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When Karen Schirack, 67, snuck into her home in January and fractured her left femur in several places, she had a decision to make. Should she have surgery to repair the fractured thigh bone and replace her hip near Ajijic, Mexico, where she has lived for 20 years, or be flown back to her home state of Ohio? for surgery and rehabilitation?
As the number of American retirees living abroad grows, more and more of them are faced with choices like Schirack’s when it comes to medical care. If they lived in the United States, Medicare would usually be their coverage option. But Medicare does not pay for care outside of the United States, except in limited circumstances.
Expatriate retirees can find private insurance policies and national health plans in other countries. But these may not provide the comprehensive, high-quality, affordable care retirees expect from Medicare. Faced with imperfect choices, some retirees concoct different types of insurance, a mix that includes Medicare.
That’s what Schirack did. She pays around $ 3,700 a year for a private insurance policy through Allianz that covered her operation at a private hospital in Guadalajara, about an hour from Ajijic. She also has a medical evacuation policy that would have paid for her flight to the United States, had she opted for that. This policy costs about $ 3,000 for five years. And she pays for Medicare Part B, which she can use for care when she visits family in the United States (the standard Part B premium is $ 135.50 per month.)
Schirack has a scar stretching from her waist to her mid-thigh, but she no longer requires home nursing and completed months of physiotherapy in June. After five more months of recovery, she hopes to get back to normal.
His private plan paid the equivalent of about $ 20,000 for his surgery. Before leaving the hospital, Schirack had to cover his share of the total, around $ 2,400, plus bills for other expenses, including blood transfusions.
After leaving the hospital, she was responsible for paying for other services – home nurses, physiotherapy and medication – and submitting receipts to the insurer for reimbursement. She estimates that she has spent about $ 10,000 and has been reimbursed for about two-thirds of that amount so far.
If she had had surgery in the United States, she might have had fewer paperwork issues, Schirack said, “but overall I’m not going to complain.”
The quality of health care varies considerably from country to country, as do the services available to foreign residents. And there are quite a few of these transplanted Americans.
From 2012 to 2017, the number of retired workers living abroad receiving social security benefits increased by nearly 15% to more than 413,000, according to the Social Security Administration. The largest numbers were found in Canada (nearly 70,000) and Japan (over 45,000). Mexico was third, with nearly 30,000 retirees.
Commercial health insurance policies for them can offer decent coverage, but people can usually be denied a policy or charged higher rates for medical reasons. Plans may refuse to cover certain pre-existing conditions. Schirack’s policy, for example, does not cover any services related to his allergies.
Private policies can be problematic for another reason – they can have age limits. The GeoBlue Xplorer Essential plan, for example, only enrolls people aged 74 or younger, and coverage expires when people turn 84. In contrast, Medicare eligibility typically begins at age 65 and continues until the death of a beneficiary.
And policies don’t come cheap. A 70-year-old man could pay $ 1,900 per month for an Xplorer Essential plan with a $ 1,000 deductible, said Todd Taylor, GeoBlue sales manager. A plan with a $ 5,000 deductible can cost $ 1,400 per month. This does not include service coverage in the United States.
Prices may also vary by country. A 67-year-old American living in Costa Rica who purchases a mid-level Cigna plan with a deductible of $ 750 for inpatient care and $ 150 for outpatient care could pay $ 1,164 per month, said David Tompkins, president of TFG Global Insurance Solutions. The same policy could cost $ 913 in France, Tompkins said.
Claudia Peresman moved from Connecticut to San Miguel de Allende, Mexico, last November. She opted for a private insurance plan, for which she pays around $ 100 per month. “What I wanted was catastrophic coverage,” she says. “Things are so affordable here that other than being admitted to the hospital I can probably afford it. ”
Since medical care is sometimes much cheaper abroad, some retirees choose to pay out of pocket for minor or routine services.
Claudia Peresman, 63, moved from Stonington, Connecticut, to San Miguel de Allende, in central Mexico, last November. On her first night there, she tripped in the bathroom, banged her face against a wall, and slit her lip. Her neighbors helped her take a taxi to a 24-hour emergency room at a hospital about five minutes away, where staff cleaned up the cut and sent her home. She paid the fee of about $ 25 in cash.
Peresman recently bought a private insurance plan with a deductible of $ 2,500, for which she pays about $ 100 per month.
“What I wanted was catastrophic coverage,” she said. “Things are so affordable here that other than being admitted to the hospital I can probably afford it. “
Even when retirees buy a private policy, Medicare is another piece of the puzzle they need to consider. Once people become eligible for Medicare coverage, typically at age 65, they face a 10% penalty for every 12 months they are not enrolled in Part B, which covers outpatient services. (People who are 65 but still covered by an employer-sponsored plan are generally not subject to this penalty.)
After decades of paying into the Medicare system, it’s no wonder some expats are frustrated that they can’t generally use the program outside of the United States.
This is how the law is worded, said an official with the Federal Centers for Medicare & Medicaid Services.
“CMS cannot speak or speculate on the intention of Congress,” the official said.
And retirees should honestly ask themselves if they will be spending the rest of their lives abroad.
“Even if this is their goal, will their health and mobility allow them to achieve it? Said Dr David Shlim, 69, who cared for many expatriates when he ran a medical clinic in Kathmandu, Nepal in the 1980s and 1990s. “People should imagine they might have to come back in the United States and wonder how are they going to do this and afford that. “
The rules allowing non-citizens to register for a national health plan vary from country to country.
After living in the United States for almost 30 years and raising a family here, Alberto Avendaño, 61, returns to northern Spain in August with his wife, Zuni Garro, also 61. Avendaño has dual nationality and his wife is a citizen. the United States. The couple can register with the Spanish universal health system and receive treatment there. They also plan to purchase a private plan to use if they want to get medical services right away, Avendaño said.
Once they turn 65, they will also be able to enroll in Medicare, Avendaño said, depending on their circumstances. Their two children live in the United States.
“It’s something that is part of our American system, and we want to have it,” he said.
Peresman also has a few years before she turns 65 and makes a decision, but she leans the other way. She is concerned that the Medicare program does not exist in its current form when it comes time to make a decision.
“I would sign up if it was absolutely free,” she said. “But I’m already paying $ 100 a month here. “
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