Medicare for Overseas Americans

Americans who travel or live abroad cannot have medical treatment received outside the United States covered by Medicare, even though they have fully contributed to the program. Medicare recognizes no providers outside of the USA and has not implemented a method for reimbursement, despite ample evidence that qualified care is available abroad, usually at lower cost. Medicare-enrolled Americans must travel to the USA, often in poor health or suffering an acute condition, to receive the covered care for which they have paid.

Unlike most seniors, retired military veterans and their families living abroad do have access to covered care under the Tricare Overseas Program-Tricare For Life (TOP TFL). By statute, these military beneficiaries must be enrolled in Medicare Parts A and B, but since Medicare does not cover them abroad, TOP TFL serves as the primary coverage, reimbursing for reasonable, scheduled medical expenses incurred at host nation providers (local, private providers that have been approved by Tricare). Upon submission of proper claims, reimbursement amounts to 75% of expenses incurred.

The military’s Tricare coverage is evidence that administration of cross-border healthcare coverage is practicable and thus that Medicare could function abroad. Tricare’s program as administered by the Wisconsin Physicians Service is not only effective – it has encouraged the adoption of medical standards recognized as meeting Medicare criteria in Mexico.

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Supplementary medical coverage

In a small victory for AARO, the Regional Officer of the US Social Security Administration in Rome has confirmed that Americans who have supplementary medical coverage from a private insurance organization (mutuelle) as part of their employment in France at age 65 or later will not be penalized for late enrollment in Medicare Part B when they later retire and seek enrollment in Medicare.

She added that a non-working spouse may likewise benefit from this interpretation if she/he is covered by the working spouse”’s mutuelle. The question was raised at our Social Security and Medicare conference last June because failure to enroll in Part B when a person becomes eligible for it will usually result in a late-enrollment penalty if that person wishes to apply at a later time, and it was clear that coverage by the French Social Security system did not qualify to bar the penalty.

It should be noted, however, that AARO members outside of France may find their situation to be different, since mutuelles in France are private/semi-private entities and supplementary insurance in other countries may not be comparable. Nevertheless, the door is now open to exploring whether employer health plans in other countries may similarly qualify.

Submitted by: Thomas Rose

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