Medicare coverage does not extend to eligible Americans who retire abroad even though they have fully contributed to the program. There are no Medicare providers outside of the U.S., despite ample evidence that qualified care is available abroad at lower cost. Medicare-enrolled Americans must travel back to the U.S., often in poor health or suffering an acute condition, in order 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 proves that administration of cross-border healthcare coverage is practicable, and thus it is clear that Medicare can operate 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.

Lower Costs

Americans who chose to retire abroad usually do so for either family or cost of living reasons, not to “abandon” or be disloyal to their country. The prevailing rationale in Congress holds that (1) reimbursement rates for medical services abroad are undetermined and undeterminable and likely to be very costly, and (2) compliance with Medicare standards by foreign medical facilities and personnel cannot be ensured. These objections govern the thinking of the Centers for Medicare & Medicaid Services (CMS). In practice, medical costs outside the USA are almost invariably lower, even in the wealthiest countries such as France, Germany and Switzerland. Prohibiting coverage to fully qualified Americans is costly to the Medicare program since (1) they often receive treatment anyway, by traveling back to the USA, (2) the program pays more for the same procedures due to higher healthcare costs in the USA, and (3) people tend not to access preventive medical attention in the country they are living because it’s not covered, and when the condition becomes acute, they come back to the USA where expensive operations and treatment are often needed. Costly treatments can often be avoided by early diagnosis and preventive care, which could be provided at low cost where eligible beneficiaries live.

Automate Health Care Information

The Obama Administration has already focused on the need to automate health care information, particularly patient medical records. As Americans resident overseas, we have considerable experience with different systems in Europe, and are impressed with the efficiency, security and cost savings that such automation has yielded to the health care systems of these countries. Automated records reduce the inefficiencies of duplicate paperwork, control the use of prescription drugs, track allergies and other conditions, and speed up the transfer of data for use by providers. We would welcome the opportunity to assist DHHS in facilitating such a review.

Financial Penalty

Another issue concerns the financial penalty applied to Americans who enroll in Medicare when they return to the USA after their initial year of entitlement. Overseas Americans associations contend that an American, covered by medical insurance through employment, directly or indirectly, should be able to sign up for Medicare without penalty upon return to the US, even if he does so at age 68 or 70. Since the American has not been able to draw on the program, penalizing him for late enrollment is unreasonable and punitive since it saves a negligible amount for the program.

Summary

The United States should honor its commitment to civilian Americans who have contributed to Medicare and retire outside the USA by extending healthcare coverage to eligible persons.

The methods of entitling Americans abroad to benefit from medical coverage exist – we respectfully request Congress and the Government to find an appropriate solution for the medical needs of American civilians abroad.

We ask that a Medical Research and Demonstration project be funded to provide for the collection of data about relevant medical costs and services in the market. This would provide the data needed to design a medical coverage or reimbursement programs for civilians abroad. Another possibility is the design of high-deductible insurance abroad coupled with Health Savings Accounts useful to civilian Americans on retirement abroad.