Aug 06 2015

Healthcare in Costa Rica: An Update about Medicare Advantage, by Bob & Linda Beavis

Bob & Linda recently wrote about their experience with the public healthcare systems in Costa Rica as well as the private. You can read the original article at this link.


Update from Bob Beavis: I just thought I’d let you know that we have finally received word that our claim against our Medicare Advantage plan for Linda’s emergency shoulder surgery (on an out-of-country provision of the policy) has been approved.  Payment in full has been confirmed and the reimbursement may hopefully be issued this week, with no deductibles or copays.

roadmap-to-medicareTo review, there are many Advantage plans available for those who are covered under Medicare Part B.  The plans are not all alike and offer different variations for deductibles, copays, etc.  The particular one we located and subscribed was somewhat unique in that it offered an out-of-country emergency medical provision for up to $50,000.

It, like other Advantage plans, typically covers medical expenses when provided within the U.S.  Our main reason for seeking such a plan was with thought for a backstop coverage under Medicare should we encounter something chronic that would be best treated in the U.S.  The out-of-country provision in the policy we chose was just an added bonus not offered in many Advantage plans.

The key, of course, is that one must maintain a U.S. address.  Many of us do this as a matter of course for various purposes (banking, credit card billing, etc.).

The bottom line is that Gringos locating to Costa Rica (or other foreign retirement homes) are well advised not to forego carrying their Medicare Part B simply because they will be no longer living in the U.S.  Having to return to the U.S. for treatment or, as in our case, having an Advantage plan with foreign coverage, is important for older folks who are eligible for Medicare.  If one does decline Part B when first eligible & later decides to enroll in Part B, there are premium penalties imposed at time of enrollment that last for ever.  One friend here had dropped out of Part B eight years ago.  To enroll now, his premium (for life) will be $188/month rather than the normal $104.90.

One other footnote to this is that the Advantage plan costs nothing over & above the normal Medicare Part B premium (currently $104.90 per month).  The Part B is simply deducted from the monthly Social Security amount the person is eligible for.  That Part B premium then is simply transferred by Medicare over to the Advantage plan provider as the provider’s payment for providing the Advantage plan.  In summary, it is no-cost supplemental medical coverage.

Just thought I would give you this update on our experience with Linda’s $18,000 shoulder replacement emergency medical treatment done at a private hospital in San Jose.  It was money we DID have to pay up front and endure what has been a 2-month process in sorting out the claim with the insurer, and that has several hoops that anyone making such a claim needs to be aware of up front.  In the end, however, it was a lot of money that we did NOT have to pay out of our pockets.”

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