Jun 03 2017

In the Mailbag – Medicare and Health Insurance

emaildelivery-200pxWe always get lots of responses and questions from readers, both newsletter subscribers and on Facebook. This month’s questions dealt with Medicare (U.S. citizens) and health insurance.

Mark N. wrote,

I notice in your budget and in other representative budgets on your web site (the woman living for ~ $1200 per month) there is no deduction from social security for monthly Medicare payments. I was under the impression that once one hits 65, Social Security automatically deducts somewhere on the order of $134 per month for Medicare Part B premiums. Could you please discuss this – I’m not yet that age, but approaching it so would like to hear how people deal with this: i.e. purchase Costa Rica health insurance(s) and keep Medicare as a backup, or if not then opt out of Medicare (am not sure if that’s even possible or if so, how?). Thanks for all your useful information.

Great question, Mark. When you reach retirement age,you will have the option to have Medicare B deducted from your Social Security or to opt out. If you opt out and later decide you want Medicare B coverage, they charge you a monthly penalty.

Paul opted out of Medicare B since we do not return to the States on a regular basis. We have the Caja here and can pay for private care out-of-pocket as needed. We recommend that, if you can afford it and plan to spend some time in the States, you keep your Medicare B. In our case, Paul’s SS was only $922 and his Medicare B would have been over $100. We couldn’t afford it at the time. But if you can, it would be something to fall back on.
We have several articles on our site about health insurance and alternative plans. Here are a few links:
Two readers wrote in with questions about Rob Evans’ article, “Our 2016 Costa Rica Healthcare Plan,” specifically concerning the Worldwide Expatriate Association (WEA) worldwide insurance plan.
First, Megan wrote:
Hi Rob,
I’ve found your articles on finding health insurance so helpful as our family prepares for a sabatical year in Costa Rica, beginning in June. I’m a little late in sorting out insurance and I’ve been in touch with Perfect Circle and am inclining towards a WEA plan combined with BUPA, but something is getting lost in the translation as I try to get info from Perfect Circle about how claims are processed. My question is: Do in-network outpatient provider claims get filed directly with WEA from provider or am I required to pay the medical provider first and then file a claim for reimbursement? I’m hoping you can clear this up for me. Thanks so much for your help and this website has been so useful!

 Here is Rob’s answer to Megan:

I have used them for a year and never been sick but I will tell you how it worked for me. I have a $2500 deductible so probably and hopefully will never need insurance. When I do go to the doctor, I have to collect the invoice, the receipt showing I paid, and the report from the doctor on what he did.

Claims need to be submitted in 90 days. I can either drop the papers off at the Perfect Circle (PC) office, or they will send a messenger to collect them, or I can take a picture with my phone and email them.

PC organizes the papers, translates them and figures the exchange rate and submits them for me. I can do all that myself but I am lazy and love being pampered. PC also calls the doctor to get more info if needed which I love since me Spanish is terrible.

I also get pre-certified for anything to make sure things go smoothly. I can see all my claims online and could do all this myself if I wanted but PC does it so much better. I like knowing that if I move to Europe, I can do it myself though I could still email the information to PC too.

I understand if bad things happen, I could either pay myself and submit the bills or call PC or WEA and they would work out a direct pay with the hospital. WEA sent me a list of preferred hospitals they already have a relationship with which includes all the major ones in Costa Rica so no worries. I like that PC is local, speaks Spanish and would be my advocate with the hospital and WEA. In network/ out of network only applies if you choose care in the US.

Regarding your question, “Can you use Medismart discount plan and then submit those claims to WEA to work towards the deductible?” Yes, do it all the time. Medismart is like Cosco , a discount provider. So, when I see my primary doctor it costs $15 which I submit. My annual Dermotologist checkup is only $30. With those low prices, it is unlikely I will ever get over my $2500 deductible.

Claire also had a question about the WEA plan:

I read your article on your 2016 insurance plan and have been looking into the WEA plan. My husband and I plan to be living in CR 6 months a year and 6 months in the US. We will have permanent residency in CR and are both US citizens…We are curious about how the WEA plan has worked for you so far. I have not been able to find any customer reviews on line. Any feedback you can offer will be appreciated. Thanks.

Rob replied,

WEA offers expat policies that you can use worldwide which was what I wanted. With that feature, we can travel and live anywhere without applying for new coverage in each country when we move.

In addition, WEA offers the option to exclude care in the US which halves the cost. So, our cost went from $3600/yr/couple to $1800/yr/couple by excluding the US. Given I can get care in every country in the world except the US seems like a reasonable risk for the cost benefit.

At this point, it depend on what you want. The problem you will have is that splitting your time between the US and CR means you are subject to Obamacare. Obamacare exclusion requires you live outside the US for 330 days a year. WEA policy does not qualify for Obamacare exclusion so you will need US coverage too or pay a penalty.

An option would be to get WEA without US coverage and buy a US policy too. That could be very expensive. $1800/yr/couple for CR and $13,000/yr/couple for the US. If you have Medicare or Tricare, you are lucky and covered in the US. Given you are required to get US coverage since you are in the US six months of the year, you should look into trip insurance while in CR as a less expensive option than WEA. Note trip insurance will just stabilize you until you can get back to the US and use your US policy.

I am writing up my observation now on my first year with WEA. I am pleased with the value. Since moving to CR we have gotten much healthier and need little medical attention so I am happy to to have affordable insurance I hope I will never use.

Stay tuned, everyone, for Rob’s update!

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