Question for Americans: Medicare B and D

Daily Life, Swiss News and General Topics
1
Hoping some of my fellow Americans have experience of Medicare B and D while resident overseas...

I've been pouring over the medicare.gov and Americans Abroad sites, but can't find an answer to this question.

Now I know that Medicare is not usable overseas (with a few border exceptions), but what about when I am visiting the US?

It's likely that I will remain resident in Switzerland for a few years after turning 65, so I will have to purchase Medicare B and D. (Or face the 10% premium increase per year not enrolled penalty once I return home.)

As long as I am paying for B and D, and since I anticipate spending a fair amount of time in the US during those bridge years, it would be nice if I could seek treatment during my visits back to the US.

Anyone know if this is possible? Or must one be officially resident in the US in order to use all parts of Medicare?

(I was surprised at how expensive B and D have become!)

Many thanks!

2
It's a real conundrum.

Everything I've read says that keeping Part B is essential if you intend ever to return ($141/month?), so I have. Part D: My insurer (Anthem) just notified me via two completely confusing letters that they had automatically de-enrolled me from Part D as a result of changing my address to Europe. No idea what this means.

Did you see this website?

https://www.medicareinteractive.org/...-living-abroad

If you find out, please post here...

3
https://www.medicare.gov/your-medica...ts-at-a-glance

Looking at 2021 figures, Part B premiums can range from $148 to $504 per month, income dependent. So that late enrollment penalty of 10% per eligible year not enrolled could end up being quite painful.

2021 Part D costs, again income dependent, $12-77 per month - plus your plan premium. I have no idea what the plan premium is....

And then once home, there is the cost of Part C... And the deductibles...

Fortunately I had my 40 quarters in before hopping on the expat merry-go-round, so if I understand it correctly, I don't pay for Part A.

Yikes - all told, that's still more than my Swiss insurance!

Now I'm totally confused.

I thought that one had to enroll in Part D on turning 65, as one does with Part B.

But according to the Medicareinteractive site :

https://www.medicareinteractive.org/...ho-live-abroad

Part D requires you live in the service area (i.e., not outside the US), and so you have to disenroll if you move overseas. But that once you return to the US you will have a special enrollment period where you can join without late enrollment penalties:

Medicare.gov does not mention this - at least as far as I have plunged down the rabbit hole so far.

Dear doG, this is confusing! And I'm no stranger to tilting at Medicare windmills, thanks to a decade plus of eldercare.

This is a great site, thanks!

Interesting bit here, my underline:

https://www.medicareinteractive.org/...ack-frequently

If you plan to move back to the U.S. or travel back frequently , you might consider delaying or dropping Part B if:

You or your spouse currently work outside the U.S. for a company that provides you with health insurance, or you or your spouse work in a country with a national health system . You will qualify for a Special Enrollment Period to enroll in Part B without penalty. This SEP begins at any time while you (or your spouse) are still working and for up to eight months after you lose your health coverage or stop working.

I wonder if Medicare considers Switzerland's mandatory insurance a national health system? I couldn't find a list of qualifying countries. If Switzerland qualifies, that could buy me a few years.

And, that 'or travel back frequently' would seem to imply that I can, indeed, use Part B (but not D) when traveling back to the US. Interesting.

Off to do more research...

Thanks for your insights, Bossybaby!

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ACA has a good write up on medicare and they are usually very good on staying on top of the expat topics for Americans in terms of both advocacy and providing useful information. Here's a link to one page, but there are several there at ACA. Also, as they note, there's a SS person at some embassies for US persons to contact who I think also have details on medicare, so might be worth taking contact there as well, but with changes not sure which embassy in Europe now.

https://www.americansabroad.org/basic-medicare/

I have not crossed the bridge yet, nor do I plan to, but often read ACA info for making future decisions. But what seems to be clear from many media sources is that you can enter us for medicare covered health treatments. I thing many Americans living over the Mexican border for cheaper living cross regularly for this.

5
There is no doubt that you can return periodically to the US to have medical treatment under Part A/B. It remains active as long as you've paid your Part B (assuming you already qualified for free Part A or paid your tariff if you don't have the credits for free Part A). What's a wild card is Part D (pharma). I wonder how expats in, e.g., Mexico deal with this?

I have continued to pay Part B (my Part A is free, thanks to waaay more than 40 quarters), but I am unsure what my forced de-enrollment from Part D (because of my European address) may mean for the future. The Anthem letter seems to threaten me with penalties upon return into the system.

And here's a new thought: Assuming you follow that advice (to de-enroll if you have coverage in Europe through work), what if you suddenly want care that is not covered in Europe but is in the US (possibly experimental, or you want to go back for a year to enroll in a clinical trial, or there is new therapy not offered in Europe)? Better have your Part B in place?

Lord luvaduck!

6
Maybe a stupid question, but why not maintain an address there starting from the next time you visit? Surely a friend or relative would let you use his/her address? I realize that means monthly premiums for something you mostly won't use but it might save some hassle?

I still use my mom's address for everything except the IRS.

7
Not a stupid question at all, but things get waaay more complicated when you lived in a no-state-tax state, still run a business still in that state, have to tell your primary pension-issuer where you are, and they ALL communicate with each other...e.g., Social Security communicates with pension source and IRS, and pension source communicates with health insurance. I recently got a letter from Anthem with my new membership cards. I had not given them our European address yet. The envelope was addressed to the right street address, but in Australia . They had clearly heard from the pension folks and then messed up AT for AU. If I used my family's address, Calif might get the idea I am now taxable there, and that would be a complete disaster! We use a digital mailbox for most stuff.

8
Thanks for the advice and ideas, one and all.

Since it's likely that we cannot stay in Switzerland for more than a few years after OH retires, I'm trying to get as many of my ducks in a row as possible ahead of time.

(Would love to stay in Europe, but as a US citizen that's pretty much a pipe dream...)

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Still trying to chase down a list of countries where Medicare considers that their national health system qualifies for the special enrollment exception for Part B.

I called the embassy and guess what - the embassy in Bern and the consulates in Zürich and Geneva are no longer qualified to advise on federal benefits. One has to call the Federal Benefits Unit in Frankfurt:

https://ch.usembassy.gov/u-s-citizen...cial-security/

If anyone ever picks up the phone, I'll report back with what I've learned.

(Your tax dollars at work. )

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Given that the penalty for not enrolling when one becomes eligible means increased premiums for the rest of your life, it seems most prudent to plan with the idea of returning to the US in mind. Which means paying for Medicare B while still resident in Switzerland.

But it's good to know that I could return to the US for treatment under Medicare as long as I qualify for A and pay for B. I've had to go back to the US twice now for diagnosis, and paying for that out of pocket was rather painful. At least now if I have to do it again I will get something in return for the premiums I'll have to pay. (Not to mention the small fortune I pay to Uncle Sam every year while resident overseas...)

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I've thought about a US address, but I worry that about state tax complications while still resident here. Been there, done that for a couple years; I don't want to get caught in that mess again, so need to do more research.

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Good thing I'm still a few years away from Medicare eligibility - it looks like it will take me that long to figure this all out!

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Plug away, mc. Our situation is so weird that I can't help, except to say that it would be very prudent to sign up for Part B when you have to. My letter from Anthem intimated that I might have to pay a penalty for being de-enrolled from Part D without getting other similar insurance while I was gone from the US. That does not jive with what you found on the website. However, the way things are going, fat chance we will go back. I don't want to run a ranch/vineyard in the wine country that's burning up, nor do I want to see my beloved SF as a tent city. I may have to go back some day, and that will be only for an estate settlement. I am certainly never going back to a Trumpy FL.

10
Why would you need to buy Medicare while visiting the US, especially as a Swiss resident, and presumably still with a Swiss health insurance?

Attractive European countries for American (retired) expats: Spain, Portugal, Germany, France, Malte. Check out the subreddits for FIRE in Europe - I know, the RE (retire early) part is not applicable to you, but there is a lot of info that can help in your decision to stay in Europe.

A couple of general articles:

https://www.investopedia.com/retirem...ies-to-retire/

https://www.forbes.com/sites/william...retire-abroad/

11
It's not so much a question of coverage when traveling, but rather weighing the risk of getting hit with a significant increase in Medicare B monthly premiums - for life - if one fails to enroll when one first becomes eligible.

If I thought it unlikely that we would return to the US, I'd chance it.

But we are almost certain that we will eventually return, and so have to think about the costs of late enrollment vs paying premiums for some years when I can't take full advantage of the system.

However, having learned that I can indeed use A and B when visiting means that at least I might get something for what I pay.

12
Keeping A and B also gives you flexibility if one of you dies and the other would not want to stay in Europe. In our case, OH would stay; I don't know how I'd feel...and maybe you would want to rejoin family. I try not to think too hard about that $141/mo. Good luck.

13
Bringing this back up with hopes that someone here might have already run the US Medicare-while-living-abroad gamut...

If I understand correctly, the monthly premium for Medicare Part B - required even if one lives abroad and can't use it, at the cost of a stiff life time penalty - is based on one's income from two years prior to enrollment.

Which means for most people your premium would be determined by pre-retirement income, not post retirement. So one could easily end up paying top rates ($500+ per month) when your post retirement income should qualify you for the basic rate ($164).

That can't be right, can it? It would mean that many retirees must pay way more than they can afford.

So question:

Can anyone already enrolled confirm that this is how premiums are determined?

Is there any ability to adjust premiums after enrollment, based on actual post-retirement income?

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If there is no income adjustment possible, it looks like delaying enrollment until two years after OH retires and taking the 20-30% lifetime penalty hit might make financial sense.

Any comments from those already enrolled would be greatly appreciated.