Medicare For Expats, Or A Mess Of Pottage?
Healthy Retirement
The latest intelligent ‘guesstimate’ from the State Department suggests that there are roughly 5.25 million Americans citizens not affiliated with the US Government who are living abroad. Of this figure, an increasing number are US citizens who have made the bold decision to retire overseas. With the American economy going through an extended period of extreme negativity and the resultant effects that this has had on every citizen’s life, it is not surprising that increasing numbers of baby boomers want to leave the US behind and go in search of a better life abroad in their retirement.
One of the main obstacles restricting many who dream of an international retirement is the fact that Medicare coverage stops at the US border. A pensioner’s eligibility to any other form of health insurance abroad can be strictly limited and prohibitively expensive.
One of the most frequently asked questions at Escape Artist from American citizens who actively long for an overseas retirement is ‘does Medicare stretch beyond US borders for American retirees overseas?’ And unfortunately, in all but a few exceptionally limited cases, the answer is a resounding ‘no!’ However, that is absolutely not a reason to stop dreaming and even to stop actively planning your escape from America when you retire.
In this report we will detail how Medicare does offer (very limited) cover overseas, what your eligibility is to other forms of international health insurance cover, what the future holds in terms of changing policy on the health protection obligations of the government to Americans who choose to retire abroad, and how you can actually use the opportunity of a new life abroad as a chance to turn your life around for the better in terms of your long-term health prospects.
How Far Does Medicare’s Coverage Extend Beyond American Borders?
Medicare is a US based health ‘insurance’ solution for those over the age of 65. It is a system into which you have probably paid for the majority of your working life. Yet it is a system that becomes almost wholly useless to you if you decide to exercise your right to freedom of movement and move to live abroad in retirement. The only exceptions to Medicare’s rule of not offering coverage outside the US are as follows: -
1) You will most likely be covered for a medical emergency that arises as you’re en route through Canada and traveling the most direct route between the continental United States and Alaska.
2) If you’re in the United States when an emergency occurs and either a Canadian or a Mexican hospital is closer to you than any in the United States then Medicare should cover your expenses.
3) Finally, if your US based home is actually closer geographically to a Canadian or a Mexican hospital than to one in the United States then Medicare should again cover you.
None of these scenarios is ideal or suitable for an American citizen planning their retirement overseas – whether that is to Argentina or Mexico, Costa Rica or anywhere in Europe for example. Other issues that Americans can face with regard to Medicare are that whilst you are automatically included in Medicare Part A (for hospital coverage) at no cost to you, (assuming you have made sufficient payments towards the system during your working life), you have to sign up for the optional Part B cover (for doctors visits) during a narrow window of opportunity after turning 65. If you’re living abroad at the time and you fail to do so and instead sign up some time after this period you will be subject to permanently increased premiums (which are roughly an additional 10% for each year you could have signed up but did not).
Can You Get Health Insurance Abroad to Cover You in Retirement?
Most medical insurance companies local to a given nation or those that offer truly international coverage have an age related restriction on when they will stop offering new policies – the upper age limit is usually 75. Additionally, the older you get before you sign up for an insurance policy with a given provider, the higher your annual premiums will tend to be. This is because statistically speaking, the older we get the more expensive and long-term care and medical assistance we are likely to need. Therefore, anyone thinking about retiring abroad certainly needs to begin looking into the health insurance options available to them in their proposed new nation of residence as soon as possible.
If you have any pre-existing health conditions or you would like the additional benefits of having access to home help or residential care these may all be available but certainly for extra cost. Whilst you may initially be ‘comfortable’ with the thought of having to return to America if you fall ill and use your right to Medicare, that may not become practical over the longer-term. You will at the very least need some form of emergency insurance in your new country to ensure you will be treated in the event that some critical medical event arises.
There are two organizations to consider contacting to get more advice on insurance companies offering the most flexible and potentially suitable international medical insurance policies. They are American Citizens Abroad (http://www.aca.ch/joomla/index.php) and The Association of Americans Resident Abroad (http://aaro.org/). Additionally, there are companies based onshore in America that offer long-term insurance abroad, as well as international insurance companies that offer cover in multiple countries overseas. Finally you have the option of looking to a local insurance company in the country to where you move in order to find an affordable and nation appropriate and specific policy.
Will the Medicare Restrictions on Overseas Retirees Change in the Future?
Multiple organizations supporting American citizens resident abroad are actively campaigning for the Obama administration to consider extending Medicare’s reach beyond US borders – if only to Canada and Mexico. Simply because of the logistical and potential cost factors involved, few people in a position to offer expert comment are of the opinion that it will never be practicable to offer Medicare coverage to American citizens if they choose to retire abroad. If you want to join the debate and put your weight behind the campaign you will certainly be welcome, but you should not put your plans of retirement abroad on-hold waiting for policy to change.
What Can You Do to Help Yourself?
With the cold hard fact of the matter clearly identified – that is if you move abroad you’re on your own when it comes to affording health insurance or medical care – you have no real option other than to take it on the chin and move forward. As part of moving forward from this realization you may like to consider how a retirement abroad may actually benefit you and your long-term health anyway! It’s well known that the sunshine and warm weather has many positive aspects conducive to good health. After all, sunshine offers our bodies the vitamin D we need to absorb calcium properly for healthy bones, and warm dry air is perfect in the fight against the pain of arthritis and some chest complaints. Sunshine offers a feel-good factor as well and prevents us from feeling the blues seasonally. So if you’re thinking about retiring to the sun you may well be doing more for your own wellbeing than any amount of Medicare insurance could offer.
At the same time, if you escape the hectic pace of your current working life in America and the stresses of economic meltdown, potential terrorist attacks, increasing youth dissatisfaction, rising unemployment, falling house prices and the general malaise that all of this brings, you’re bound to immediately feel the positive health effects in your life. You can add to this feeling of well being because you will have more time in retirement to eat well and healthily, to source the best local ingredients from daily markets; you will be able to take exercise in the form of a walk along a local beach which is far better for you than running on a treadmill in a sweaty urban gym for 20 minutes three times a week. You’re more likely to have time for friends and family and this will do you good. You will have the choice to live in a healthier location with no air pollution perhaps. What’s more, away from the stresses and strains of your old life you will likely find a new zest and passion for life and with all the positive endorphins rushing around your system you will be helping yourself towards a happier and hopefully healthier retirement anyway.
Good thoughts, I am a few months away from Medicare and find it very frustrating trying to find insurance. Something to add on to my Medicare coverage offering me coverage in my part time life in SE Asia.
It looks as though Secure Horizons by United health care offers a Medicare advantage plan that might offer coverage for mu-ti-month stays outside the US. Though, I haven’t got a firm commitment on anything covering anything more than emergency’s. However, all of the Medicare gap coverage programs offer emergency coverage for your first 2 months overseas, after that your on your own. Doug
In responce to your article, my wife and I moved to Uruguay several years ago and immediatly got health insurance from a local hospital group. I was over 70 and had to take a medical examination, but my wife who was 69 had only to sign the policy. We have since had excelent medical service. My wife was in the hospital several times. We then decided to cancel the medicare policy. In so doing we saved US$165 per month for each of us. Uruguay provides an excelent solution for Americans seeking to move overseas.
Sincerely, Roger Southwick
Dear Roger Southwick,
Thank you for your input. My new/old husband ( of 4 years now) and I have been considering Uruguay for retirement. Would you share with us where retirees can live inexpensively and safely? I hear it is a beautiful country which “takes one back to the 1950s.” (I look forward to cancelling our medicare policies.)
Barbara (BarbHicks.CFII@yahoo.com)
For information on Uruguay I recommend our ebook Buying Real Estate in Uruguay by David Hammond which you will find listed in the index located at http://ebooks.escapeartist.com/index.php
Susan Beverley – Editor
humana medicare supplement offers fair coverage for six countries including panama – unfortnately they are not sure they will offer it next year – stay tuned – it costs $28/mo – they call the program ‘foreign travel coverage’ – it is fairly extensive and not just emergency coverage which is covered
Wow, that’s excellent coverage and is very inexpensive.
Dear Roger Southwick:
Not sure if my previous comments went thru to you. My new/old husband and I are considering Uruguay for retirement. What is the best time of year to go there to rent for a few months?
Thank you again for your input. We also look forward to cancelling our medicare policies.
Barbara (BarbHicks.CFII@yahoo.com)
After five years residence in France a person has access to the entire French medical system as if a French citizen – only two years to go ! Until then I am working and covered by an expat policy, so that is one option.
A future article might list the residency requirements in various countries to qualify for local medical coverage benefits.
hi! can i ask what your ex-pat policy is????i’m an american that has (medicare) living in romania,but i want to go to france for the best medical care.can u help?thx