MEDICARE

I will be turning 65 in February and eligible for Medicare.  I do visit the USA and spend several weeks a year there, and have travel insurance for those visits. Will I automatically be enrolled in Medicare Part A?  Should I enroll in Medicare Part A?

I'm a dual US/UK citizen living in the UK with no intention of ever moving back to the USA but do have a daughter who lives in California, so who knows what may happen in future.

If you think you might make a permanent move back to the US in the near future, it's probably advisable to enroll in Medicare Part A.  If you don't enroll when you first become eligible, later, if you do decide to enroll, your premiums will always include a 'penalty' based on how long you delayed enrollment.  But if you'll only be making brief visits to the US and will have good travel insurance cover, it's silly to let them deduct the premium from your check every month while living in the UK.

Since, in your case, a move back to the US is unlikely, or years down the line, I'd skip it for now and just pay the higher premium later when/if you do need it.

If you think you might make a permanent move back to the US in the near future, it's probably advisable to enroll in Medicare Part A.  If you don't enroll when you first become eligible, later, if you do decide to enroll, your premiums will always include a 'penalty' based on how long you delayed enrollment.

I've seen this scenario described for part B. Most people don't pay for medicare A according to this.

https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

Will I automatically be enrolled in Medicare Part A?  Should I enroll in Medicare Part A?

Yes. When I applied for Social Security, I was asked by the FBU person doing the interview if I wanted MEDICARE. If so, it was automatic. I replied yes, and was then questioned about why I wanted it since it was of no value in the UK. My reply was similar to yours: there was family in the US and I visited yearly. At least I would have some US ID to get me inside the hospital door, if needed. Somewhat like you, we had a full year travel policy through a UK private insurer for the US. Neither were ever needed.

Unlike jfkimberly's experience, I was not told of any penalty for Part A if postponed. But, you'll also be asked if you want Part B. I decided no, based on the fact of the travel policy. I was told if I ever intend to return permanently to the US, required Part B, and have not elected Part B whilst in the UK, the yearly cost of Part B would be increased by 10% a year for each year the election not to participate was made. If you elect Part B whilst in the UK, there is a yearly cost: the same as for those living in the US.

We no longer have need to travel to the US and have no plans to do so in the future, so not selecting Part B was fine. If, by some bizarre, strange twist of fate, I would ever live in the US again, I'll have to pay more for Part B.

   

Thanks folks, great advice.

I’ll probably do something along the lines of what theOAP has done.

I think I have posted in error.  I was just logged in to SSA.,gov today to check my earnings report and only skimmed the blurb about part A...

"Part A (hospital insurance): Hospital insurance helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.

The other three parts of Medicare require premium payments, and if you don’t enroll when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have coverage. Also, you may have to wait to enroll, which will delay coverage."

I somehow skipped the italicized bit.  Oops.

I have the automatic Part A card; I chose NOT to enroll/pay for Part B (as did my husband) and the chances of either of us returning to the USA to live are slim, remote and none (not necessarily in that order).

I have the automatic Part A card; I chose NOT to enroll/pay for Part B (as did my husband) and the chances of either of us returning to the USA to live are slim, remote and none (not necessarily in that order).

Thanks for that. It really does seem like getting the part A is worth doing. Our chances of returning for a significant period are slightly higher just based in the fact that our daughter lives there.

Ok, so I know Medicare part "A" (hospitals) is free once I hit that age. Part "B" I have to pay for. I think the Part "B" charge for this year is $145 a month. (Income of less than $85k.) There is a $200 annual deductible. After that, I am responsible for 20% of Medicare-approved costs.* (I don't think there's a cap on that - the bill can go through the roof?)  Part "B" covers doctor services (including most doctor services while hospitalized), outpatient therapy, and durable medical equipment (DME). I don't believe it covers the cost of all drugs/medications, but does cover some. For what Part "B" doesn’t cover in a hospital outpatient setting, I would have to pay pay 100% for the drugs - unless I have Part "D"  or other prescription drug coverage. With Part "D" I'd pay 25% of the cost of the medications.

So, all of the above is useless outside the USA. But inside the USA, I'm thinking I'd really want to be on Parts A, B, ...and D. So, A & B are "regular" Medicare, and Part D is optional, for added cost. I've no clue how to find that cost. 

And then there is Plan "C", the Medicare Advantage plan. It is run by private insurance that bills Medicare for anything Medicare would have paid for and then covers most of the rest? I'd pay them and they'd pay my Parts B and D?

My ex-employer has a set of insurers they pay towards. If a retiree is out of California, the insurance paid for by them is limited to two companies. Once you hit Medicare age, which is looming for me, if you are out of California, they shunt you over to an entity with whom they have contracted to arrange Medicare coverage for you, and drop $3k into a flexible spending account to pay towards any associated costs. I've been trying to talk to the entity for some time now to get an idea of the costs of their plans, and how much more than that $3k I'm going to have to fork over for full medical cover once I'm back in the US of A, but they will not discuss any of the costs of any of their plans until I am actually in-country and ready to apply. So I cannot budget at all - VERY frustrating!

*Medicare-approved costs. That phrase worries me. The medical system in the US routinely charges quite a bit for services, and I'm wondering what happens if the cost of services billed exceeds what Medicare will pay? Balance billing? I know some states have laws prohibiting billing for charges above what you expect your insurance to pay -  California (A.B. 72: Out of Network Coverage and A.B. 1611 Emergency Hospital Services: Cost), Connecticut, Florida, Illinois, Maryland, and New York. Do they cover Medicare as well?

We are still not sure where we're going to end up. Right now the two most likely places are  California or New York. But if we end up in another state, I'm wondering if I have to worry about balance billing? [The number of states we would go to is limited by the Daughter's situation. If she's not working in a position with private insurance and not earning enough to buy it, or is not in school, she will have to rely on Medicaid. Not all states expanded Medicaid coverage to low-income adults, so there are still some states where she would have no resource to medical care. Hence we wouldn't move to one of those on a bet.]

And, having dealt with private insurers and also Medicaid in the past, I know that not all medical care providers will accept all insurances. And a very high percentage of non-hospital providers do not accept Medicaid patients. So, is it the same for Medicare? Am I going to have a hard time finding a doctor who'll accept Medicare?

I think most folks in the USA on Medicare also have part C to cover the 20% of charges not covered by part B.

The following is from a retired doctor on Medicare who got billed $25k for a 2 night stay when he went to an ER. (Many hospitals aren’t finding loopholes to jack up prices on Medicare patients)

With part B and no Part C this would cost $5k.  If you get really sick, 20% of health costs is a lot of money.

https://www.latimes.com/opinion/story/2019-12-20/medicare-coverage-hospitalization-patient-costs