Expatriate medical insurance and overseas travel insurance for those with U.S. Medicare – Part 2.  Good Neighbor Insurance has been asked over the years how does U.S. Medicare work?  Many of our long term, expatriate, clients who reside for many years outside the U.S. have some idea of how U.S. Medicare works but not fully. 

The team at Good Neighbor Insurance has decided to bring you, our clients, a three-part series all about U.S. Medicare.  This is a good area to start learning about Medicare but not the end of your journey on this subject.  One of the best web sites to learn more on Medicare is at https://www.medicare.gov.  There are, for sure, a variety of other web sites that will have valuable information on Medicare.  However, this one has a good overview of all four parts of Medicare. 

Just remember that Medicare Part A and Medicare Part B are through the U.S. government and the Medicare Part C and Medicare Part D is provided by insurance or other commercial companies.  Having all four parts will provide you a complete medial insurance package for any future medical needs.  

Good Neighbor Insurance is not an insurance company but an international medical insurance brokerage firm that specializes in coverages for outside of the U.S. or outside the country of your citizenship. Good Neighbor Insurance provides a variety of international medical insurance solutions from travel insurance, expatriate insurance, international war and terrorism coverage, organizational group medical insurance, specialized adventure sports, international student insurance and many types of risk management solutions.  Here are our web sites that have international medical insurance and risk management solutions for our clients around the world!

https://www.gninsurance.com – Corporate web site

https://www.goodmissionaryinsurance.com

https://www.socialgoodinsurance.com

http://www.goodinternationalstudentinsurance.com

https://www.adventuresportsinsurance.com

https://www.overseastripinsurance.com

http://www.insuranceforbali.com

http://www.asia-insurance.com

 

Let’s continue in this three-part series, this being part 2:

(1) Provide the best expatriate web page at https://www.gninsurance.com/long-term-international-health-insurance with many different overseas medical insurance options for those residing outside the U.S. for over 12 months, and…

(2) Provide the best travel medical insurance web page at https://www.gninsurance.com/international-travel-health-insurance-plans with many different travel insurance options for those traveling up to 12 months outside the U.S., and lastly…

(3) Explain key components of U.S. Medicare for you.

U.S. Medicare may seem like a “maze” but rest assured it isn’t. 
Good Neighbor Insurance has provided overseas medical insurance to those living and travel outside their country of citizenship/residence since 1997.  Over the years we have received (and answered!) a lot of great questions about U.S. Medicare from our American clients abroad. 

We have compiled the following information for our clients who are turning 65 in the next few months so that they can begin to think about decisions they (and you) may need to make soon, within 30 days either before, or after, your 65^th birthday. 

Five things to keep in mind as we go through this U.S. Medicare series with you, our client:

• All information below is the latest that we have, and is to the best of our knowledge – It is not “the final word.”
• Two places that have the final word on U.S. Medicare:
  1. The U.S. government has done a fabulous job in making medicare.gov an “easy read” as well as an up-to-date information source for all of your U.S. Medicare questions. We are very pleased and proud to say that their web site is very good! You can find great information that will be relevant to your questions when it comes to U.S. Medicare. 
  2. Since Medicare Part C MA (Medicare Advantage) is regulated primarily through each state in the USA, we highly recommend that you connect with a local agent in the State you usually reside in when in the USA, to get the most up-to-date information on Medicare, especially when it comes to Medicare Part C MA.
• All information in this series is the most up-to-date information we have at the time of this writing which was January 2018.
• Good Neighbor Insurance is not an authority on U.S. Medicare programs. Our goal is to provide you the best information we have.  A good place to verify, as shared above, is medicare.gov.  Also verify any questions/answers with a local authorized agent (who provides Medicare coverage options) in your own state. 
• Medicare benefits do NOT cover you outside of the USA.
  1. Yes, there is one little (and I mean little) part of Medicare Part C Medicare Gap / Medicare Supplement that covers you depending on the plan you choose. [As of this writing, the amount covered for medical care overseas is $50,000 but you will have to pay 20 percent of that in coinsurance with a deductible. Example: Out of a $80,000 l you will have to pay $10,000 plus deductible on $50,000 of that amount, plus you will be responsible for the $30,000 in additional expense.  This is why we say that Medicare does not cover you outside the U.S. 
  2. We strongly advise choosing a long-term expatriate medical insurance plan at https://www.gninsurance.com/long-term-international-health-insurance or a travel medical insurance plan for travel under one year from https://www.gninsurance.com/international-travel-health-insurance-plans. You may want to consider a plan with coverage for pre-existing conditions. Call us at 480-813-9100 with any questions on the best coverage to fit your specific needs.
  3. Medicare does NOT include any medical evacuation benefits. This is one of the key reasons of having expatriate insurance or a travel medical insurance plan.  Medical evacuation, also called medical transportation, is a vital overseas medical insurance benefit included in all of Good Neighbor Insurance policies.  Please note that Good Neighbor Insurance is an international brokerage firm that provides many different international insurance options from many international medical insurance companies.
  4. Lastly, this three-part series will discuss U.S. Medicare information. Some may have retirement medical insurance from a state, or other type of grandfathered medical insurance program.  This series will not address those types of coverage.  (If you have that coverage you will probably know it.  Those coverages are very few and thus most Americans, or those who have put monies into the U.S. Medicare system will have standard U.S. Medicare options.)

Like always, our licensed international agents are here to serve you.  Please feel free and call us at 480-633-9500 here in Phoenix Metro, Arizona or email us at info@gninsurance.com.

 

• Medicare Part B
  • Can choose to get it at the start of Part A
  • One can get Part B at the same time as Part A.
    • Or one can wait to get Part B.
    • If one waits, then there is no penalty if one has an equivalent or better health insurance policy like an employer group insurance policy.
    • If not, there is a 10% penalty each year one does not have Part B.
    • Living overseas is not a valid excuse or make you eligible for a special enrollment period or late enrollment.
  • Part B cost around $135 (and up) per month.  A great web page for more information on this is https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html. 
  • Only for outside hospital costs, minus Rx.
  • Part B covers two types of services:

(1) Medically necessary services: Services or supplies that are needed to diagnose or treat an individual’s medical condition and that meet accepted standards of medical practice and
(2) Preventive services: Health care to prevent illness (like the flu) or to detect it at an early stage, when treatment is most likely to be effective.

• • Learning Tip – If an individual is enrolled in Medicare part A, he or she will be automatically enrolled in Medicare part B.
    However, enrollment in Medicare part B requires the individual to pay for premiums. Should the individual not wish to be enrolled in part B, he or she is allowed to refuse the enrollment.
  • Individuals who are over the age of 65 and not eligible for Medicare part A must meet certain conditions to be eligible for Part B. The individual must be a U.S. resident. The individual must be a citizen or alien who has been lawfully admitted for permanent residence with 5 years continuous residence in this country at the time of filing.
  • Fun Tip – Does Medicare Part B cover Rx? 
    No!  Only Part D or if you bundle your Part C MA (shown below) with Part D.
  • Fun Tip – Will Medicare Part B cover all ambulance service? 
    Answer – No!  Only to the nearest appropriate medical facility that is able to give you the medical care needed.

• Medicare Part A and Medicare Part B together cover around 80 percent of all medical costs in the U.S. minus outside the hospital Rx.
• There are 3 enrollment periods for Medicare: An initial enrollment period, a general enrollment period, and special enrollment periods.
  • Initial Enrollment Period
    • For any “eligible” individual, the initial enrollment period lasts for a total of 7 months.
      This period:
    • begins on the first day of the third month preceding the month of the eligible person’s birth
    • includes the person’s birth month
    • ends on the last day of the third month following the month of birth.
  • There are two other enrollment periods throughout the calendar year and they are dependent on your situation.  Here is a good place to start to learn more about enrollment time frames – https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html. 

  • Fun Tip – In order to be eligible for Medicare Part B you must be a U.S. Citizen or lawful permanent resident for 10 years?  Answer – No!  You have to pay for this benefit though through different methods.  The best way to learn more about that is go to www.medicare.gov.   Here are other ways to learn more about U.S. Medicare – (1) Apply online at Social Security (2) Visit your local Social Security office (3) Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) and (4) If you worked for a railroad, call the RRB at 1-877-772-5772.
  • Fun Tip – Are dental services covered under Medicare Part A and Medicare Part B?  Answer – No!

• Medicare Part C
  • This option covers the 20%-25% that Medicare Part A and Medicare Part B does not cover.  Rx outside the hospital is covered under Part D, shown below.
  • Travel or living overseas is not a valid reason for missing open enrollment for Medicare Part C (3 months prior, the month of, and 3 months after your 65^th birthday)
  • Two options with Part C.
    • Medicare Gap (also called Medicare Supplement) regulated by U.S. Federal Government
    • Medicare Advantage (also called MA) for the most part regulated by each State. 

Learning Tip – You do not have to get Part C and will not be penalized if you do not select it.  Part C provides what Part A and Part B does not cover.  There still are deductibles, copays, and coinsurance (OR no deductibles, coinsurance and copays on these two major options) – depending on what you choose.  However, MA plans most likely will include copays, deductibles, and coinsurance.

We’ll explain both options next.

• • Medicare Gap / Medicare Supplement
    • Best of the two options
    • More comprehensive
    • Covers throughout the U.S.
    • Has no “networks” limiting the doctors you can see.  Can be used by any medical facility taking Medicare.
    • Out of the different options, Plan F is usually the most comprehensive.
    • Medicare Gap does NOT cover you overseas.  Yes, there is 50k maximum medical coverage (if you choose a plan like Plan F), but read the fine print.  There is a coinsurance of 80/20 which means the policy holder would pay 10k of the 50k and a deductible of 250USD (deductible as of 2017).  You are responsible for all bills above and beyond $50k. There is also NO evacuation coverage. Plus, the medical care is only for the first 60 days of the trip.  Again, medical evacuation is not covered which is why the U.S. State Department strongly recommends travel insurance, and Good Neighbor is listed and recognized by the U.S. State Department website.
    • Around $110 – $130 or so per month for one age around 65, non-smoker.
    • U.S. Congress sets the benefits, so no difference between insurance companies.
    • If one chooses Plan F, there are no copays, no deductibles required in most situations.
  • Medicare Advantage / MA
    • In Network only.  Out-of-network you are on your own and must pay for yourself.
    • Between $0 – 80 per month.
    • Has copays, deductibles.
    • Best for those who are okay being seen by doctors in a small network, and want a lower policy cost/benefits.
    • Learning Tip – Medicare pays a fixed amount for the insured’s care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how the insured receives services (like whether the insured needs a referral to see a specialist or if the insured has to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.
    • Fun Tip – Who offers Medicare Advantage (MA) plans under Medicare Part C?  Answer – private companies approved by Medicare.
  • One does not need to get Medicare Part C.  There is no penalty for not getting Medicare Part C.

However, if one does not get Medicare Part C during open enrollment (3 months prior, the month of, and 3 months after ones 65^th birthday) then one will have to wait till the end of each year for the policy to start January 1^st of the next year.  Annual open enrollment is around mid-October to mid-December for a January 1 start of the next year.

• Medicare Parts A, B, and C will cover 100% of medical cost (minus any deductible or copays depending on what you choose) minus Rx outside the hospital.

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www.gninsurance.com is the corporate website of Good Neighbor Insurance. Good Neighbor Insurance has been in business since 1997! Every one of our international trained and licensed insurance agents has a heart to serve you, our guests.  It is a joy to know that we can provide you all with peace of mind with one of our many overseas medical insurance options to safe guard from financial calamity as well as providing you the best medical care while on your short-term travels or long-term expatriate travels.  To connect with Good Neighbor Insurance, please email us at info@gninsurance.com or call us here in our Gilbert, Arizona office at 480-633-9500 or toll free at 866-636-9100.