Expats Signing up for Medicare

We realize that being an Expat can be challenging for any number of reasons.  One such challenge is getting questions answered when it comes to expats signing up for medicare.  In this article we hope to provide you with some insightful answers that will make the move to Medicare easier for you.

QUESTIONS: I am about to turn 65. As an Expat, am I required to sign up for Medicare? If so, what parts are required? If I do sign up, will I have to pay even though I am out of the USA and can’t use my benefits? If I don’t, will I have to pay a penalty? Can I wait until open enrollment?

ANSWERS: Assuming you are Medicare eligible, at age 65 you will be automatically signed up for Part A, hospitalization. If you are still a full-time employee and your employer has more than 20 full-time or full-time equivalent employees, then Medicare is secondary and your health insurance is primary. That means signing up for Part B can be put off until your full-time status with your employer changes, so you will not be charged the 10% penalty per year for not signing up for Part B, but can sign up for it when your status changes. So, if you decided to work until age 70 and then go part-time or totally retire, you can now go into Medicare (or I recommend going online at www.Medicare.gov ) and sign up for both Part B (doctor and outpatient coverage) and if you need it, Part D which is for RX, unless you don’t need it because you buy an “Advantage Plan” which includes RX. Once signed up for Medicare basic (Part A and Part B) then most people make a choice as to whether you choose a Medicare Supplement (F is most popular) and also sign up for Part D as I stated, or they buy an Advantage Plan, which is where an insurance company is paid a flat amount for your care and they set up a plan for you to follow that has deductibles and co-insurance like you are used to under your present plan. The big difference has been cost in that the Advantage Plan is sometimes as low as $0 (free) per month while an F supplement will cost you around $150 to $200 a month depending on the area of the U.S. you live.

A breakdown for costs for you would be:

1. Part B will cost you over $100 a month from Medicare ($104 a month this year) and is usually taken out of your Social Security check although you can pay it direct.
2. Part D, if you need it will cost in a range of $40 to $125 a month depending on what you buy.
3. An F supplement to Medicare covers all deductibles or charges that are Medicare eligible that Medicare doesn’t pay. These charges can be significant…for instance, Medicare has a deductible per hospital stay (not annual) of over $1100. Part B covers 80% of all eligible Medicare charges, but that can leave a lot as this is for all doctor’s charges, outpatient charges, etc. That’s why most people get a supplement.
4. If you decide to buy an Advantage Plan from a company like Blue Cross or United Healthcare, it is usually a lot less per month, but will include its own deductibles and co-insurance or co-pays (if you buy this you still have to buy Part B, but you don’t need Part D (RX) as it’s included in the Advantage Plan).

Bottom line for your question:

You want to go on Medicare.gov and make sure you are signed up for Part A, which should happen automatically, but then you don’t need to sign up for Part B until your employment changes from full-time. With that said, I will also tell you that a person can “voluntarily” move to Medicare. You can reject your employer’s insurance [remember that Medicare doesn’t cover overseas so you probably will not do this option 🙂 ] , and move to Medicare once you turn 65.  Your employer cannot provide incentives for you to do so. This is not a normal occurrence, but it can happen.