# Keeping Medicare Coverage



## dvinton (Mar 8, 2019)

Hello,

For those permanent US expats 65 and older, what's your Medicare status/coverage?

My friends in Ajijic have private Mexican coverage but kept Medicare coverage as a worst-case scenario.

Keeping Medicare coverage seems the prudent thing to do.

I look forward to hearing how you are handling this.

Regards,

Don

P.S., You'll find an introduction about my wife and me in the Introduction Forum.


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## citlali (Mar 4, 2013)

have private Mexican insurrance and do not have Medicare. we have no plan to go back..


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## lagoloo (Apr 12, 2011)

I think it depends almost entirely on how you think (or feel) Mexican health care compares to that in the U.S., because the numbers work thus:

We canceled our Medicare (Part B) when we moved to Mexico in 2004 and ever since, have paid out of pocket in addition to carrying SP as a disaster backup (which we have never used.) Can't get private insurance due to pre-existing conditions.
Our expenses have included office visits, drugs, surgery for cataracts, minor back surgery and one for coronary problems.
Part B Medicare would have cost approx $210 per month for two people X 180months = $39,600. Added to that are co-pays.
We may have spent half that for everything.

Another factor is whether one wants to seek a doctor that takes Medicare patients (not that easy any longer) and your options for post-residential care and its cost. 

The companies that will fly you to the U.S. will not take you there until you have been "stabilized" here for whatever your condition may be.

Just some things to thing about....


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## citlali (Mar 4, 2013)

We feel that the flying back for us is useless , each time my husband got an emergency surgery , there is no way he wanted to fly or go anywhere..not even to Guadaljara 2 hours from Chiapas.. , The flying option we know is a waste of money for us.


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## Stevenjb (Dec 10, 2017)

My understanding is that if one is returning to the U.S., they can within the first two months of returning, (re)enroll in a Medicare Advantage Plan (part C) as long as they already have Medicare Parts A and B active. This would most likely be for those returning to the U.S. longterm.


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## Stevenjb (Dec 10, 2017)

Link for above:

https://www.medicareconsumerguide.com/moving-to-us-and-enrolling-in-medicare


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## dvinton (Mar 8, 2019)

Thanks to everyone who responded! All good information. It reinforces all the positive things we've heard about medical services and costs in Mexico.


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## dvinton (Mar 8, 2019)

*NY Times Article*

All,

Below is a link to an NYT article titled "Dream of Retiring Abroad? The Reality: Medicare Doesn’t Travel Well." A couple of American expats in Mexico are cited.

https://nyti.ms/2NZBjGc

I found it informative, but nothing new since my wife and I have been studying (and asking on this forum) and giving a lot of thought on what kind of coverage we'll have (US & Mexico) when we move to the Chapala area next year.


How does the discussion on private insurance in Mexico pan out in this forum? Good, bad, expensive, cheap, must-have, waste of money?

Thanks,

Don


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## Stevenjb (Dec 10, 2017)

Interesting subject for a traveler in Mexico. Perhaps catastrophic coverage in Mexico would be good, then pay basics out of pocket.

Leaving the U.S. and returning to use Medicare might be tricky as I see it. You would have to drop the Part C or Supplemental, then re-establish on return - time frame (call SSA about that). Using original Medicare would mean a long term relationship with a flexible doctor in the U.S.

I have an Excel cost spreadsheet of the savings and penalties of dropping Medicare Part B (for up to 10-years) - pm me with an email address and i can send a copy, or pdf print.

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## Ajijic Lady (Jan 19, 2009)

@stevenjb: We carry Medicare and a medigap policy through my ex-employer; we were not required to drop it nor is there any requirement to maintain a long-term relationship with a specific doctor. All you need to do is go to an Urgent Care clinic or an ER. The medigap policy also covers us in any country outside the US for the first 60 days of any trip, though it does have limitations and deductibles. Our medigap is appx. $40 per person per month. 

@lagoloo: While you and your spouse have built up a nest egg of nearly 40K by declining Part B for ten years, the question for new arrivals is: What if you have a major medical need in your first year or two here in Mexico? 

All of my friends and family who were diagnosed as needing heart bypass surgery had enough time (weeks) before their surgeries took place. Same with most cancer surgeries and the follow-up chemo or radiation....there was plenty of time to get back to US.


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## Stevenjb (Dec 10, 2017)

Ajijic Lady said:


> @stevenjb: We carry Medicare and a medigap policy through my ex-employer; we were not required to drop it nor is there any requirement to maintain a long-term relationship with a specific doctor. All you need to do is go to an Urgent Care clinic or an ER. The medigap policy also covers us in any country outside the US for the first 60 days of any trip, though it does have limitations and deductibles. Our medigap is appx. $40 per person per month.
> 
> @lagoloo: While you and your spouse have built up a nest egg of nearly 40K by declining Part B for ten years, the question for new arrivals is: What if you have a major medical need in your first year or two here in Mexico?
> 
> All of my friends and family who were diagnosed as needing heart bypass surgery had enough time (weeks) before their surgeries took place. Same with most cancer surgeries and the follow-up chemo or radiation....there was plenty of time to get back to US.


Thank you for your input. I assume you are referring to original Medicare with a Supplement (medigap) plan. The last time I researched these plans they had limits on the time out of the U.S.one could be before losing coverage. Additionally, Supplement plans are pricey for the average insured, depending on which alphabet letter plan is chosen (A, B, F ....), some with high deductibles, and the premiums increase with the plan members age.

I choose to go for a Part C ( Advantage Plan ).

Returning to the U.S. and using an E.R. or Urgent care, interesting option. And if you are admitted to a hospital, does that hospital take Medicare Part A for full reimbursement. Hard to research of one is sick. You would still needed a general care doctor for follow-up and ongoing care. Also there is original Medicare (no Part C or Supplement plan association) Part B 80/20% pay - you could end paying 20% of - an MRI. Appreciate your input on this.

Living in another county, I would research catastrophic coverage, and pay out of pocket for general care.

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## Ajijic Lady (Jan 19, 2009)

Answers highlighted below. 



Stevenjb said:


> Thank you for your input. I assume you are referring to original Medicare with a Supplement (medigap) plan. The last time I researched these plans they had limits on the time out of the U.S.one could be before losing coverage. Additionally, Supplement plans are pricey for the average insured, depending on which alphabet letter plan is chosen (A, B, F ....), some with high deductibles, and the premiums increase with the plan members age.
> Yes I have original Medicare A&B and a Medigap plan which is a group plan through my retirement system. There is no limit on my time outside the US; I have this in writing from the plan administrator. I have no deductibles when used in the US, very low co-pays and my premiums do not increase with age.
> I choose to go for a Part C ( Advantage Plan ).
> I researched Advantage plans as many have zero premiums, but found they all require US residency.
> ...


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## Stevenjb (Dec 10, 2017)

Ajijic Lady said:


> Answers highlighted below.


You have a awesome employer benefit.
U.S. government?

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## Ajijic Lady (Jan 19, 2009)

Local government. Not as good for new hires, but mine is pretty sweet. Age 50 I retired with full bennies (70% salary). But I did work there 30 years.


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## Stevenjb (Dec 10, 2017)

Awesome

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## mattoleriver (Oct 21, 2011)

Supplement Plan F was the most attractive to me and I have to assume that it is one of the most popular plans among expats and travelers but it may be going away. I ended up in an Advantage Plan and I do find the geographic restrictions to be very limiting.
https://www.ehealthinsurance.com/medicare/supplement-all/is-medicare-supplement-plan-f-going-away


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## Stevenjb (Dec 10, 2017)

mattoleriver said:


> Supplement Plan F was the most attractive to me and I have to assume that it is one of the most popular plans among expats and travelers but it may be going away. I ended up in an Advantage Plan and I do find the geographic restrictions to be very limiting.
> 
> https://www.ehealthinsurance.com/medicare/supplement-all/is-medicare-supplement-plan-f-going-away


I believe Plan F has two versions, one being a lower premium high deductibles. Part C Advantage plans are geographically centric, yet from my memory one can seek emergency care at an E.R. in any U.S. city.

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## mattoleriver (Oct 21, 2011)

*Plan F*

Supplement Plan F was the most attractive to me and I have to assume that it is one of the most popular plans among expats and travelers but it may be going away. I ended up in an Advantage Plan and I do find the geographic restrictions to be very limiting.
https://www.ehealthinsurance.com/medicare/supplement-all/is-medicare-supplement-plan-f-going-away


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## dvinton (Mar 8, 2019)

At the end of this calendar year, new Medicare enrollees cannot subscribe to Plan F and Plan F High Deductable. Its logical replacement is Plan G; the only difference from F is the elimination of the Plan B Deductable, an out of pocket increase of $185, assuming you have enough claims. Current Plan F subscribers are grandfathered.

I've just enrolled. Since I'm still stateside, I selected an Advantage plan which cost $0. When we move next summer, leaving no domicile in Oregon, I'll likely change to Plan G or Plan G High Deductable.

As we figure out if Mexico is our final stop and we gain a personal comfort of the medical services around Lakeside and Guadalajara, I expect to dial back or eliminate Medicare coverage. Only time will tell.


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## ojosazules11 (Nov 3, 2013)

I have to say that reading the above about the US Medicare alphabet soup sure makes me glad - both as a family doctor and as a patient - that I’m in Canada with its single payer (provincial government) system. It’s not perfect, and there are variations by province, but I still think it’s a great system. Mind you, if you are out of country for more than 7 months per year, you are no longer covered, and have to wait three months once back in country for it to be reinstated. I believe this is one reason many Canadians stay only half the year or less in Mexico, rather than year round. When I retire, it will certainly be a factor for me. Also, Ontario in the summer is gorgeous. Just got back from camping in the woods. So beautiful. But I know winter is coming...


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## Stevenjb (Dec 10, 2017)

Yeah the U.S.needs a Medicare (for All) system. Over 200-years with this system ain't working. Fortunately those on original Medicare (retired/disability) can keep their coverage while outside the U.S. - however they need to return to the U.S. for coverage services.

When I was younger employed, medical coverage could be obtained through the employer for free, or reasonable cost - I have read that availability is becoming less.

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## lagoloo (Apr 12, 2011)

Why the U.S., a "first world country"can't devise a system such as other countries have come up with is either lack of will, lack of creativity or (hevvin forbid) plain old greed. Right now, millions of bucks are being spent on lobbyists whose purpose is to prevent any interference with the profits of drug companies. Our legal system is set up to allow lawsuits that could bankrupt doctors, who pay obscene amounts for insurance to prevent this happening.

What is gets down to is the usual; FOLLOW THE MONEY.


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## Ajijic Lady (Jan 19, 2009)

It's not just Big Pharma. 

The US opted for a private insurance system long long ago. Even US Medicare is fairly new, only since 1965, and most Medicare members also carry private insurance (Supplemental or Advantage plans). 

The US Insurance Industry is a powerful lobbying group.....


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## citlali (Mar 4, 2013)

In France we have social medecine and we take insurrance to cover the gap. If we change job the nsurrance and national cover we call social security goes with us so there is no interruption. The French are always compalining about once thing or another but they have a hel od a coverage in comparaison to the US. I do not understand why people would be against asocial medecine Agan in France if we would more expensve doctors, priorty and so on you can pay for it so you cannot say it s a totally equalitarian system but it does work for everyone.


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## Crawford (Jan 23, 2011)

Ajijic Lady said:


> It's not just Big Pharma.
> 
> The US opted for a private insurance system long long ago. Even US Medicare is fairly new, only since 1965, and most Medicare members also carry private insurance (Supplemental or Advantage plans).
> 
> The US Insurance Industry is a powerful lobbying group.....


.... as is the Medical Council...... costs for everyday routine treatments have sky rocketed without any check.

A few years ago I was paying 160 USD to see my Primary physician, now its 280 USD... I don't see that his care has improved at all to warrant such an increase....

Mammogram used to be 180 USD now its 320 USD 

What with Big Pharma, the Insurance companies and the medical profession all taking their cuts, is it any wonder the charges are as high as they are.


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