Medicare for Expats in the Philippines

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A promising development for expats seeking Medicare coverage overseas. Medicare does not pay for care outside of the United States.  This is a hardship for retirees living overseas who otherwise qualify for Medicare services.  This is understandable given the record of fraud and corruption by overseas providers (plenty of the same in the U.S.A) in the Philippines and elsewhere in connection with the Tricare military benefits program.  Offering Medicare payments on behalf of hundreds of thousands of overseas retirees to thousands of foreign medical providers could be a nightmare.

However, Medicare offers the “Medicare Advantage Program” as an alternative to traditional Medicare.  The Advantage programs provide medical services through private insurance companies, usually HMOs.  These plans receive payments from the Federal government to provide Medicare services to Advantage program enrollees.

The Medicare Advantage providers are allowed to provide services beyond those allowed under traditional Medicare.  For example, most Advantage programs offer dental and vision services.  It appears that the Advantage programs are also free (to an unknown extent) to provide services overseas.  Here’s what the Medicare brochure says: “If you have a Medicare Advantage Plan (like an HMO or PPO) or anotherMedicare health plan, your plan may offer additional coverage for health care services you get outside the U.S. Check with your plan before traveling to seewhat’s covered.”  See http://www.medicare.gov/Publications/Pubs/pdf/11037.pdf

At least one Medicare Advantage program, the Care1st HMO in Southern California is said to be linking up with an physician’s group (IPA), United Physicians International to provide Medicare Advantage services to provide Medicare services in the Philippines through their clinic at The Medical City in Manila.  The Medical City is a well respected hospital, however I don’t have detailed information on the relationship between TMC and UPI.  See the Medical City website.

One thing to keep in mind — with traditional Medicare you are free to seek medical services from just about any hospital or physician in the United States, including relatively nearby Hawaii.  If you enroll in a Medicare Advantage program, you are generally required to use providers which are part of the Advantage Plan network you have joined.  At some point you may need or desire to return to the U.S. for treatment.  You will restricted to hospitals and physicians in your HMO network.  So basically you get coverage in the Philippines at The Medical City in exchange for giving up nationwide traditional Medicare coverage in the U.S.

Another possible complication with the UPI/Care1st program is that you must reside in Southern California to enroll in Care1st.  There may be other Medicare Advantage Programs offering similar services.  The economic rationale seems compelling.  The HMO receives Medicare funding but pays for medical services at drastically lower Philippine rates.

Despite  teething problems, these new programs have the potential to be a tremendous benefit to expat retirees.

You can see a copy of the UPI brochure here.

We have a Filipina acquaintance from Tigbauan who is a nurse in Los Angeles.  She is an agent for the UPI Program.  You may contact her for additional information.

Yolanda Lim
Cell: 323-637-0691
Email: yol_mel@yahoo.com
 

If any reader knows of similar programs, please let us know.

Comments (13) Write a comment

  1. Hi all,

    I work for a California insurance broker that works with vMedicare Advantage plans (HMOs). I am currently in Manila and I know of a company that has already begun offering extended benefits here in the Philippines to its members. The company mentioned in the article is no longer offering that plan for various reasons. The company I work with took UPI’s business model and corrected all the problems they encountered.

    The company is growing slowly as they navigate the legal landmines involved in such a heavily-regulated industry but there are currently roughly 100 people that have access to medical care here in the Philippines. The company offers the extended benefits as a value-added extra to members of the HMOs the company contracts with and no Medicare dollars are used to fund healthcare here in the Philippines. Routine and preventative doctor visits, including x-rays, blood tests, colonoscopies, consultations, etc are handled through their network of providers in Manila, Quezon City, and Subic Bay with no extra co-pays or premiums. They have concrete plans to expand their network as their membership grows. Emergency/urgent care/hospitalization is handled through a reimbursement process that can be used at any hospital. So just like now you’d have to pay for any kind of inpatient care but you can at least get back up to 100% of what you have to pay. So even if someone is outside the coverage of the network, they can still take advantage of the emergency care anywhere in the Philippines (actually anywhere in the works) and get reimbursed for it. This is similar to what VA/FMP does but isn’t tied to the military or service-related injuries.

    The hospital in Subic Bay has initiated a pilot program extending a line of credit to their patients so they can leave the hospital without paying upfront then waiting for the reimbursement. There are some requirements in place to ensure the hospital is paid back, of course.

    It took me a little while to wrap my head around how their program actually works but it is a solid and above-board program. So even though the company mentioned in this article isn’t operating here in the Philippines anymore, there are options for medical care here in the Philippines.

    Reply

    • Correction: I mistyped Medicare Advantage as vMedicare Advantage. To avoid any confusion, that was a typo and there is no separate plans designated as vMedicare. Sorry about that.

      Reply

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    • Not a bad article. I do worry about the question of getting Medicare coverage outside of the U.S.A through a Medicare Advantage enrollment. Is it not true that to join a Medicare Advantage you have to claim to be a resident of the state where you are applying? Sure you can have a mailing address in the U.S. We do. But when it comes to honoring a big claim from a person who has listed a U.S. residence on their application, it opens the door to a refusal to pay. We are open-minded about this and would appreciate hearing from readers who have successfully used Medicare Advantage policies in the Philippines.

      Reply

  4. Is there anybody who succeeded in using the medicare advantage coverage that is an expat permanently reciding in the Philippines. I just retired this February and I’m very interest to know. If thru an HMO which one. Thanks.

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  5. Pingback: Medicare for Expats in the Philippines | Philippines or Bust

  6. After reading your comments about Medicare Advantage coverage, I did some checking. To my surprise, I found several plans offering overseas coverage. Good job!

    Reply

    • Hello , Could you give me information in the plans you found for the Philippines, Thanks in different ance

      Reply

      • I have paid part B for over ten years, tens of thousands of dollars, in the notion that I could return to the U.S. if I had a serious medical problem. Depending on your own situation, returning to the U.S. for care under part A & B is not so easy. Unless you have supplemental insurance, you will end up paying about 1/3 out of pocket, that is 1/3 of very high U.S. expenses. Then you have airfare (you + your wife), then you will likely have to stay in the U.S. during recovery and follow up. Perhaps you will have to rent a car, assuming you still have a valid U.S. driver licence. If you have family who can house and care for you, that saves money. In the meantime, medical care in Asia is improving and might well be cheaper than returning to the U.S. Regarding Medicare Advantage coverage which may purports to provide coverage outside the U.S., I’d be very careful. Don’t claim to reside in the U.S. in order to qualify for a U.S. HMO. It’s easy for the marketers to make sales pitches, but when you have run up a few hundred thousands of dollars in medical bills, the HMO might examine your eligibility more carefully.

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