The Truth About U.s. Medicare Benefits On Filipino Soil

Many balikbayans worry that leaving America would mean forfeiting their U.S. Medicare benefits. Talks about the extended and out-of-the-country coverage of U.S. Medicare mushroomed in 2007. (Early references are available at the My Philippine Retirement website). Is U.S. Medicare portability a rumor or a reality?

U.S. MEDICARE BASICS

U.S. Medicare, created in 1965, was originally intended for American retirees. The program was later revised to cover not just the retirees, but also the younger population who may be suffering from Lou Gehrigs disease, end-stage renal disease and permanent disabilities.

While the program does not offer completely free health care, it does foot 80 percent of the bills. The program has a 3-part structure:

* Original. Part A offers hospital insurance and inpatient hospital care, while Part B offers medical insurance and outpatient hospital services, to include emergency ambulance, preventive care and visits to the doctor.

* Medicare Advantage. Part C covers the basic health care of the original plan plus additional services like eye care and dental care. This plan can be availed through private enrolment in accredited health maintenance organizations (HMOs).

* Prescription Drug. Part D deals exclusively with prescription drugs. It is available as a stand-alone option or as a tie-up option to an existing U.S. Medicare Advantage plan.

Since the original structure is not comprehensive, Medigap plans offered by private insurance companies are there to supplement a host of special health care.

Standard Medigap plans are referenced as letters C to J, but on June 1, 2010, the U.S. Department of Health Services is scheduled to introduce new policies M and N in lieu of H, I, J and E.

U.S. MEDICARE PORTABILITY

U.S. Medicare coverage in a foreign hospital is limited, with very few exceptions: (1) when the insured resides in the U.S. but the most proximate hospital is a non-U.S. territory, or (2) when an emergency arises while the insured is travelling without unreasonable delay between Alaska and another U.S. state, and a Canada-based hospital is the closest place to seek emergency care.

In March this year, the Philippines Department of Foreign Affairs (DFA) announced that original U.S. Medicare benefits can also be enjoyed in Philippine-based hospitals.

The arrangement is limited though. The report explains: Residents of Guam and Saipan are allowed to seek medical treatment outside of the U.S. on emergency cases due to the proximity of the Philippines vis–vis Hawaii, the nearest U.S. state.

There are at least two names that paved the way for U.S. Medicare portability in the Philippines, reports attribute: Guam Congresswoman Madeleine Bordallo and then Philippine DFA Secretary Roberto Romulo.

THE REAL SCENARIO

To verify U.S. Medicare portability rumors, My Philippine Retirement called up three Manila-based hospitals which as claimed by a San Francisco Chronicle article have been processing reimbursements since 2009.

The findings: There are no records yet of original U.S. Medicare reimbursements. However, there are a number of international health insurances with U.S. Medicare Advantage tie-ups:

* Asian Hospital and Medical Center – (Allianz) Worldwide Care, William Russel, Vanbreda International, TieCare, TakeCare, Net Care, CIGNA, Pacific International, IMG, Blue Shield, Blue Cross International, Alliance and AETNA. E-mail or call +63 (2) 771-9000, 876-5838.

* Makati Medical Center – Vanbreda International, TieCare, International SOS, Prestige International, Net Care, International Health Insurance of Denmark, IMA, HTH World Wide, GMC Services, and AETNA Global Benefit. E-mail or call +63 (2) 870-3000 or 870-3008.

* St. Lukes Hospital StayWell and Calvos. E-mail or call +63 (2) 723-0101 or 723-0301.

Note: The list is up to date as of March 2010. It is essential to refer to the insurance plan by name because majority of the hospital personnel are not fully aware of U.S. Medicare details.

U.S. MEDICARE OFF-SHORE COVERAGE AND PHILIPPINE RETIREMENT

In 2011, U.S. Medicare expenditures will surpass the revenues, experts predict. Several publications indicate that this can be prevented through off-shore coverage where the same health care quality can be enjoyed at a reduced cost. This is the direction where U.S. Medicares Part C is headed.

The recently signed Patient Protection and Affordable Care Act by U.S. President Obama is also expected to influence the retirement plans of former Filipinos and U.S. tax payers. Many anticipate that the better health service promised by the latest reform may not necessarily come out cheap.

Take, for instance, Terry who will be retiring a decade from now. Im anticipating my premiums to increase from 100 dollars a month to over 500 dollars, she reveals. Her current monthly health insurance premium already covers her and her husband.

They earlier agreed to call the U.S. their permanent home, but are now open to becoming balikbayans upon retirement. When it comes to health care, Terry explains, it seems as if the health care services in the Philippines will give the best bang for our buck.

Terry will be retiring in the next 10 years.*