Medicare Rules

bscheckner wrote:

Regarding Medicare Supplemental Part F, there is some coverage overseas for travel of 60 days.

My questions are:

1) Can I come back to the U.S. for 1 day to restart my coverage (under the 60 day rule)?

2) Must I maintain an address in the U.S. & if so is a PO Box adequate?

3) If P.O Box is not adequate, can I buy a Condo,, pay for all utilities & use this as my 'registered' address?

There has to be a "Catch 22" somewher?

With the current political situation, your best source for that information would be the medicare web site, and you might want to check it regularly.

I have Plan F with AARP/United Health.  It would be best to call the provider whom you're buying the Plan F from and also read the fine print.  Since regular Plan A & B provided by CMMS doesn't provide any foreign coverage (with some limited exceptions) all the cost out of country would be reimbursed by your Plan F provider. 

If out of country coverage is a concern you might look at some Medicare Advantage plans.

Thanks for trying James.  "F" gives you 60 days coverage which is implicitly stated in my question. 
My question remains unanswered

Thanks for trying travel but, unfortuately, my question remains unanswered.
Regarding continuing research on Medicare site; of course.

bscheckner wrote:

Thanks for trying travel but, unfortuately, my question remains unanswered.
Regarding continuing research on Medicare site; of course.

But, Plan F isn't a government Medicare plan it's a supplemental insurance coverage offered by private companies and not the government.  Your OP was asking about how to "game" the system and the only way to know is read the fine print from whatever insurance company you bought the Plan F from.  I would be looking for some fine print like 60 days total within 12 months or must be US resident.

Sorry for the confusion on Part F


If my supplemental & palan F is, as an example, is $400 per month (including  prescription coverage) & the medical insurance in Mexico is $700, then that nets to $300.

Now I have $0 deductible &, of course, deductible must be added to the equa is:tion.

However, my 1st sentence: "Regarding Medicare Supplemental Part F, there is some coverage overseas for travel of 60 days."

Sorry for the confusion on Part F


If my supplemental & palan F is, as an example, is $400 per month (including  prescription coverage) & the medical insurance in Mexico is $700, then that nets to $300.

Now I have $0 deductible &, of course, deductible must be added to the equa is:tion.

However, my 1st sentence: "Regarding Medicare Supplemental Part F, there is some coverage overseas for travel of 60 days."

I read my EOB's for Part F and it says "treatment must start within 60 days after travel begins."  It will cover 80% of what Medicare would normally and doesn't, which for out of country is nothing.  So I assume my Part F will would cover 80% of what Medicare would have covered had the treatment been in the US. 

Downside to that as I can see is most of my Medicare statements show a very small payment for a very large charge, in the US.  Anybody who has Medicare knows what I'm talking about.   

So if Treatment X in the US is $1000 and Medicare is only reimbursing $200; then I'm guessing Part F would pay $160 for treatment X in foreign country.  Now, in some places that might cover it and in some it might not.  I have also read horror stories on some cruise sites about trying to get Medicare reimbursement for treatment on a cruise ship when the MD screws up the billing coding.   

There are also some very substantial lifetime penalties for dropping Medicare and then re-enrolling when you come back.  I'm reading "travel begins" as travel and not moving to a foreign country.  So, I'm guessing you better keep a US address.   I don't know how they would know if you left for more than 60 days, came back, and left again.  I'm sure DOS doesn't talk to CMMS so there's no way they're tracking your passport.

Thank you James

Definitely look at a Medicare advantage plan and make sure it provides coverage while traveling and out of the country. Mine has 25000.00 in coverage for emergencies when traveling anywhere out of the country. I have a USA address to keep it . When I am down here in Mexico I use a local doctor for routine it’s cheaper than your USA doctors copay. I use my Medicare for my 100% yearly wellness checkup.

All Medicare Advantage plans are different from state to state and even within different counties.

It is important to inquire about the following:

1. Amount of overseas coverage - total dollar amount paid for this benefit.

2. Lifetime or annual coverage amount.

3. Time constraints on travel - max number of travel days to qualify for coverage. Some plans only cover up to 30 or 60 days.

4. Definition of medical emergency - inquire about what the insurer´s terms mean to know what is covered and what is not.

Finally, consider that NO Medicare Advantage plan will pay Mexican hospitals directly. This means you will need to have cash or credit cards to pay for the full amount and submit a claim to your plan afterwards.

In my opinion, any amount under $100,000 USD is not enough coverage.

Yes, doctor´s visits and medications in Mexico are affordable. However, hospitalization services / events are not.

Melanie

Yes as I said I have a USA address . We are close to the border at both places. I can commute back and forth . We can  obtain and have the emergency evacuation here . I checked all those things in the advantage plan. I have checked the prices on the insurance plans in Mexico for catastrophic , the deductible and cost don’t work for us. My husband is a veteran he goes to the San Diego veterans hospital . I also have seguro popular, probably spelled that wrong. The hospital is 2 blocks away. I think we have everything coved . Are you a insurance agent?

A little about Air Medical Evacuations & Air Evacuation plans:

In medical emergencies that affect the lungs or heart, no attending physician in Mexico will approve an air ambulance evacuation. You will need to be treated in Mexico before being authorized for air flight (pay a hospital bill).

In any major medical emergency, your biggest cost / risk is your hospital bill.

Even if your medical emergency qualifies for air evacuation, it will take time for the transport to be coordinated and in the meantime, you will need to pay a hospital bill.

Seguro Popular is not an insurance program. It is a public health plan that offers minimal medical coverage. Mexicans who cannot afford IMSS or private care have Seguro Popular. See Cauces Handbook for details on covered conditions & medications.

I don´t recommend relying on Seguro Popular for many reasons.

I have offered seminars & webinars on these topics over the past 5 years.

Melanie

Sounds like you are very knowledgeable in the subject matter.  Let me propose a question.  We will be living in Rosarito 8-10 months of the year.  Will have a US address.  Will have Medicare + Plan F.  Will be applying for Permanent Resident status.  Spouse has another three years for Medicare so we will have to get her something when she stops working.   How would you propose getting coverage for our time in MX?