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: firstname.lastname@example.org
If any reader knows of similar programs, please let us know.