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I live overseas but need surgery in the U.S. How do I make sure Medicare covers me?

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil; and he will answer as many as he can.

Charlene – Thailand: I have lived outside the U.S. for more than 10 years and have kept my Part B all this time and have never used it. Now, I may be facing some serious back surgery, and would like to return to the U.S. this summer and have the surgery done near Portland, Oregon. How should I proceed to make sure I am covered?

Phil Moeller: You should have a legal U.S. address to make sure your Part B will cover you for care when you return. Having a P.O. box does not qualify. If you have friends or family in the Portland area, perhaps you can rent a room or co-sign an apartment lease. I am NOT an expert on establishing a legal residence but have been told by Medicare and insurance companies that this is what is required for them to honor medical claims.

In the meantime, I’d find a Portland doctor or medical practice that accepts Medicare and is willing to take you on as a patient. Once you’ve done that, I assume this doctor would be willing to accept any needed medical records from your doctors in Thailand.

Part A of Medicare does a good job of covering all hospital expenses once its annual deductible has been met. Part B, however, only pays 80 percent of covered expenses. You can cover that gap with either a Medicare Advantage plan or a Medigap plan. These are both sold by private insurers and, again, you need to be a U.S. resident to qualify. This could take a lot of lead time, so I’d urge you to get started ASAP if you want to supplement your Part B coverage.

Here’s a piece I wrote about Medicare and ex-pats that provides additional background.

Florence – S.C.: I do not understand how an application for restricted Social Security benefits works. My husband was born in December 1953; I am seven months older and was born in May 1953. His benefit at his full retirement age of 66 would be $2,193 a month, and $2,929 a month at age 70. Mine at 66 is $1,511 and at 70 it will be $2,142. What is the best way to maximize our benefits? Would I receive half of his benefits — $1,096 — when he turns 66 if he files and suspends his until 70 and then when I turned 70 would I receive $2,142 and he would receive $2,929? Or should we both wait until we are 70?

Phil Moeller: Because both of you were born before the beginning of 1954, you are grandfathered in under new rules for Social Security that were enacted by Congress in 2015.

This would permit one of you to file for their own retirement benefit at FRA, thus enabling the other spouse to file a restricted application at their own FRA for just a spousal benefit and defer their own retirement benefit until as late as age 70.

The “file and suspend” option was eliminated by the 2015 law, so one of you must file for retirement first in order to enable the other spouse to file a restricted application.

If you filed for your own benefit at age 66, you would be reducing your benefit by $631 a month for the rest of your life, compared with your age 70 benefit. If your husband filed a restricted application at 66 for a spousal benefit, he would receive half of $1,511 — your FRA entitlement. So, for at least four years, your household income would be higher. (In practice, you could improve results if you waited to file until you were 66 and seven months of age and he had just turned 66.)

Unless you need the money or one of you is in poor health, I’d suggest you both wait to file until you turn 70. If you want to file a restricted application, however, it should be you who files for retirement first. This will permit your husband to earn your family’s highest possible retirement benefit at age 70. This way, whichever spouse dies first, the surviving spouse would receive the highest possible benefit.

Kim – Wash.: I turn 65 this year. My gross income for 2016 shows $107,300 but it’s now closer to $63,000, and I will soon lose my job and have no income next year. Will my monthly Medicare premium be based on the higher salary in 2016 even though I will not have an income? Medicare’s website says my premium will be $267.90 per month.

Phil Moeller: Because your income has dropped so much between 2016 and 2018, it’s possible you could qualify for relief from these high-income surcharges due to what the rules classify as a life-changing event.

I suggest you call Social Security (which handles these surcharges) and find out how to get relief. Do it ahead of time to avoid the surcharges in the first place. Trying to get repaid for improper charges can be a major, major hassle.

Judy – Fla.: I have had complete health insurance coverage, including prescription drugs, through Blue Cross of Connecticut, and worked for that state from 1966 until 2018. I am now 70 years old. I did not take Medicare at age 65 — why should I? – but am now being told by Social Security that I must sign up for Medicare now and pay a 40 percent penalty rate to boot.

Why must I be doubly insured from age 65 thru age 70 when my employer is providing and paying for 100 percent insurance in full? This is definitely a racket, and I will continue to refuse to purchase Medicare. I may purchase it if the 40 percent was removed. Is this possible to do, and how would I proceed?

Phil Moeller: There is no requirement for you to be doubly insured.

I do not know the terms of your Connecticut plan. However, most health plans do not provide primary insurance coverage to retirees once the retiree turns 65. The person is required to get Medicare as primary coverage at that time.

If you were an active employee at the state until 2018, you would not face a late-enrollment penalty for Medicare.

If you have been a retiree, then the answer to your dilemma would depend on your Connecticut plan’s rules. So, that is where I would start.

I wish I had a more definitive reply. Clearly, someone in Social Security thinks your Connecticut coverage did not “count” as active employee coverage and is saying you should have enrolled in Medicare sooner.

Donald – Tenn.: Why does Social Security use only the last 15 years you worked for your benefits instead of all the years you put in? I worked from 1976 at various jobs until 1999. It seems to me that you would make more benefits if they used all your work history instead of just 15 years.

Phil Moeller: Someone gave you bad information. Social Security bases benefits on your highest 35 years of earnings, and also weights earlier-year earnings to remove the effects of subsequent wage inflation. If you keep working, the agency will automatically increase your benefits if you have a new “top 35” earnings year.

Anonymous – N.Y.: I just turned 62. I stopped working six years ago to take care of my father and then my disabled husband. I have had no income and receive Medicaid. If I take my Social Security now will I still be eligible for Medicaid or will I have to purchase health insurance. My Social Security will not be very much.

Phil Moeller: Medicaid eligibility is determined at the state level, so the answer to your question will depend on your state’s Medicaid income standards. The State Health Insurance Assistance Program (SHIP) provides free Medicare counseling and should have someone in an office in your state who can help you.

You will need to know details about your Social Security benefits when you contact SHIP. If you don’t already have these details, you can open an online My Social Security account. It will show you projections of your benefits at different claiming ages.