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Post by yogibearbull on Aug 15, 2023 12:25:36 GMT
While basic/original Medicare doesn't apply in foreign countries, except in very limited transient situations, Medigap insurance may cover some expenses overseas. Likewise, Medicare Advantage may also cover some overseas expenses. But there is no Medicap or Medicare Advantage without the basic/original Medicare. For travel, Travel insurance is recommended - for the US citizens travelling overseas, and foreign residents travelling to the US. For US citizens residing overseas, the insurance situation varies - that is what this OP is about. I am curious about this too as this specialized info is not covered in detail in generally available Medicare info. I have heard of some anecdotes about the US health insurance (but not Medicare) in foreign countries - both good and bad. In general, in most foreign countries, upfront payments are required for medical services. It is NOT illegal to turn patients away who (or their relatives/friends) cannot pay on spot. Good that US credit cards may be accepted. It is useful to get a denial letter/fax from your US insurance. Most travel insurance will kick in only after that. So, when you travel abroad, have the phone#, fax, email of your US insurance with you (even when you know that not much will be covered). Get full itemized receipts from foreign doctors/hospitals and submit claims to your US insurance. I have friends who have reported that in some cases, they were reimbursed fully by their US insurance. At least one brags that he made a "profit" because the expenses were fully covered by travel insurance AND also reimbursed later by the US insurance. I told him privately not to talk openly about it because keeping all that money amounts to insurance fraud that is probably criminal. Capital , also made a good point. If you drop Medicare, medical underwriting may be required for subsequent signup even with permanent late-penalties. In fact, medical underwriting may also be required just for switching Medigap insurance after a while after the initial signup, so pick the best Medigap plan that you can afford at the initial signup - G, N, old F (closed for new signups). www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-States.pdfwww.ehealthinsurance.com/medicare/coverage/do-medicare-advantage-plans-cover-overseas-travel/
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Post by anitya on Aug 15, 2023 19:04:06 GMT
my parents tried to switch from Cigna to Mutual of Omaha. Only my mother passed the underwriting. I am a few years away from qualifying for Medicare but next year I am planning to sign up with Kaiser P, my local Medicare Advantage insurer / provider, to test them before I qualify. We had positive feedback about them in this forum.
(Edit: My current idea is to not buy supplemental insurance and just pay Part B premiums (use Advantage plan) and buy travel insurance when I travel.)
As an aside, if one is OK with Medicare Advantage, does one still need to worry about insurability (I.e., can you be denied admission) if there is only one company that covers one’s area?
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Post by yogibearbull on Aug 15, 2023 19:23:18 GMT
My understanding is that one first enrolls in original/basic Medicare (Parts A & B). Then, one can move on to Medicare Advantage (Part C). Check with Kaiser P.
When first eligible for Medicare, no medical underwriting is required, nor for allowable switches.
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saratoga
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Posts: 168
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Post by saratoga on Aug 16, 2023 0:04:57 GMT
When you are 65, Medicare Advantage plans look enticing. However, as you get older, you tend to accumulate more serious illnesses. Freedom to choose best specialists gets increasingly more important. It could be difficult to move from Medicare Advantage to Medicare Supplement so you need to consider this aspect carefully.
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Post by gman57 on Aug 16, 2023 0:12:00 GMT
Yes, you automatically get A&B -- A is free and they deduct B from your SS. You can then either get a Medicare Advantage plan "C" or a Medigap policy. Medicare Advantage "C" usually has "D" (prescriptions) included. They have many Medigap versions with various letters that offer different coverages and you'll also need a "D" plan too.
Many Advantage "C" plans are $0 premiums and have perks like vision, dental, gym membership, quarterly over the counter allowances etc... while Medigap plans and "D" have a monthly premium of a couple hundred bucks per month and I don't think any perks.
The things I looked at:
Just about everyone takes Medicare so if I lived someplace that had few hospitals I would probably have gone with a Medigap & D plan. If you don't have many close hospitals and your hospital sudden stops taking Aetna and that's your Advantage plan you're hosed. You may have to drive hours to a hospital that does.
I have many good hospitals all within 30 minutes so I decided to go with a Medical Advantage plan. Even then, you need a good Advantage plan that's been around like United Healthcare, not a startup. If a local hospital decides to stop doing business with my Advantage plan I have other local hospitals I can use.
There are also other reasons to go with Medigap plans... one of them is you can go to almost any doctor as most take Medicare so if you need a xyz super specialist for a xyz ailment you can go anywhere. You can't go to that specialist if he doesn't take your Advantage plan. Well, you can but you'll probably pay a lot because they'd be an "out of network" provider.
There is open enrollment once per year and there is some question that if you don't do Medigap from the get go you might not be able to get back into Medigap in the future and vice versa . I didn't really research that part too much so "google is your friend" if you have questions in that area.
ADD: Hmmm, after thinking about it Medicare A is "hospital" coverage. Medigap and Advantage plans are to cover what Medicare doesn't. I do hear from people on Medicare/Medigap that they never get a bill while with Advantage plans you have co-pays etc... to deal with.
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Post by yogibearbull on Aug 16, 2023 0:27:55 GMT
Our Medicare Advantage has both HMO and PPO. We chose PPO and can go almost anywhere without prior approval.
I don't see why some doctor/hospital will take Medicare but not Medicare Advantage. But there are some doctors/hospitals that don't take Medicare because they don't like its reimbursement rate; by law, they have to provide a clear statement of this before any services are provided so that you can go elsewhere.
When Medigap signup is when first eligible, the enrollment is guaranteed. If you delay, keep in mind that Medicare only covers 80%, so you will be on the hook for 20%. Then, if you decide to join Medigap late, then medical underwriting will be required.
Lesson is not to play games. Signup for things when first eligible. If excess or redundant, cancel things LATER.
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Post by archer on Aug 16, 2023 0:42:45 GMT
I've had kaiser all my life so I can't compare it to anything else. I wonder with medigap plans would I be less limited by the treatment protocols of kaiser, or other advantage plans. Or, is it all gov. regulated such that you pretty much get the same access and coverage for specialists? For example, if I want to see a dermatologist, with kaiser I have to be referred by my primary care phys, (due to not seeing a dermatologist in the past 2 years). I have had incidences in the past with kaiser of having to really fight to see a dermatologist only to have them immediately agree with cancer diagnosis that the PCP misdiagnosed. With medigap plans are there less system constraints? Do we have more agency in determining our care with medigap plans vs advantage?
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Post by anitya on Aug 16, 2023 3:29:08 GMT
I've had kaiser all my life so I can't compare it to anything else. I wonder with medigap plans would I be less limited by the treatment protocols of kaiser, or other advantage plans. Or, is it all gov. regulated such that you pretty much get the same access and coverage for specialists? For example, if I want to see a dermatologist, with kaiser I have to be referred by my primary care phys, (due to not seeing a dermatologist in the past 2 years). I have had incidences in the past with kaiser of having to really fight to see a dermatologist only to have them immediately agree with cancer diagnosis that the PCP misdiagnosed. With medigap plans are there less system constraints? Do we have more agency in determining our care with medigap plans vs advantage? My parents have supplemental (Medigap) plans (PPO) but because they like the convenience of specialists and medical records in one place, they go to Palo Alto Medical Foundation. As this organization attained more corporate culture (though they claim to be a non-profit), they do not let their patients see specialists without the PCP referring the patient (but if you are not a PAMF patient, you can self refer to their specialists), and it helps them with generating revenue. So, archer , the misdiagnosing PCP could have easily been a PCP at a PAMF, with the exception that PAMF is only a provider interested in maximizing revenue whereas Kaiser can have a conflict of interest of being both the insurance company and the provider. How difficult is it to change PCPs under Kaiser and how easy it is to see more than one specialist for the same ailment? This is an unknown about Kaiser for me and is why I want to use them before getting to Medicare eligibility and deciding to go with a Medicare Advantage plan. I am sorry about your misdiagnosis but looks like you have overcome the shortcoming. One thing I do if I disagree with a PCP is I send them a message through the provider portal and document my concern which usually results in backtracking from the PCP. They tend to be less casual with me afterwards. (After I started working and noticing that not everyone I worked with is competent, not even the ones with the best Ivy League education, I do not take every doctor's word for granted. I have had many misdiagnoses and under prescriptions from family members as well, resulting in relapses, which also helped to know that not all doctors are cut from the same cloth. Means a lot of research and learning myself about my ailment(s), which good doctors usually like. I also have fond memories of dealing with great doctors for my parents.)
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Post by archer on Aug 16, 2023 3:57:50 GMT
anitya,Thanks for sharing this. In the past the misdiagnosis was 3 different GPs to look at the same issue. For many things with kaiser you can just make an urgent care appt to get seen right away. My ex had the same experience with skin cancer on her nose that could have been removed earlier with less of a scar. I finally got to see the dermatologist because the 3rd GP asked me if my wife was sending me in to "have this looked at" LOL! I told him yes, and I will be back again if he doesn't give me the referral. So he gave in and the dermatologist took one look and immediately said "that's cancer". Due to covid I let the 2 year appt policy lapse. I think for some things it can just be simpler to self pay if not covered. I did have a dermatology appt outside of kaiser about a year ago and it was only $200 out of pocket for a full body check up. I'm guessing if insurance had been involved it would have been rated for much more. I periodically have extensive lab work done on my own that kaiser doesn't cover, and it would be nice if I didn't have to pay out of pocket for it, but I'm not sure any insurance would help with that. My current partner has blue cross so I could probably find out more about what can and can't be hoped for by talking to her drs and their policies and experiences with insurance.
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Post by anitya on Aug 16, 2023 4:20:29 GMT
archer, what is a 2 yr appointment policy?
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Post by liftlock on Aug 16, 2023 4:22:10 GMT
I've had kaiser all my life so I can't compare it to anything else. I wonder with medigap plans would I be less limited by the treatment protocols of kaiser, or other advantage plans. Or, is it all gov. regulated such that you pretty much get the same access and coverage for specialists? For example, if I want to see a dermatologist, with kaiser I have to be referred by my primary care phys, (due to not seeing a dermatologist in the past 2 years). I have had incidences in the past with kaiser of having to really fight to see a dermatologist only to have them immediately agree with cancer diagnosis that the PCP misdiagnosed. With medigap plans are there less system constraints? Do we have more agency in determining our care with medigap plans vs advantage? With a traditional Medicare / Medigap plan, approval from a PCP gatekeeper is not required by Medicare in order to see a specialist. One can simply make an appointment directly with a specialist. However, I am finding that some specialists require a referral from a PCP. I suspect this may be due to a shortage of physicians in certain specialties. Recently, it has taken me 2 months to get an appointment with my dermatologist, 2 months to see my orthopedic specialist. I am interested in seeing a rheumatologist but local wait times are 6-12 months with some requiring a referral from another physician. Wait times are long because there are not enough new physicians coming along to replace the ones that are retiring. I have not studied physician demographics, but I suspect an aging population is going to cause a shortage of physicians to get worse.
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Post by Capital on Aug 16, 2023 9:20:20 GMT
My understanding is that one first enrolls in original/basic Medicare (Parts A & B). Then, one can move on to Medicare Advantage (Part C). Check with Kaiser P. When first eligible for Medicare, no medical underwriting is required, nor for allowable switches. When I signed up for Medicare at age 65, I first went thru all the motions to sign up with Medicare parts A and B. Once I was signed up and had my Medicare card I then signed up with my Advantage Plan provider. I started as early as possible to have adequate time to complete these stages prior to the month of my 65th birthday. Medicare coverage begins the first day on the month you become age 65. If memory serve me correctly the window to sign up for Medicare on your SSA.gov website is beginning of the third month prior to the month th you become age 65. I also have a login account on the Medicare.gov website and would suggest that all Medicare recipients do so as well. There is information there regarding your coverage and your premium payments. Once you have your Medicare card you can establish yourself an account because you need your Medicare number on your card to do so.
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Post by archer on Aug 16, 2023 14:32:24 GMT
archer , what is a 2 yr appointment policy? With Kaiser, if you haven't seen a dermatologist in 2 years you have to have a referral. Once you are seen by a dermatologist you can continue making appointments directly with their department as long as you don't let 2 years go by without an appt. I was fine for many years and kept up with appointments, but when Covid came along I let it lapse.
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Post by anitya on Aug 23, 2023 22:23:02 GMT
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Post by anitya on Aug 25, 2023 13:56:41 GMT
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Post by yogibearbull on Sept 3, 2023 14:28:08 GMT
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