal Employee Plan (FEP) - The Office of Personnel Management (OPM) administers the FEP - there are several insurance companies in the program - you can switch between them during November Open Season - no issue regarding pre-existing conditions.  I am in the BC/BS FEP plan which carried over into retirement. It does cover me outside the USA - in fact they have a special Overseas Claims Section to process claims. They also contract with a company to provide "overseas assistance" in locating providers and dealing with hospitals directly on behalf of the insurer (I usually pay my outpatient claims and file for reimbursement, which is 85% - also applies to drugs if they require a doctor's prescription if you obtained them in USA. - for inpatient care, Bangkok Hospital Pattaya contacts them, receives a letter of guarantee, and files the claim direct).  

 

Since I am now on Medicare Part A (I turned down Part B), BC/BS FEP acts as a supplemental insurer - if in USA, I would first have to file claim under Medicare and they would pick up what Medicare didn't pay - but, in Thailand, Medicare pays nothing, so as mentioned, they pick up the tab - prior to going on Medicare, I had a $250 co-pay for each in patient admission - now that they act as a supplemental insurance, there is no co-pay and they pick up 100%. For outpatient care and since I am not on Part B, they continue to pay under the same provisions as they always have - the only change when I became Medicare eligible is that by law they use Medicare's reasonable cost schedule instead of their own -- but, considering how much lower is the cost of healthcare here compared to USA, I doubt any costs incurred here would exceed the Medicare limits.

 

 

So, as Up2U mentioned, I am very fortunate in having this coverage. Also, I don't anticipate much in the way of any change in their providing coverage outside the USA when you consider the number of civilian employees the US Government has stationed in countries around the world that need health care coverage.

[Guest travelerjim]

2lz2p

 

I find it amazing you can waive out of paying for Part B...

and still receive full insurance benefits.

 

I know of no retiree - age 65+ health plan which allows this.

 

tj

[Up2u]

I am envious of 2lz2p's coverage, it is a wonderful plan for someone living in Thailand. Like TJ, I am surprised he could drop Part B as it required for the medicare plans I reviewed. I had to have part B to get part D (outpatient drug plan) or my drug plan which is better part D.

[Bob]

The governmental and huge employer plans must be allowed to be different.  For the rest of us slobs, we can't purchase a Medicare Advantage plan without ponying up for Part B of Medicare. 

[2lz2p]

2lz2p

 

I find it amazing you can waive out of paying for Part B...

and still receive full insurance benefits.

 

I know of no retiree - age 65+ health plan which allows this.

 

tj

 

As I mentioned, if on Medicare, it becomes supplemental insurance - it is not a Medicare Advantage Plan.  The FEP program is unique - the BCBS FEP program as I mentioned does not require Part B coverage; nor does it tie drug coverage to any Medicare coverage. The drug coverage remains the same whether on Medicare or not.  Another aspect of the FEP program is that the insurer is not the final decider on whether a claim is or is not covered. If the insurer denies a claim, you have the right to ask for reconsideration - if they still deny it, or do not make a decision within 30 days of submitting any additional documentation, you have 60 days to file an appeal with the Office of Personnel Management, who will make the final determination.

 

Only once, about 3 years ago, I had a problem when they denied one inpatient claim (back then I was paying and filing reimbursement on inpatient claims) and 4 outpatient claims - they had all been submitted at the same time (I had got behind on filing claims while undergoing outpatient radiation treatment in Bangkok - I had arranged in advance with overseas assistance unit to get a letter of guarantee for the radiation treatment as the total cost was about US$18,000 and was over a 7 week period.

 

When I inquired about why they needed more documentation as I had submitted the same as I had been submitting for the 8 years I had lived in Thailand, the customer rep told me that because the claims coming in at the same time had hit a threshold that caused them to go to a special unit for review.

 

I will not bore you with details, but after submitting additional documentation, the 30 days passed and I didn't have a decision one way or the other - I then informed them that I wanted a decision within 7 days or I was filing an appeal with OPM - did that do any good? Maybe as all the claims were approved and paid within the next 5 days.  Since then, for inpatient care, I have arranged for direct billing - all approved and paid direct to Bangkok Hospital Pattaya.  Also, no future problems with my outpatient claims - I fax in the claim form and documents and it is usually approved and paid with 2 to 3 weeks.