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stevebrtx

Mar 23, 2010, 2:39 PM

Post #1 of 44 (6312 views)

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Do I need to buy healthcare?

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Ok, now the new healthcare bill in the US has been signed, I've not yet found a single person or post on any forum who can tell me what it does for or to me - specifically do I now have to buy healthcare insurance?

I live in MX, they forced Medicare on me even though the nearest Doc is 700 miles. Do I now have to buy some sort of "healthcare insurance"? - And if not here and I move back do I have to buy it then and there and is there a penalty for not having it while I was out of country (like opting out of Medicare and then joining later)? I'm sure somewhere in the 2,700 pages this is covered - right?
http://www.chapalaweather.net



Manuel Dexterity

Mar 23, 2010, 3:20 PM

Post #2 of 44 (6292 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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You aren't interested in any factual answer. You just want to post a veiled political rant. Its a done deal. Learn to live with it.


Rolly


Mar 23, 2010, 3:34 PM

Post #3 of 44 (6285 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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Steve, since you have Medicare, you have insurance. You don't have to buy anything else.

Rolly Pirate


La Isla


Mar 23, 2010, 4:10 PM

Post #4 of 44 (6266 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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Quote

I live in MX, they forced Medicare on me even though the nearest Doc is 700 miles.


I'm not thrilled that once I hit 65, I'll have to pay for Medicare, but I look at it this way: It's my choice to move to Mexico where I can't use Medicare benefits. In addition, I am happy that people like my 89-year-old mother have Medicare benefits, something that she wouldn't have had 50 years again. So I advise you to follow Manuel Dexterity's and learn to live with it (-: !


Peter


Mar 23, 2010, 4:17 PM

Post #5 of 44 (6262 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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Regardless of you motive for asking I'm sure it's a valid concern for many folks, especially those citizens that live outside the US. Rolly's answer should put many retirees here at ease.

I'm too young for Medicare but have health insurance as part of my retirement benefits, though I have to pay a share of it myself each month deducted from my pension. If I opt out I will not be allowed to get it back so I keep it although my deductibles are high enough that I pay out of pocket for my routine health care here in Mexico. Someday I may need it for something major and I'm sure it will easily pay for a very high quality of service here.

I'm sure with the new laws we'll all be finding out soon enough what our new obligations are and shortly thereafter what benefits we can expect. In my situation I would think lower premiums should be the outcome, but that is not what I expect.

If universal coverage in the US is what this will be we should expect doors to other countries to reopen for US retirees once again, but not if we can opt out/


Gringal

Mar 23, 2010, 4:49 PM

Post #6 of 44 (6250 views)

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Re: [La Isla] Do I need to buy healthcare?

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Basic Medicare insurance comes free with your basic Social Security payments. You pay for Part B of Medicare, but can opt out of it. If you do, and if you go back to the states and want to re-up, there are penalties for doing so. See the Social Security website re this.


Brian

Mar 23, 2010, 5:06 PM

Post #7 of 44 (6248 views)

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Re: [Gringal] Do I need to buy healthcare?

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"Basic Medicare insurance comes free with your basic Social Security payments. You pay for Part B of Medicare, but can opt out of it. If you do, and if you go back to the states and want to re-up, there are penalties for doing so. See the Social Security website re this."

That, I think, is the crux of Steve's question. Is it any longer an option to decline Medicare Part B while living outside the USA and relying upon IMSS or paying out of pocket for outpatient medical care. Is there an exemption for expats so that they wouldn't have to pay a fine for lacking coverage? I can foresee a huge problem for the IRS in terms of enforcement. Peoples' residential status is hard to track. I think this is a good question and hardly political. Maybe it would be political if people supported the law's adoption without knowing what it contains. Someone must know the answer. Hound dog perhaps?

Brian


Hound Dog

Mar 23, 2010, 5:11 PM

Post #8 of 44 (6244 views)

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Re: [La Isla] Do I need to buy healthcare?

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La Isla writes:

I'm not thrilled that once I hit 65, I'll have to pay for Medicare, but I look at it this way: It's my choice to move to Mexico where I can't use Medicare benefits.

Well, La Isla, I´m 68 years old and have been on Medicare for three years at no cost to me as I opted out of Part B after a few months once I figured out the fact that it had no value for me and if I later wished to opt back in I could do so with back payments plus a reasonable penalty. I would never opt for medical treatment in the U.S. over Mexico unless a particular medical procedure was not available here as with certain organ transplants. Rather, I carry major medical coverage with a reputable Mexican based international company to cover me for any extraordinary medical care that may occur down the line. Normal stuff I take care of out of pocket at a fraction of the cost in the U.S. even with Medicare after taking into consideration the applicable deductible.

As for our being forced to carry medical insurance coverage in the U.S.; I am not worried about that as we live in Mexico full time and have no address in the U.S. However, I suppose that we might be compelled to pay for coverage if we maintained a U.S. address and spent part of each year up there. It strikes me as only fair that part-time residents of the U.S. or people who maintain phony U.S. addresses for whatever reasons, thereby pretending to live there, should be required under the new law to either maintain health insurance coverage or pay the tax penalty if they fail to do so. I base that opinion on the notion that anyone who might burden the medical system in the U.S. by spending part of the year there should be a contributing potential recipient of the medical delivery system. If steve, therefore, maintains a U.S. address, it is only fair that he carry health insurance in that country. Of course, once Steve qualifies for Medicare, the point becomes moot.

As for those who never visit the U.S. but simply maintain addresses of convenience there, perhaps it is time to rethink that strategy.

Besides, Manuel´s observation is correct. Steve is simply trying to make a point for political reasons which is his right but it behooves the reader to discern the difference between a poster´s genuine health care concern and obvious political posturing.


(This post was edited by Hound Dog on Mar 23, 2010, 5:22 PM)


esperanza

Mar 23, 2010, 5:19 PM

Post #9 of 44 (6232 views)

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Re: [La Isla] Do I need to buy healthcare?

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In Reply To

Quote

I live in MX, they forced Medicare on me even though the nearest Doc is 700 miles.


I'm not thrilled that once I hit 65, I'll have to pay for Medicare, but I look at it this way: It's my choice to move to Mexico where I can't use Medicare benefits. In addition, I am happy that people like my 89-year-old mother have Medicare benefits, something that she wouldn't have had 50 years again. So I advise you to follow Manuel Dexterity's and learn to live with it (-: !

I opted out of Medicare Part B when I became eligible for Medicare. Plain ol' Medicare is free.


http://www.mexicocooks.typepad.com









Rolly


Mar 23, 2010, 5:24 PM

Post #10 of 44 (6229 views)

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Re: Part B

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Part B is optional (opt out) additional coverage added on to the basic Medicare coverage. Without Part B, you still are insured.

Rolly Pirate


Hound Dog

Mar 23, 2010, 5:40 PM

Post #11 of 44 (6217 views)

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Re: [Brian] Do I need to buy healthcare?

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That, I think, is the crux of Steve's question. Is it any longer an option to decline Medicare Part B while living outside the USA and relying upon IMSS or paying out of pocket for outpatient medical care. Is there an exemption for expats so that they wouldn't have to pay a fine for lacking coverage? I can foresee a huge problem for the IRS in terms of enforcement. Peoples' residential status is hard to track. I think this is a good question and hardly political. Maybe it would be political if people supported the law's adoption without knowing what it contains. Someone must know the answer. Hound dog perhaps?


You raise a good point, Brian. We long ago faced this issue by maintaining a mexican address only for all purposes including all purposes related to the U.S. government including income tax filings and social security benefits.

Our current major medical policy with the Mexican insurer covers us for emergency care in the U.S. or anywhere overseas up to a maximum of $50,000USD so should we become ill while overseas that emergency coverage would see us through in a limited sense and help get us back to Mexico for ongoing treatment if needed. Therefore, technically, we have medical insurance in the U.S. - no?

As for being forced to take part in Medicare Part B which we now opt out of; how can they rationalize that requirement if they refuse to cover our medical expenses in Mexico since we never, ever visit the U.S. and never will if we can avoid it. Now, France is another matter but we go there for the foie gras not the charnal houses.


(This post was edited by Hound Dog on Mar 23, 2010, 5:44 PM)


La Isla


Mar 23, 2010, 5:41 PM

Post #12 of 44 (6212 views)

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Re: [Rolly] Part B

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I take it, Rolly and Esperanza, that I do have to opt out of Plan B, or else I'll be signed up for it automatically, ¿verdad?


Hound Dog

Mar 23, 2010, 5:56 PM

Post #13 of 44 (6201 views)

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Re: [La Isla] Part B

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I take it, Rolly and Esperanza, that I do have to opt out of Plan B, or else I'll be signed up for it automatically, ¿verdad?

Verdad, but opting out is simple. I simply went to the SSA at the LCS in Ajijic during their monthly visit there but one can also go to the Guadalajara consulate or contact the SSA in the U.S. I simply signed a request for removal from Part B.

I opted out of Part B when I finally figured out that with the Medicare deductible, unless I also carried supplemental insurance for the deductible at an additional monthly premium, it would cost me a fortune to seek medical treatment in the U.S. rather than Mexico, Think about it. If your deductible is 20% of the total cost and medical care in the U.S. is obscenely expensive in comparison to Mexico, what do you have to gain by carrying Part B, especially after you factor in the costs of returning to the U.S. for treatment such as housing, etc.

And besides, the medical treatment we have received in Mexico has, so far, been far superior to that we could expect in the U.S. under Medicare or with private insurance and I´m including care we received in lowly Chiapas as well as Guadalajara. Why would I want to return to the land of HMOs and dormitories full of like old farts moaning away when I can have my own private room and chosen doctor in Mexico? Get serious.


(This post was edited by Hound Dog on Mar 23, 2010, 6:52 PM)


stevebrtx

Mar 23, 2010, 5:59 PM

Post #14 of 44 (6194 views)

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Re: [Rolly] Do I need to buy healthcare?

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Rolly,
To you and those civil enough to give honest thoughtful answers I thank you, obviously others are carrying old baggage and presume too much.

I attempted to opt out of Medicare 3 years ago and finally after 3 extremely long calls on hold and a dutifully filled out form to "disenroll" I gave up, the $1200 a year would be nice to invest in something more productive, but I view it as simply a tax on something I don't want, don't need and don't use.

At any rate, it was, and is, an honest question as often we expats are surprised by the specter of unintended consequences i.e. some of the recent "stimulus" checks etc., so as I said I have been watching and reading to see what will be required, for instance; Medicare does not cover everything, my Mother carries a supplemental policy and I could imagine that if I were to drive up to the border for care under Medicare I might be expected to have a mandatory supplemental coverage - or not, that is the crux of my inquiry.

Again, thank those of you who provided civil thoughtful answers, it's something many of us will need to know.
http://www.chapalaweather.net


Gringal

Mar 23, 2010, 6:08 PM

Post #15 of 44 (6182 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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It sounds like you didn't read the posts, Steve. You aren't paying for Medicare Part A, so you can't opt out. Part B can be opted out of by sending a request by mail. Once a year, Medicare sends a thick booklet to tell you what is/is not covered.
The "unintended consequences" is where you are approaching the political area. The ice is getting thin.


Reefhound


Mar 23, 2010, 6:12 PM

Post #16 of 44 (6178 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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Not even the politicians who just passed it really understand what is in it. It is simply going to take some time for things to shake out and be evaluated and interpreted. It's not like it goes into effect immediately anyway. The very first effects (banning denial of coverage for pre-existing conditions and a special liability pool for high risk members) don't occur for six months and the requirement to carry insurance doesn't kick in until 2014.

Edit: correction, what kicks in this year is ban on lifetime limit, ban on cancellations after one gets sick, and extending to age 26 a person can be carried on parent's policy. They can deny based on pre-existing conditions until 2014.


(This post was edited by Reefhound on Mar 23, 2010, 6:20 PM)


Hound Dog

Mar 23, 2010, 6:18 PM

Post #17 of 44 (6175 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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I attempted to opt out of Medicare 3 years ago and finally after 3 extremely long calls on hold and a dutifully filled out form to "disenroll" I gave up, the $1200 a year would be nice to invest in something more productive, but I view it as simply a tax on something I don't want, don't need and don't use.

Nonsense. I opted out after about nine months by simply going to the grounds of the Lake Chapala Society during the SSA monthly visit to the grounds of that organization in Ajijic and signing an opt-out statement. I was dropped from Part B immediately. No additional questions asked. One can also do this in Chapala at the American Legion post there on the same day each month. My wife will also opt out in the same fashion when she turns 65. Nothing could be simpler or easier. In my experience the "disenrollment" process is neither tedious nor difficult and, since the OP lives at Lakeside where dealing with the SSA is easy, I´d advise him to follow the same procedure.

Nothing personal, Steve, but it seems to me that is unfair to mislead readers considering their options in this fashion based upon your negative experience with the SSA.


(This post was edited by Hound Dog on Mar 23, 2010, 6:47 PM)


stevebrtx

Mar 23, 2010, 7:32 PM

Post #18 of 44 (6139 views)

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Re: [Hound Dog] Do I need to buy healthcare?

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Bob,
Sorry, but I can document my exact actions and dates and I'm still paying per month, so it is what it is. Now, you being the banker, I'm sure you have run the numbers and I could lay back a lot of years and pay the penalty and still come out ahead - right?

Gringal, sorry, I get the two mixed up, but whatever the nomenclature, the thing I'm interested in is that if I continue to contribute to Medicare and don't have a supplemental policy and go to Laredo to get care - am I required to have some "policy" issued by someone.

As I hear it now, if I lived back home and was named "Bill Gates" and said "I don't want to buy a policy, I can afford to pay out of pocket" that isn't allowed, he has to pay. So, if I show up in Laredo and say "I'll pay out of pocket" - is that ok? It would seem a simple question, but is it?
http://www.chapalaweather.net


Rolly


Mar 23, 2010, 7:39 PM

Post #19 of 44 (6137 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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...if I continue to contribute to Medicare and don't have a supplemental policy and go to Laredo to get care - am I required to have some "policy" issued by someone.

No. Basic Medicare covers you. Part B and other supplementary polices are optional without which you are still insured and don't have to buy anything to comply with the law.

I wonder why you had a problem dropping Part B. It is so easy to drop.

Rolly Pirate


La Isla


Mar 23, 2010, 7:56 PM

Post #20 of 44 (6113 views)

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Re: [Rolly] Do I need to buy healthcare?

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I want to thank stevebrtx for starting this thread. Thanks to him and the other contributors I now have a better idea of what to do about enrolling for Medicare coverage in the coming months. I also found the official Medicare website (http://www.medicare.gov/default.asp) and filled out a brief questionnaire regarding enrollment and eligibility, and here are the results I got:
You will be eligible for Medicare on [ ]. If you are living outside of the United States at that time, you should contact the Foreign Service Post which is normally located at the American Embassy to enroll in Medicare. Note: Medicare doesn't pay for services outside the United States, except for some emergency situations in Mexico and Canada. The Medicare regulations define the United States as the 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Northern Mariana Islands, and for purposes of services rendered onboard ship, the territorial waters adjoining the land areas of the United States.

Lucky for me I live just a few blocks from the American Embassy, so enrolling should be easy, or at least it won't require a long shlep across the city on the Metrobus (-:


(This post was edited by La Isla on Mar 23, 2010, 8:01 PM)


stevebrtx

Mar 23, 2010, 8:14 PM

Post #21 of 44 (6099 views)

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Re: [La Isla] Do I need to buy healthcare?

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Enrolling is NOT a problem, it happens automatically. But, here is one of the "unintended consequences" - if you live here as I do and have a TX mailbox address you get your SSI checks just fine and a couple years ago I got a stimulous check. So, at some point I notified the Consulate I was resident here, two things happened, first my SSI check now HAS to be delivered to me by the 3rd of each month, that's a good thing, but - - - when the last "stimulous" round of checks went out they only went to those with US address's (even though they may be living here and mine still is deposited in a US bank) - so, there are many crooks and turns in the road to living out of country, and forgive me for being concerned, but this one could be a huge "gotcha" at a very bad time.

Ok, now, let's assume a situation, Bob (who is not covered by Medicare) and me who is; we decide to take a trip together to who cares where NOB, but we get smacked by a truck somewhere in Mississippi - now, apparently I who have Medicare would be at least partially covered, but Bob? - no medicare, so he wants to pay out of pocket - I'm still unclear as to how or if that is possible.

Now, I realize this is all speculative to a point, but as we all know, with the number of expats and the way we live it will come up at some point and while I have no intention of trying to read or make sense of 2,700 pages of DC leagaleze, I sincerely would like to know what is going to happen when and if I face that situation. Maybe it can't be resolved here and now, but I consider it one of the more important issues of today.
http://www.chapalaweather.net


bournemouth

Mar 23, 2010, 8:19 PM

Post #22 of 44 (6095 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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Bob still has Medicare Part A - he opted out of Part B - you apparently have both parts.


Brian

Mar 23, 2010, 8:23 PM

Post #23 of 44 (6089 views)

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Re: [Rolly] Do I need to buy healthcare?

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"No. Basic Medicare covers you. Part B and other supplementary polices are optional without which you are still insured and don't have to buy anything to comply with the law.'

Rolly, if you are correct then this aspect of the healthcare reform and required coverage is meaningless. Medicare Part A covers inpatient hospitalization costs only. Part B takes care of outpatient coverage and if you don't have it then you aren't really insured are you? All the examples that were used about folks needing care for cancer, diabetes and other chronic diseases dealt with issues that are treated in clinics and doctor office visits. From what I read here, this really is a confusing issue. I wish it had been explained better before becoming law. I'm in a different situation. I have Medicare and a "Cadillac Plan" for the copays and prescription costs as a retirement benefit. Now that there will be insurance exchanges, it wouldn't make sense for my former employer to continue paying my supplemental policy. It will be cheaper for them to drop my coverage since I am no longer employed. Obama said that if you like your existing coverage, you will be able to keep it, but the new law doesn't mandate it for retirees. I'm not trying to be pessimistic but I don't think he was thinking about retirees when he made that statement but, rather, those in the current workforce.


(This post was edited by Brian on Mar 23, 2010, 8:24 PM)


Rolly


Mar 23, 2010, 8:24 PM

Post #24 of 44 (6088 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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Your friend, Bob, can pay out his pocket. And so can you if you had rather not use the Medicare coverage you have. Nothing in the law says you can't spend your own money for what ever care you want. What the law does say is that later, when the rule kicks in, you will have to buy health insurance or pay a small fine. But nowhere does the law say you have to use the insurance or that you cannot pay out of your own pocket if that is what you want to do.

Rolly Pirate


La Isla


Mar 23, 2010, 8:27 PM

Post #25 of 44 (6082 views)

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Re: [stevebrtx] Do I need to buy healthcare?

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Quote
... with the number of expats and the way we live...


I don't really understand what you mean by "the way we live". I have the feeling that the way I live in Mexico and the way you live here are quite different. For example, I almost never travel NOB, and when I do, it's by plane, not in a car, so no danger of me being hit by a truck, especially not in Mississippi! (-:
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