Expats, don’t be devastated by a medical emergency by not having adequate health coverage when visiting the U.S. When moving overseas, many expats find it convenient and cost-effective to enroll in the in-country health coverage or a private health coverage specific for that country, region or hospital association. Few of these programs have any coverage when leaving their country of origin. This can be of concern for expats who travel to the States to visit relatives, vacation, or live part-time. If the expat is over 65 and has enrolled in Part A and deferred Part B of Medicare, they may leave themselves open to some challenging financial circumstances.
John & Nancy’s Story is based on a hypothetical couple.
John and Nancy were living in Colombia when Nancy turned 65 and they decided to sign up for Part A and defer Part B because they were well covered by their Entidad Promotora de Salud (EPS) which is a government sponsored health insurance program in Colombia. However, two years later, when John’s mother became ill in Georgia, they immediately packed up and traveled back to the States to be by her side. They remained stateside for several weeks for her recovery.
During their stay with John’s mother, Nancy became ill and had to be hospitalized. They were comforted by the fact that she was covered by Part A hospital insurance. However, before they returned to Colombia, they were confronted with a stark reality. Nancy had seen a doctor in his office for her symptoms, and he had ordered an EKG and several extensive lab panels. Before receiving the results, her situation deteriorated, and she was transported to the hospital by ambulance. When she arrived at the emergency center, she was seen by several doctors, given more lab tests, an MRI, and several IV drugs. She was kept overnight at the hospital for observational care but was not admitted. The next morning, she saw more doctors, had several more tests and was admitted to the hospital in critical care.
Everything Nancy was poked, prodded, and treated for before she was finally admitted to the hospital fell under Part B of Medicare which she had not enrolled in. Because John and Nancy were in a base EPS plan which had no out-of-country coverage, they were financially responsible for covering the entire cost of these procedures. Probably a bit more than the two years of Part B premiums at $134 per month at the time.
Medicare – The Great Negotiator:
Don’t be devastated by a medical emergency. You can hire a powerful medical cost negotiator by enrolling in Medicare Parts A and B. Few people realize the power of Medicare when it comes to negotiating the cost of medical care. Whether it is hospital charges covered under Part A or medical expenses covered under Part B, Medicare brings home the bacon from the negotiations. When a Part A or Part B charge is billed, it is sent to Medicare, and they first determine if it is covered. If the billed service is covered by Medicare, they offer up what is termed the Medicare Approved Amount for the billing. I have seen thousands of EOBs (explanation of benefits) and seldom have I seen a Medicare Approved Amount of more than 60% of the billed amount, often far less. Once the Medicare Approved Amount is established Medicare pays it’s 80%, and the Medicare beneficiary is responsible for the remaining 20%.
In the example of John and Nancy, they had Medicare as their negotiator for the hospital stay, however, since they were not covered by Part B, the charges that would typically be negotiated by Medicare were passed on to them at 100% of the billed amount. True, they can then try their hand at bargaining, but they just do not have the power that Medicare wields.
When considering whether to enroll or defer Part B of Medicare look at everything Part B covers, think about how Medicare will negotiate for you, and evaluate the likelihood of your returning to the States for any reason in the future. If you have questions Ask Ron.
If you decide to delay your Part B coverage, be sure you have some type of world or traveler insurance when you visit the U.S. It may seem odd to many U.S. citizens, but evacuation insurance from the U.S. may be a consideration for those insured in a foreign country. International Living has agents ready to help you with your world coverage options.