Medicare Thread

In My Humble Opinion
1

As with many others on this Board, I am marching inexorably into my senior years. I will turn 65 next year and must soon make a decision about Medicare. My understanding is I will start to be bombarded with confusing information, although that has not started yet.

My main purpose in returning to the US six years ago was to build up my Social Security a little more, as I have lived most of my adult life in Thailand and could not contribute to the SS scheme while there. (The US seems to be unique in this regard, as my other Western friends and colleagues in Thailand could contribute to their countries’ schemes.) Targeting 12 years in Hawaii, we plan to retire back to Thailand once I reach 70, so we are now halfway through our sojourn. I have been working steadily since moving back here and expect to work six more years.

Once we return to Thailand, the wife, having retired Thai civil servant status, will receive free healthcare for life, so I’m not worried about her. I have been advised that health insurance for me in country will be doable albeit not cheap – although much cheaper if I start it in my 60s than in my 70s, so I intend to set up insurance there just before I turn 70. And once we have moved back there I intend to keep Medicare Part A so that if something serious happens, I can hightail it back to a US hospital, while jettisoning Part B, as I won’t be able to use that outside the US. I’ll look for one of the cheapest policies I can find for office visits and such in Thailand. (Increasingly, Thailand is requiring foreign residents to show proof of local insurance coverage, plus it’s just a good idea to have it anyway.)

But that leaves the question of what to do for the five years after I turn 65. I have private health insurance through my workplace. While I am experiencing a lot of the common aches and pains associated with aging, nothing too serious is going on with me now. I do intend to sign up for Parts
A and B for those five years but am unclear on Part C and D plans. Some of them are called Advantage plans. (And some of these seem tied to AARP, but I have no intention of joining AARP, so those will remain closed to me.)

The wife is now a US citizen and working full-time here herself. It looks like she will eventually meet the 40-quarter requirement for getting SS benefits herself someday, but we don’t expect that to be substantial. But she herself will turn 65 in just a few short years also, and she’ll need to make a similar decision about which plans to use while we’re still here.

Speaking of Social Security, the wife has heard something about by just being married to me, I can get a little extra in SS benefits once retired regardless of how many many quarters she herself has under her belt. Does anyone know anything about this?

Any advice or opinions on the above will be greatly appreciated.

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Search for the poster @JohnT and read all his postings about Medicare. He explains it more cogently than anyone I’ve ever read.

There are a lot of pitfalls in your plan. If you need a hospital you very well may not bein any shape to be able to get back to the US. You don’t need to belong to AARP to use one of their health plans. Medicare Advantage plans are an advantage only to the stockholders of the company-you could die waiting for things to be authorized.

As for ‘extra money for you through your wife’s SS’, the only safe course is to make an appt with your local SS office and ask them those questions. It is very complex and if you make a wrong move or assumption you may have to live with it. They are very helpful and can look up your records and give you reliable advice you can count on.

Doing without Part D is the only partway reasonable suggestion of yours,if you live in a country where medicines are much cheaper than in the US. Then you better not need that trip to come back to the US to use that Part A because drugs here out of pocket will be the end of you.

Go read @JohnT, all insurance threads in the past 3 years. Make an appt to talk face to face at a SS office. Forget Advantage plans. Don’t try to game the feds~they’ve been at it longer.

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No, I think she will get more (up to half your benefit).

4

The thread @BippityBoppityBoo mentioned is so valuable that I have it bookmarked in my Favorites bar.

Link

mmm

5

If you do return to the US for medical care at some point, will your Thai coverage kick in at all? as in, whatever Medicare does not cover, will you be able to use the Thai coverage as a sort of Medigap plan?

The Advantage plans have the, er, advantage of requiring little to nothing out of pocket but then often offering over options like dental and vision care. As noted, however, you may run into issues with them denying or delaying coverage - and they may not offer coverage for care in Thailand, meaning your Thai insurance is all you’d have.

I don’t know if you’d have trouble getting any kind of Medigap coverage if you are living outside the US. Plans tend to vary by state in terms of cost - for example where my in-laws live, in God’s Waiting Room (southern Florida), coverage is more expensive than similar coverage where we are. It may not be worth having such a plan,

I get the impression that medical care in Thailand - at least for those with means - is mostly on par with what you can get here in the US, and considerably cheaper. It’s a medical tourism destination, anyway. So the odds of your needing to come back to the US for care seem lowish, barring something really unusual. I could be wrong though - maybe it’s not so good for something longer-term like cancer treatment?

I am going to have to read the other thread in much more detail - I’m 2 years away from being Medicare-eligible; my husband is just over 2 years away, and while we might continue working past 65, we’re just effing TIRED.

6

Ditto the advice to look at the JohnT threads. He’s the best.
I have an AARP Medigap plan, but it is branded - it is really done by UHC. My wife joined us in AARP but I doubt they are going to object taking your money.
I did not do an Advantage plan since none of the ones available when I signed up included my doctor and clinic. They are all limited in the providers you can use so my guess is that none is going to be at all useful to you in Thailand.
My Medigap plan pays I think 50% for expenses outside the US, but it is so good that they don’t offer it anymore, so you should check. That with your in-country coverage might be useful. It was important because my daughter was living in Germany when I signed up and it was very possible this could have been useful.

7

Here’s something that might surprise some folks: it kicks in on the first day of the month you turn 65, not your birthday. My wife’s birthday is on the 30th. We were surprised. Fortunately it didn’t matter because I’m still employed and she’s on my work plan, but I naturally assumed the date was your birthday.

And yes, it’s hella confusing.

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Thanks, all. I will definitely check out that other thread.

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No, I don’t think any Thai coverage would be good outside Thailand at all.

Medical care most certainly is on a par with anything in the US … if you know where to go, and I do. I have had several operations in Thailand already – salivary gland removal and a couple of shoulder surgeries along with several intricate dental surgeries. The care is top notch. In fact, while I was a Peace Corps Volunteer in the 1980s and visiting a fellow PCV in the hospital in Bangkok, they brought in a US diplomatic staff airlifted from India, because Thailand had so much better care. Maybe India has improved since then, dunno, but it just goes to show the quality of Thai healthcare.

I understand there are pitfalls with my plan, but it is still my plan. Far from being a newbie to the country, someone moving to someplace based on second- or third-hand hearsay, I am 64 years old and have already spent most of my adult life there. I know my way around.

10

Excellent. Thank you.

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Isn’t there a 3-month period before your 65th birthday during which you need to sign up for whatever it is you’re going to do at the best price - you can sign up later but it will cost more? Or something like that.

I turn 64 in a couple of months and am enjoying my last few months where I don’t have to worry about that stuff … my plan when I reach 64 yrs and 6 months is both to read the @JohnT thread, and also see if I can get some guidance from the Hawaii County Office of Aging. They seem to offer a lot of guidance for seniors; I figure if I call them and say, “help! I need to figure out Medicare” they will either be able to provide assistance or will point me to someone who is an expert and for a fee (which I will gladly pay) will make sure I do what’s right for me.

Maybe I’m wrong and the County won’t be as helpful as I’m hoping, but I get their newsletter and it is always chock-full of excellent information and encouragement to contact them for more details.

@Siam_Sam , you are in a different county than I am but we’re both in the State of Hawai’i; maybe you should nose around to see if you have any local government resources you could ask for help from. One nice thing about Hawai’i (at least on my island) is that they do try to take care of their kupuna!

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Thanks, Carol. I believe you can opt out of Part D, but if you decide to opt in later it will cost more. Dunno about Parts A and B. I’m not really interested in what the state can do, we’re far from indigent… My main concern is what to do about Medicare. Ages 65-70, I’ll have employer insurance as primary still.

After 70, I think Part D may be good to keep in addition to A, just in case. Will have to look through that thread.

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Laurence Kotlikoff, who has written a book about maximizing Social Security, warns strongly against taking the SSA’s advice at face value. Here’s an example.

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@Siam_Sam

Check your employer provided health plan very carefully. MANY health insurance plans cease coverage at age 65, because you are then eligible for Medicare. The employer-provided health care plan may offer a supplement to Medicare coverage.

Gotta read all the fine print!

~VOW

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Every state has a health insurance assistance agency~they advise about health insurance specific to that state. They offer information and advice, not paying for insurance. Their advice is free.

16

Yes, that’s what I was referring to - the possibility of consultation on how to navigate the system, not assistance paying for insurance.

Ugh. I am not looking forward to dealing with all this. TBH, I don’t even know (I guess I’ll have to learn) how SSI and Medicare are interrelated, which this thread suggests they are. I thought they were two separate government programs?

I was planning on waiting to start taking Social Security until at least 66, and at that point taking what I’m entitled to from my spouse of 40 years (higher than what I’d get on my own). I didn’t know that was entangled with my Medicare choices.

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I am working full-time until age 70, and they will be continuing to provide health care until I retire.

18

Oh, I’m sure your employer will provide healthcare as long as you are working. BUT the health insurance provider may stop covering you at 65, and only offer Medicare Supplemental.

I think it has to do with an agreement between all insurance companies and Medicare.

And Medicare is always first pay.

~VOW

19

Check anyway - for certain employers, Medicare is primary for employees/spouses over age 65 and for others Medicare is secondary to the employer provided insurance. My employer-provided health insurance will cover me as long as I am collecting a pension - but if I were still working at 70, my employer plan would have been primary and Medicare secondary. I think Medicare is always primary for retirees.

20

Though Medicare is under Social Security, they are not really the same. I took Medicare at 65 but waited until 70 for my Social Security. If you are getting SS they’ll take the Medicare premiums out of it, but they don’t have to. When I switched from getting money from spousal benefits to my own benefits I found my bank info was wrong, and my plan D payments aren’t deducted from SS for the moment, but no problem.

I’d research what to do independently, but once you have a good idea of what course to take I found the SS office excellent in navigating the intricacies of the system. The strategy we used would be difficult or impossible to implement with their on-line system, but the SS people handled it no worries.
Any immense system is going to have a few things that go wrong, but SS is at least as good as any businesses I have dealt with, and a lot better than many.