Making Your Plans
Many seniors dream of enjoying their retirement as an expatriate, immersing themselves in a new language, culture, and way of life. Living out your golden years in another country can be exciting, enriching, thrilling, and perhaps even a little nerve-wracking all at the same time. Health insurance for aging seniors is a critical necessity, and even more so perhaps, when travelling and living abroad, yet it can be difficult to understand, not to mention that getting the ideal solution is not easy; it takes a significant amount of research and planning to 0btain economical yet effective international health insurance. Hopefully, this article will help you get this down more easily..
Some important questions you should consider before retiring to your destination abroad are as follows:
- Is there any way I can supplement my Medicare and make it work while I am abroad?
- Will my policy end when I reach a certain age?
- Will I be covered if I return back to my country of citizenship?
- Do I need to acquire this insurance before leaving the US?
- How does international health insurance work with or compliment medicare?
- Should I also get medical evacuation insurance?
- What are the pros and cons of international vs. domestic in-country health care insurance?
Other questions you will probably need to explore:
- Am I covered immediately?
- What deductible amounts do you offer?
- What pre-existing conditions are covered?
- What hospitals are covered under your policies?
- How long may I remain in the US and have coverage?
- Do the plans have a deductible per event or for all of your health insurance costs? Are deductibles calendar year, policy year, or per event?
- How do you file claims?
- What is pre-certification?
For some plans, the age for eligibility completely ends at 65 years, or at least there are more stringent qualifications include thorough medical examinations. Other plans offer “senior coverage” if you’ve had their plan for a specified length of time (this is usually ten years of continuous coverage. Most plans that offer “senior coverage” have limited benefits and reduced maximum policy limits. Because of this, it’s wise to have an annually renewable international health plan in place – early.
There are several types of health insurance plans for aging expatriates available in the marketplace today. Some are annually renewable, providing worldwide coverage, and others are short-term plans that will provide coverage outside the home country, such as a trip for less than a year.
Age and How it Affects Insurance Costs for International Retirees
Individuals typically receive more benefits the younger they are when they apply for expatriate health insurance. Starting to plan for worldwide health insurance early in your retirement planning is definitely a step in the right direction (as long as it is feasible to do so). An individual that is over sixty will find higher premiums and possibly probably more expensive medical care in their country of residence.
To make good decisions, you will need to understand the benefits, premiums, and processes are for expatriate insurance at any age close to and exceeding sixty. As you age, there are policies that will exclude your pre-existing conditions or deny you coverage due to your age (practically all plans will deny your application once you are 74 or older. Don’t wait until you sick or injured; the prime time to purchase is when you are healthy.
What About Medicare?
If you’re traveling abroad after age 65, then you will want to consider a supplement to your Medicare coverage, because, for the most part, Medicare won’t cross the border with you. But be aware, although there are supplemental plans that can help provide coverage, there are many limitations, most notably time, that will make this less, if not entirely an unfeasible option. But let.s cover it so you have all the options.
Medicare covers your health care in the 50 states and all US territories — including Puerto Rico, Guam, American Samoa, the US Virgin Islands and the Northern Mariana Islands. Elsewhere, you’ll need supplemental insurance since Medicare will only cover emergencies in some very limited circumstances. Those include emergency services in Canada if you are traveling between Alaska and another state — “without unreasonable delay” — and a Canadian hospital is closest.
What Does Medicare Cover While You’re Abroad?
Medicare may pay for services at a foreign hospital if it is closer to your home than an American hospital. That circumstance could apply to Americans living on the Canadian or Mexican borders. The program will also cover you if you suffer a medical emergency while traveling in the US and treatment at a foreign hospital is closest.
Medicare also covers medical care on cruise ships that are in US territorial waters, meaning that the vessel is within six hours of an American port.
But beyond that, if you wish to leverage your Medicare coverage while abroad, you will need a policy that falls under one of three categories: Medicare Supplement, Medicare Advantage, or trip-specific travel health insurance.
Does Medigap Cover You While Abroad?
Most Medicare Supplement (or Medigap) plans, include a foreign travel benefit; check to see if yours does. Medicare Supplement plans C, D, E, F, G, H, I, J, M, and N that cover travel, pay for 80% of the cost of medically necessary emergency care outside of the US and its territories.
You’ll be responsible for a separate $250 deductible. The medical emergency must occur within 60 days of the start of your trip. So please note, it won’t work if you leave the country indefinitely. Plus, there’s a $50,000 lifetime limit to the amount this benefit will payout.
Medigap policies are not a Medicare replacement. They’re an additional benefit on top of your existing coverage under Original Medicare (Part A and B). And be aware that Medicare Part D prescription benefits also do not extend outside the US and its territories.
What About Medicare Advantage?
Unlike Medigap coverage, Medicare Advantage (or Part C) plans are a government-approved alternative to Medicare offered by private health insurance companies. These plans differ in which added benefits they provide. Check with your Medicare Advantage provider to see if your plan includes health insurance for foreign travel; many do.
If your Medicare Advantage plan does have travel insurance, make sure that it explicitly covers health issues — such as pre-existing conditions or medically necessary emergencies. Be mindful that Part C plans may not cover travel in every country or may even be limited in covering domestic travel emergencies. Part C plans operate in limited geographic areas. Your benefits will be equal to or better than Original Medicare, but they don’t apply everywhere.
Again, please note that if your Medicare Advantage plan becomes aware that you’ve lived away from your plan’s service area for 6 months or more, you may be automatically disenrolled.
Given all of this, unless you are travelling for a limited time, you will need to explore other health care insurance plans beyond Medicare and various supplements. There is one other way to utilize your Medicare while you are abroad, and this will be covered later in this article under Medical Evacuation Insurance.
What Type of Plan Should I get?
It is understandable that picking a plan best for you can be a challenging process. When determining what type of policy to get, the biggest factor in deciding is how long you will be abroad or how long you will be out of your home country.
If you are traveling for more than six months, it may be best to get a long-term health care policy. This is the most comprehensive plan that you can get to protect you. Furthermore, these plans typically include evacuation and have the option for life insurance as well.
Here is a list of the types of plans, some of which are mutually exclusive (e.g., short and long term), and others are sometimes acquired in combination.
Short Term Health, or Travelers Insurance
A policy meant to cover you for unexpected accident or illness for a few days or up to one year. This is a good idea for those that are not planning to stay abroad for more than six months.
Pros
- Simple to apply with no medical policies
- The policy will be issued instantly upon purchase.
- Will not cover pre-existing conditions
- Additional travel benefits may be included to cover lost items
Cons
- The policy will terminate at some point
- An existing condition can be denied due to pre-existing conditions
Long Term Health, Permanent Major Medical
A major medical policy that is meant to cover your current and new illness or accidents. This is a plan for ex-pats that want full major medical coverage while abroad and, if needed, coverage for trips back to the USA.
Pros
- Covers you indefinitely, and most policies are guaranteed to be renewed
- More cost-effective than a short-term policy for long-term ex-pats
- Health and pre-existing conditions will be reviewed in advance
Cons
- Requires underwriting and possibly a health exam
- Possibility to be declined
Medical Evacuation Insurance
A policy that provides transportation back to the USA or Canada in the event of a major illness or accident. If you are living or traveling abroad, getting Emergency Medical Evacuation Coverage is of paramount importance. The situation may arise where you might need to get evacuated to perhaps seek better medical facilities or even to save your life. In particular, this is a good plan for Americans that have full Medicare Coverage or private insurance in the US or for Canadians that qualify for Canadian Provincial plans.
Now you might still be concerned that you could rack up huge hospital bills before you are stabilized enough to be evacuated. The typical hospital stay in Mexico costs less than 1/10th of what it would cost in the US ($120/day versus $1,564/day). And you can obtain medical evacuation insurance for around $200 a month for the entire family (click here for more info).
Pros
- Easy to qualify for., with limited underwriting
- Let your home country health plan cover medical care.
- Some plans cover pre-existing conditions after a waiting period.
- No deductibles
- Receive treatment and care in a familiar environment
Cons
- Only a transport service and will not cover medical expenses abroad.
- You are hospitalized before being transported and stabilized enough to travel and have coverage in the USA or Canada.
- Your copays and deductibles might cost more in the USA or Canada than for the actual care abroad.
Medical Tourism
This is a policy that covers unforeseen complications that might arise from a medical procedure done abroad. It is a good plan for people that might be considering bariatric or cosmetic surgery in a foreign country.
Pros
- Simple to purchase
- Covers a wide range of complications that might arise
- Provides coverage for up to 1 year for a covered complication
- Reimburses certain travel expenses
- The most comprehensive policy offered in the industry
Cons
- Coverage is for unforeseen complications that arise only during the period selected at the time of policy issue (from 1 to 30 days after the procedure).
Ex-pat Life Insurance
This is a life insurance policy that will cover the life (or rather, the loss of life) of an ex-pat. Most life insurance companies in the US and Canada will not insure ex-pats living a majority of their time abroad.
Pros
- The policy that is geared for ex-pats living abroad and the insurance company is aware of your status living abroad
- Simple underwriting and processing
Cons
- The plan will terminate if you return to your home country
- Medically underwritten and can exclude deaths from pre-existing conditions
National vs. International Health Insurance
When choosing a policy, if you do not have any major pre-existing conditions or the local country has an unfavorable policy towards ex-pats or a poor healthcare system, and you can afford private insurance, then you should probably choose an international provider.
International insurance providers offer coverage and familiarity that an ex-pat comes to expect from insurance policies. They offer worldwide coverage backed by some of the largest insurance institutions.
Even when deciding to purchase international health insurance from international insurance providers, it can still be a trying process. Decisions need to be made as to the company, the program, the options, and the deductibles. One major decision is to decide from what type of company to purchase the policy from. In general, there are two types of companies that you may obtain coverage from in your country:
- Domestic In-Country National Providers
- International Insurance Providers
Let’s cover differences between national health insurance (i.e., domestic in-country insurance) and international health insurance because deciding what type you want to work with should be your first step.
Insurance Brokers Recommend International Insurance Providers
It is most common for insurance brokers to recommend international insurance providers as they provide a much more robust policy that has better coverage, as well as the fact that they are backed-by international insurance trusts that are regulated by agencies that support some of the biggest providers in the world.
That said, there are instances where it may make more sense getting a local or national plan is:
- When you have pre-existing conditions that private policies will not cover
- If you do not have the budget to afford the $100-$400USD a month the private insurance companies charge
- If the host country has a great free healthcare system.
Here is a list of some of the main topics that you should address as you consider a plan, but especially a domestic health insurance plan.
- Challenges with the Language: Can you understand everything the agent is discussing?
- Deductibles: Many national carriers treat deductibles as a per-event deduction.
- Guaranteed Renewable: Will the carrier guarantee coverage for life, and not cancel you if you have substantial claims?
- Hidden Exclusions in Policies: It is not entirely uncommon for individuals to sign up with national plans, not sure exactly what they purchased, and then discover that issues such as cancer or cardiovascular will only be covered after a 12-or-24-month waiting period.
- What will they pay? If you need the top cancer specialist in that country, who charges more than his peers, will you be able to use him?
- Options for Care: International plans usually allow you to have coverage anywhere in the world and allow you to use any doctor and any facility on a reimbursement basis. This means that typically you have to pay up to your deductible, submit a claim, and then they will reimburse you.
- Third-Party Arbitration: If a dispute arises, most international plans have a process in place to appeal to an outside party in the event of a denied claim.
- Lastly, who is behind your insurance carrier? Is there a reinsurer such as Lloyd’s of London behind them in the event of catastrophic, unplanned claims that would financially cripple smaller carriers?
International Health Insurance Companies
Here is a list of the top International health Insurance companies:
And here are some of the top companies in comparison to illustrate how widely their offerings differ:
| Levels of Coverage | |||
| High-quality, affordable coverage. Best for ex-pats, families, or individuals living abroad for one or more years. Most Popular Option. | Premium level coverage. Great for U.S. citizens living abroad or internationals residing in the U.S. | Flexible Coverage. Comprehensive benefits and flexible plan design for internationals looking for private medical insurance. | Affordable coverage. Good option for all citizenships and budget-conscious individuals. |
| Plan Levels | |||
| Cigna Global Health Options (Silver, Gold, and Platinum with add-on modules) | GeoBlue Xplorer Health Plans (Essential, Select and Premier) | Aetna MHP and Pioneer Plans | IMG Global Medical Insurance (Bronze, Silver, Gold, and Platinum) |
| Plan Cost | |||
| $$ | $$$ | $$ | $ |
| Policy Maximum | |||
| $1,000,000, $2,000,000 (per year) or Unlimited | Unlimited | $4,000,000 (MHP) or $1,750,000 – $5,000,000 (Pioneer) | $1,000,000 – $8,000,000 lifetime per individual |
| Deductible | |||
| $0 – $10,000; outpatient visits subject to a separate deductible if elected, no deductible for preventative services | $0 – $5,000; deductible waived for preventative care, office visits, evacuation, and prescriptions | $0 – $10,000 | Multiple options from $100 – $25,000 |
| Who is Eligible | |||
| All nationalities, all ages | U.S. citizens up to age 74 | MHP: citizens of the Americas up to age 64, Pioneer: other citizens up to age 79 | All nationalities up to age 74 |
| Coverage Area | |||
| Worldwide or Worldwide excluding the U.S. | Worldwide or Worldwide excluding the U.S. | Worldwide, Not available to residents of select countries. | Worldwide or Worldwide excluding U.S., Canada, China, Hong Kong, Japan, Macau, Singapore & Taiwan |
| Home Country Coverage | |||
| Up to 6 months per 12-month policy period | U.S. citizens up to 9 months per 12-month period; All other citizenships 12 months per 12-month policy period | Limited by country of citizenship | U.S. citizens up to 6 months; all others 12 months per 12-month policy period |
| Pre-Existing Conditions | |||
| Pending results of underwriting; No waiting period if approved without exclusion, specific exclusions may be added to your plan | Pending results of underwriting; 6-month waiting period (waived if there is prior creditable health coverage) | Pending results of underwriting; Possible inclusion after 2 years | Pending results of underwriting; Platinum immediately, other plans (excluding Bronze) after 24 months |
| Doctor and Hospital Network | |||
| Inside the U.S.: Cigna Network. Outside the U.S.: Direct billing options available, no out of network penalty | Inside the U.S.: Blue Cross Blue Shield Network. Outside the U.S.: Direct billing options available, no out of network penalty | Aetna offers a global network of leading hospitals and doctors around the world | Inside the U.S.: FirstHealth or UnitedHealthCare Network Outside the U.S.: Expansive networ |
Brokers and Informations Resources
Here are some resources that can further assist you in researching and acquiring the insurance to best meet your needs and desires:
Additional Information Resources
We have an extensive collection of curated YouTube videos, in fact, over 600. Here is a playlist of health insurance-related videos you can reference for further information. Click here
About Us - Cielito Lindo Senior Living
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We are Cielito Lindo – a senior care facility in beautiful San Miguel de Allende and we serve as the assisted living and memory care component of Rancho los Labradores, which is a truly incredible one-of-a-kind country club resort-like gated community. Rancho los Labradores consists of individual villas, man made lakes, cobblestone streets, and a rich array of wonderful amenities (e.g., tennis, club house, pools, cafe, long and short term hotel suites, theater, Cielito Lindo, a la carte assisted living services).
What makes this place so amazing is not only the beauty and sense of community, but also the fact that you can have the lifestyle you desire with the care that you need as those needs arise… and all of this at a cost of living that is less than half of what it would cost comparably in the US.
Learn more about Cielito Lindo here.
Download the Expatriate Guide for Senior Living in Mexico – For your convenience, the entire 50-page guide is available for download as a PDF. Send us an email us at information.cielitolindo@gmail.com or give us a call for any other information you might want
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