Should a Full-Time Expat Get Medicare?

It is easy to start getting medicare coverage the month one turns 65, part A is automatic and part B must be paid for quarterly in advance, credit cards can be used with no additional charges.  The month before I turned 65, after signing up by phone through the local SS office, I received payment info by mail and sent in  my cc info for the $314.70 for 3 months of Part B.  Many diagnostic tests, such as colonoscopies, are no charge to the medicare patient.  Once one starts collecting SS retirement benefits by direct deposit, the monthly part B, currently $104.90, will be deducted from your  retirement benefits, and any prepaid part B payments will be refunded in the form of a US Treasury check, looks just like a tax refund check, mailed to your current address.

Hi,
A good reason to keep one's Medicare is, as I have been told by some seasoned ex-pats living most months of the year abroad, should you decide to return to the U.S. for any length of time but had opted out of Medicare previously, one is charged a hefty penalty (can't remember the % but probably can be found on the SSA website). Also, if one returns to stay in the U.S. and has no medical insurance, you know the new Obama regs -- you will be penalized for not having some type of coverage.

As for a colonoscopy, Medicare only covers a colonoscopy as a routine diagnostic test, but if polyps are found, then one must pay surgical fees (surgeon, anesthesia, etc.); out-of-pocket $ and co-pays are contingent on the type of supplemental plan you may have. I was shocked when I had to have an x-ray at the hospital, which happened to be located next to my physician's MOB, and the intake clerk said, "That'll be $90!"  Parts A and B alone don't cut it (these days, rarely covers 60% of total costs) so I'll be exploring better supplemental plans next time enrollment rolls around if I'm still here and not in Ecuador. I speak from experience. Salut!
PS

Only 60 percent!  Wow!

If that is correct -- and I have no reason to doubt it -- then Medigap coverage is essential if you have a major medical experience in the U.S.

cccmedia in Quio

Absolutely, ccm! Part B only covers 60% of "routine" procedures. This means MRIs, CAT Scans, and other more sophisticated tests are NOT considered routine.  Supplemental plans vary so much. That's why there are always reps at the local supermarkets during open enrollment to make appointments to explain all the particulars of various plans.

Of course, the higher premium you pay in a supplemental plan, the better coverage (less co-pays/deductibles) than the lower paying ones. This is where folks need to be savvy and know their particular medical needs. Also, these plans have a formulary for Rxs where Tier 1 is a -0- copay, Tier 2 can be $10-20, and after Tier 3, well, it's ALL out of pocket. So, remember during implementation of Obamacare, the ubiquitous phrase that appeared on tv and quoted by opponents to the new health reforms was "You CAN'T keep your doctor and you CAN'T keep your plan." Well, with "mediocre" Medicare you often cannot retain the same PCP and suddenly those meds you've been taking for years don't even exist on the formulary so you can't keep those either, thus indicating one's decisions require a lot of  research. Maybe one may ultimately decide it's time to head south of the border.

Regards,
PS

peripatetic_soul wrote:

Absolutely, ccc!...Maybe one may ultimately decide it's time to head south of the border.

Good points, Soul gal.

For those who are heading "south of the border," there is yet another reason to head to Quito for healthcare benefits.

A Danish company, EMI, offers a low-cost plan covering ambulance service and at-home medical service for patients who are ill or were recently released from a hospital and need specialized attention or testing.  The company is a subsidiary or partner of Denmark's Falck company.

The English-language website is  www.falck.com/en/countries/ecuador

Quito tel. 2274700

Thank you, member Pájaro Azul, for leading Quito Expats to this company.

cccmedia in Quito

May I inquire as to the cost of a colonoscopy with polyp removal in Ecuador at a hospital to compare costs in the US? Or do most ex-pats return to the US for such tests? In my "basic" plan, the colonoscopy is covered but the removal of polyps is $265! And that doesn't cover the cost of anesthesia, etc. I'm sure you've read about the $712 million in Medicare fraud committed by health care personnel and MDs recently in the news. Who shall pay?

Regards,
PS

You are not going to get such a procedure done in Ecuador anytime soon unless you are paying 100 percent out of pocket.  And that won't be cost-effective, not for tests and delicate surgery, compared to what you personally would pay in the U.S.

Private insurance in Ecuador will not cover pre-existing conditions.

Let's say you arrive in three months from now, get your visa and Ecuadorian ID three months later, enroll ASAP in the national IESS healthcare program, wait the 90-day period before you can request a non-emergency appointment, see a doctor a month later and then a specialist a few weeks after that, and wait still another month until the procedure can be scheduled.

Can you wait a year? 

Is it ethical to burden IESS with a pre-existing problem that could be solved in the U.S. for $265 plus anesthesia, etc., when you haven't been paying into the IESS program?

If it is a borderline decision, do you want to rely on a new Spanish-language medical system for a sensitive operation?

Think it over.  Based on what you told us, I would lean toward getting it done and over in the U.S. even if it would be inexpensive in Ecuador.

cccmedia in Quito

Hello, ccm,
Two conclusions clearly emerge from your insightful reply:

1. Retain Medicare to avoid penalties as one may need coverage in the future, and
2. it is imperative to learn Spanish to function in Ecuador, no matter where you interact, esp. in the medical setting.

Thanks so much. You are a wealth of information!

Regards,
PS

Excellent information.  Thanks.  I turn 65 next month and have the best coverage available here in Ecuador through private insurance.  I received notice my SSI will be reduced.  The notice was about Medicare but it was not clearly stated.  While I do not foresee returning to the US, I will keep my Medicare enrollment.
Thank you so much.

Interesting thread. I am only 62 and just arrived less than a month ago with a 2 year temp visa. I had to have medical to get my cedula, so out of necessity and speed opted for a recommended EcuSanitis. I assume it may be related to ColSanitis which is my coverage company in Colombia. Are the normal medical companies for basic coverage all the same cost or does the monthly premium vary company to company. I had heard coverage for a couple would be under $100 a month and as myself and my wife it is around $135 a month. I thought it may very from company to company. I now have 3 months coverage and figured this would give me time to shop around if needed.

***

You should remember that after you turn 65, there is generally only one enrollment opportunity for Part B open to you, which is annually from January 1 to March 31.  If you sign up in that window, coverage becomes effective on July 1.

So if you get sick in March and decide to re-sign-up and return to the US, you can have coverage within four months.  If you get sick in April, it's going to be 16 months -- July of the following year -- before you have Part B coverage.

To clarify some things above: Part A covers services while you're admitted to a hospital. (Sometimes you may be IN a hospital but not technically admitted.) And Part B covers outpatient services, including some very expensive ones, like outpatient surgery, dialysis, chemotherapy, radiation, rehabilitation after a fall, etc. Everyone who's not rich needs these covered somewhere, somehow.

In 2019, Part B costs $134.50 a month.

It is my understanding that with colonoscopies polyps can be discovered anytime. So a preexixisting condition, not always if in keeping with the Roccommended interval. My last one in South Carolina the anesthesia alone was billed to my 80/20 plan insurance at 3500. After insurance negotiations I paid 250.  Nate